1. 1 Understanding Service Redesign RCN Policy Unit

2. 2 Some Background… n “1950’s public service model no longer effective or affordable” n Public expectations for services increased to support pace and direction of reform n Policy decisions underpinned by EU and International policy intentions and desire to make health and social care ‘competitive’

3. 3 Key Questions… n What will the Health and Social Care economy look like? n Where will care be delivered? n Who will deliver it? n How will it be funded?

4. 4 ‘New’ NHS - Overview New providers NHS & ISTCs Foundation Trusts Provider Plurality Easy to shift money between providers Money flows with the patient. Fixed price Tariff Providers paid ‘in year’ for activity Patient Choice PAYMENT BY RESULTS

5. 5 Who will be delivering care? n Career Framework –AfC only the start of modernisation process –Bold public statement but has generic focus –Challenge for labour markets following AfC n New ways of working –Encouragement to use more NHS Act flexibilities –Collaboration and sharing human resources (e.g. ISTC’s)

6. 6 Mixed health economy A&E ‘Catastrophic care’ Chronic Disease Planned Elective Care ‘Marketisation’ Public Sector ‘Free’ market

7. 7 Managed Market approach n Why the managed market approach? –Political sensitivity around greater independent sector involvement –Recognition of the benefits of competition –Need to shift capital burden away from public purse n Dependent on –Fixed prices (costs still incredibly important though) –Regulation and Inspection –Information for consumers –Protection against ‘market failure’

8. 8 Inspection and Regulation n “Level playing field” for NHS and Independent sector n Regulation of the workforce –Professional bodies remain (for now) –The unregulated workforce? –PoVA, PoCA, CHR any more for any more? n Good-bye CSCI?

9. 9 Where next? n Choices, choices… –Dependent on Increased capacity –Information is key –Mobility important issue to tackle n New partnerships –Social Care Green Paper –New primary care models –Continued infrastructure reform n Future Patient –Greater economic power –“Consumer must be sovereign” –Expectations will continue to drive pace of reform

10. 10 In Conclusion… n Promise of further reform Bill’s after election n Structural reform to bolster PCT’s develop Foundation Trusts and encourage other providers to enter the field n Choice will remain a key policy driver (rather than a policy in itself) n Individualism over collectivism and “…an end to mass production [of public services]