1 Understanding Service Redesign RCN Policy Unit

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

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 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 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 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]