1. Commissioning for children

2. Background to the White Paper
Equity and Excellence: Liberating the NHS is a NHS White Paper setting out a future vision for the NHS
It describes a system where:
Patients are at the heart of everything the NHS does
Healthcare outcomes in England are among the best in the world
Clinicians are empowered to deliver results
A Health and Social Care Bill will be introduced into Parliament later this year

3. What do the White Paper reforms mean for children?
The majority of services, including the majority of services which children require will be commissioned by groups of GP practices, working together in consortia
Commissioning by GP consortia will bring decision-making much closer to patients and local communities, and ensure that redesign of patient pathways and local services is always clinically led.
GPs will work in partnership with secondary care, other health and care professionals and with community partners to decide how to use NHS resources to get the best health care and outcomes for patients, through well designed, joined-up services that make sense to patients and the public.
GP consortia will be supported by an autonomous NHS Commissioning Board, which will also commission some services, such as primary care or specialised services, directly. The Board will work with consortia when commissioning these services.
The NHS Commissioning Board will host some clinical commissioning Networks, for example for targeted health services for ill and disabled children, to pool specialist expertise.
Following consultation on the White Paper proposals, it has been decided that maternity services will be commissioned by consortia, rather than the NHS Commissioning Board, as was originally stated

4. Joint working
In their commissioning role, GPs will work closely with local authorities, who will have a lead role in ensuring services across the NHS, social care and public health are joined up and meet the needs of local people.
We will establish new statutory arrangements within local authorities –"health and wellbeing boards" – to take on the function of joining up the commissioning of local NHS services, social care and health improvement. These health and wellbeing boards allow local authorities to take a strategic approach and promote integration across health and adult social care, children's services, including safeguarding, and the wider local authority agenda.
GPs will contribute to the Joint Strategic Needs Assessments led by local authorities, which aim to assess the health and social care needs for populations. They will also contribute to the local Health and Well Being strategy, and have regard to both of these in the development of their commissioning plan.
Local authorities will promote collaboration on local commissioning plans, including by supporting joint commissioning arrangements where each party so wishes
There is scope under the new arrangements for GP Consortia to enter into Service Level Agreements with Local Authorities to provide services.

5. Accountability
The NHS Commissioning Board will hold GP Consortia to account for the outcomes they achieve and their stewardship of NHS resources
Local Healthwatch organisations, supported by HealthWatch England, will ensure that patients are given a stronger voice. Commissioned by the Local Authorities they will be key in ensuring the voice of children, young people and their families is heard through the commissioning cycle. It would be possible for local authorities to commission local HealthWatch to provide advocacy and support to help people with particular needs to access services.
The NHS Outcomes framework will provide direction for the NHS. It will include a focused set of national outcome goals determined by the Secretary of State, against which the NHS Commissioning Board will be held to account, alongside overall improvements in the NHS.
In turn, the NHS Outcomes Framework will be translated into a commissioning outcomes framework for GP consortia, to create powerful incentives for effective commissioning.
The criteria used will ensure that we do not exclude outcomes for key groups and services such as children, older people and mental health.

6. Public Health for children
The Government proposes that public health services for children under 5 will be a responsibility of Public Health England which will fund the delivery of health visiting services, including the leadership and delivery of the Healthy Child Programme for under 5s (working closely with NHS services such as maternity services and with children’s social care); health promotion and prevention interventions by the multi-professional team and the Family Nurse Partnership.
Public health services for children aged 5-19, including public mental health for children, will be funded by the public health budget and commissioned by local authorities. This will include the Healthy Child Programme 5-19; health promotion and prevention interventions by the multiprofessional team and the school nursing service. Local authorities may wish to encourage active travel for children.
Local authorities will want to consider the needs of vulnerable groups, which includes ill and disabled children, for whom they have a responsibility to promote health and welfare, as part of their commissioning arrangements

7. Pathfinder consortia
The Secretary of State recently announced a GP consortia pathfinder programme, to empower pioneering groups of GP practices that want to press ahead with commissioning care for patients. Specifically, the programme will:
Identify and support groups of practices keen to make fast progress and can demonstrate capacity and capability
Enable GPs, working with partners, to test different design concepts for GP consortia
Create learning networks across the country
Involve these clinicians more in delivering the QIPP agenda
The Command Paper is clear that we will ensure that there is particular emphasis within the GP consortia pathfinder programme on testing new ways of ensuring consortia quickly develop knowledge and expertise, this will include exploring joint commissioning with local authorities, in relation to care and support for children.

8. Supporting disabled children
The Coalition Agreement of May 2010 gives a commitment to provide £10million a year beyond 2011 for children’s hospices, which will benefit many children with disabilities.
To support disabled children and their families, the Chief Secretary of the Treasury said starting from 2011/12, over £20million each year will be available to provide additional respite care for severely disabled children
In 2010/11 there was up to £30 million available from the Department of Health to support local projects to develop children's palliative care services, bringing together local commissioners and providers, including voluntary sector organisations.
Short breaks can have a positive impact for families with disabled children, by providing much-needed help and support. This is why the Government has recently announced that it will be providing local authorities with £800 million over the next four years to fund short breaks for families with disabled children.
There are currently some pilots of Individual budgets for the families of disabled children. These started in 2009 and will run until March 2011
In July 2010, the Department for Education also announced plans for a new Green Paper on Special Educational Needs and disabled children, to be launched this autumn.

9. Implementation Timetable.
The proposed implementation timetable is:
In 2010/11: GP consortia to begin to come together in shadow form (building on practice based commissioning consortia, where they wish).
In 2011/12: a comprehensive system of shadow GP consortia in place and the NHS Commissioning Board to be established in shadow form.
In 2012/13: formal establishment of GP consortia, together with indicative allocations and responsibility to prepare commissioning plans, and the NHS Commissioning Board to be established as an independent statutory body. Authorisation of consortia will begin.
In 2013/14: GP consortia to be fully operational, with real budgets and holding contracts with providers.