1. SAMPLE TITLE Influencing the reforms - the policy context for paediatrics November 2011 PATRON HRH The Princess Royal

2. SAMPLE TITLE AGENDA How did we get here? The NHS Bill proposals Implications for children What we’ve done so far What’s coming up Your role - clinicians building the best for children

3. SAMPLE TITLE “So big you can see it from space” 420 pages + 235 pages of notes Only together can we protect the NHS (conservative party Manifesto – 2010) The Bill.......a turbulent journey Lansley’s NHS Plans : Still in Good Health? commissioners to 'outsource' care for high- cost patients BMA campaign to scrap Health Bill Forum has made 16 key recommendations

4. SAMPLE TITLE HOW DID WE GET HERE? 16 reforms in 20 years 1989-90 Health Authorities established from FHSAs 1990-92 Purchaser – provider split - directly managed units became NHS trusts 1992 GP practices applied for their own budgets to purchase services – GP Fundholders and locality commissioning groups held 59% of budgets by 1998, 1996 - 14 Regional Health Authorities became 8 Regional Offices for NHS Executive 1999 481 Primary Care Groups formed in 1999, still with 100 HAs 2002 ROs and NHS Exec reformed to 28 Strategic Health Authorities 2002 PCGs merge to form 300 PCTs. Principle of ISTCs introduced 2003-5 Reorganisation of staff roles – consultant & GP contract. Agenda for change 2005-8 Commissioning a Patient led NHS – 28 SHAs to ten, PCTs merge to total 152 2006 Development of Foundation trusts with less accountability 2008-11 Transforming community services – removing provider arms from PCTs 2008 World Class Commissioning, Darzi review, Polyclinics and independent sector treatment centres. Waiting time targets, and changes to out of hours services 2009 Nicholson cuts – reduce by 6% or £20bn between 2011-14 CQUIN and QIPP 2010-13 Heath Bill – wholesale reforms to commissioning and provision…………. 2011 - PCTs and SHAs clustering following loss of provider function 2011 – development of pathfinders, pilots and early implementers

5. SAMPLE TITLE HEALTH BILL PRINCIPLES – UNCHANGED IN 20 YEARS? NHS free at the point of delivery Clinicians driving decision making Front line staff influence the design of services Must meaningfully involve people who use services Choice inherent in the system (but not costed) Local decision making not central government control Local Government lead on Public Health Structural change is already in hand

6. SAMPLE TITLE Funding Accountability Local Health Watch Parliament Department of Health NHS Commissioning Board Local offices & senates Clinical Commissioning Groups supported ‘clinical’ networks Patients and Public – (adults and children) Monitor Care Quality Commission (Any Qualified) Provider Spheres of influence Accountability for results licensing contract Local partnership Public Health England LSCB With thanks to Briony Ladbury for this slide

7. SAMPLE TITLE HEALTH AND WELLBEING BOARDS Statutory duty to promote joint working Joint health and wellbeing strategy Local democratic accountability Crucial role of DPH, DCS BUT…. Violence and child protection? HealthWatch development LAC health responsibility Involvement of schools Development of JSNA 94% early implementers – are children in?

8. SAMPLE TITLE NHS COMMISSIONING BOARD 3500 staff, mostly ‘field force’ Commissions primary care, specialist services Oversees CCG activity Clinical Senates development Supports networks BUT Role of clinicians Funding support Interface with specialist care

9. SAMPLE TITLE CLINICAL COMMISSIONING GROUPS Population coverage must be coterminous with HWB Require an acute clinician Looking again at referral pathways Potential to review outcomes ‘encouraged’ to work in partnership Support for Networks BUT….. Funding complex needs? Engagement with SEND Green paper pilots Vulnerable families and LAC Awareness of children’s needs?

10. SAMPLE TITLE CHILD PROTECTION Insufficient detail in Bill re child protection PCT responsibilities largely go to CCGs Accountability Framework expected Jan 12 “Working Together” being revised Legislation is clear and in place – needs enforcement SHA oversight role disappears – who oversees? Need tough contracts with providers and clear accountability Expertise and clinical / CP skills must be retained Child Protection, violence agenda and substance misuse/mental health connections/accountabilities are still too vague Need a clear role for the LSCB

11. SAMPLE TITLE PROGRESS THROUGH LEGISLATION Through Commons with significant amendments – due to the Future Forum and Select Committee 2nd reading in Lords passed after 100 statements/ questions. Committee till December – detailed scrutiny Leaves the Lords in January – back to Commons Future Forum continues with President as a member Pressure remains to scrap the bill – lobbies and petitions Less likely to succeed now second reading has been passed

12. SAMPLE TITLE RCPCH APPROACH - Making the best of reform Set Standards Influence and empower our members Lobby for improvement

13. SAMPLE TITLE THE ROLE OF THE COLLEGE IN MAKING IT HAPPEN Influencing system design with DH/DfEd Supporting / developing NQIs, PHOF, JSNA Supporting RCGP around Commissioning Guides Development of Clinical Standards of care Pressing for accountability in child protection Publication of service standards for acute services Examining networks of specialists for children’s healthcare Informing and working with local teams to encourage innovative high quality care Involvement and participation of CYP in HealthWatch

14. SAMPLE TITLE MAKING IMPROVEMENT HAPPEN LOCALLY Clear standards to support commissioning Statistics and evidence of what is working well acute and community Using your contacts and ideas from others Working with unlikely people – find out their agenda Use influence / opportunity of CQC registration and licensing Document and share successes Use the tools available...

15. SAMPLE TITLE Primarily a “standards document” Best Practice : 10 Minimum Safety Standards 8 : Acute service standards: Seniority/Timeliness of review Consultant of the Week Networks for Specialty Services Handover 1 : Training : Extrapolation of AoMRC 2004 1 : Safeguarding FACING THE FUTURE

16. SAMPLE TITLE GETTING INVOLVED LOCALLY 220 National Pathfinder groups (http://healthandcare.dh.gov.uk/context/consortia)http://healthandcare.dh.gov.uk/context/consortia Just five have apparently nominated children as their key area for development work – how are you engaging with them? 95% coverage of Early Implementers of HWBBs http://healthandcare.dh.gov.uk/category/public-health/early- implementers/ http://healthandcare.dh.gov.uk/category/public-health/early- implementers/ Are you linked to yours?

17. SAMPLE TITLE THE VISION FOR CHILDREN Providers work to clear standards Commissioning takes account of children’s views and local needs Clear links between HWBs and CCGs Child protection & LAC systems working effectively Meaningful involvement of CYP Complex care commissioned nationally/ regionally Fabulous communications and info flows And the headline figures show improvement….

18. SAMPLE TITLE FIND OUT MORE Sue.Eardley@rcpch.ac.uk 020 7092 6091 Or health.policy@rcpch.ac.ukhealth.policy@rcpch.ac.uk www.rcpch.ac.uk/policy