Equity and excellence: Liberating the NHS David Williams Director of Commissioning

Centred on patients and carers; Achieves quality and outcomes that are among the best in the world; Refuses to tolerate unsafe and substandard care; Eliminates discrimination and reduces inequalities in care; Puts clinicians in the driving seat Sets hospitals and providers free to innovate Transparent, with clearer accountabilities for quality and results; Vision

Gives citizens a greater say in how the NHS is run; Less insular and fragmented, and works much better across boundaries, including with local authorities and between hospitals and practices; More efficient and dynamic, with a radically smaller national, regional and local bureaucracy; and More stable and sustainable footing, free from frequent and arbitrary political meddling.

Liberating the NHS – the headlines Demand Side Abolition of PCTs and SHAs and “PBCs” Creation of NHS Commissioning Board Creation of statutory GP Consortia Extend choice: no decision about me without me Health improvement duties transfer to LAs, under DPH with Health and Well-being Boards Supply side All Trusts to be FTs by April 2013 FT private patient cap to be removed Ability to form Social Enterprises Any willing provider model in all services Regulation Economic Regulator: Monitor regulating competition, setting prices and supporting continuity of service CQC to focus on inspection (min standards) NICE to develop 150 standards Goals and payments £20Bn efficiency savings & mgt costs down 45% by 2014 NHS Outcomes framework: national outcome goals, to be translated into GP Consortia objectives Board defines structure of payment systems: Regulator sets tariff to include quality measures

The role of GP Consortia Consortia of practices working in partnership with local authorities and communities responsible for commissioning majority services Statutory - - not optional, practice agreements GP contract change accountable officer Size, geography Duties – equality, outcomes, public patient involvement GP Consortia will decide what support services They will receive a management allowance

NHS Commissioning Board Provide leadership for quality improvement –Setting guidelines for improving standards –Design model contracts –Design structure of tariff Promoting and extending patient choice and involvement Development of GP consortia –Hold consortia to account Commissioning certain services –GP, dentistry, community pharmacy, primary ophthalmic, maternity services, specialised Allocating and accounting for NHS resources

Improving Public Health White paper December 2010 new public health service Joint DPH LA and public health service Joint strategic needs assessment Health improvement budgets (eg. weight management, smoking cessation, promotion and prevention) UA responsible for population health outcomes

Health and Well-being Boards Key mechanism to support democratic legitimacy Support, promote partnerships and integration Scrutiny role for major service redesign Lead on JSNA and public health priority setting Consist of local representatives, elected councillors, Directors of Social Care, GP consortia, Healthwatch, DPH

Healthwatch Champion users and carers Voice for patients locally Information to improve accountability National structure Represent patients and the public and provide independent evidence of local services Representative on Health and Well-being Board

Timelines 2010/11 October 2010 Consultation ends:- Liberating the NHS; Equity and excellence Increasing democratic legitimacy in health Commissioning for patients Regulating healthcare providers Transparency in Outcomes: a framework for the NHS December Public Health White Paper January Social Care Proposals

Timelines Separation of Provider Arm March 2011 Shadow NHS Comm Board established April 2011 GP Consortia established April 2011 GP Consortia operational April 2012 GP Consortia take full financial resp April 2013 Dissolve PCT June 2013

What are we doing locally? Ensuring we deliver £100m efficiencies in the next four years whilst improving quality (QIPP) Discussing shape and size of GP consortia in preparation for ‘shadow’ consortia April 2011 Engaging with boroughs on joint plans for change – RBWAM project group Working through transition plans at JSCB- September 2010 Preparing for OD processes and transition plans

‘Transparency in outcomes; a framework for the NHS’ EFFECTIVENESS PATIENT EXPERIENCE SAFETY Preventing people from dying prematurely Enhancing the quality of life for people with long-term conditions Helping people to recover from episodes of ill health or following injury Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Outcome Areas, Specific Improvement Areas, Quality Standards (NICE-150)