1. Care homes and the NHS Standard Contract Alastair Hill Senior Lead, NHS Standard Contract NHS England RCPA Seminar 20 November 2013

2. About NHS England An arms-length body Separate from Government and Department of Health Runs the NHS commissioning system Provides guidance and support to Clinical Commissioning Groups Directly commissions primary care and specialised services Works closely with regulators such as Monitor and Care Quality Commission NHS England | Presentation to RCPA Seminar 20 November 20132

3. Evolution of legally-binding NHS contracts Introduction of Foundation Trusts (acute services) Development of separate contracts for different provider types: mental health and learning disability community; ambulance care homes Introduction of increased choice and competition Move to the single NHS Standard Contract (2012/13) NHS England | Presentation to RCPA Seminar 20 November 20133

4. Who uses the NHS Standard Contract? Low volume, high value NHS Trusts and Foundation Trusts High volume, low value Independent and voluntary sector providers (hospitals, care homes, AQP, patient transport providers, enhanced services providers) NHS England | Presentation to RCPA Seminar 20 November 20134 The NHS Standard Contract is not used for routine primary care services

5. Why have a Standard Contract? There are benefits in a standardised approach: one set of rules which everyone understands a level playing field for all types of provider economies of scale (contract production, legal advice) The Standard Contract is mandated for use by NHS commissioners, and commissioners cannot vary the nationally-set terms. NHS England | Presentation to RCPA Seminar 20 November 20135

6. National and local elements There are elements which are set nationally: boiler-plate legal clauses (payment, contract management, dispute resolution, variation, suspension, termination) national quality standards and reporting requirements But much of the key detail is for local negotiation: service specifications local prices local quality standards and reporting requirements NHS England | Presentation to RCPA Seminar 20 November 20136

7. Tailoring the Standard Contract This isnt intended as a one size fits all approach The General Conditions are the same in all contracts But the content of the Service Conditions varies depending on the specific services being commissioned So standards or requirements that arent relevant dont apply This tailoring approach works best if the electronic contract system (the eContract) is used NHS England | Presentation to RCPA Seminar 20 November 20137

8. Updating the Contract for 2014/15 Extensive engagement process, covering payment systems, tariffs, incentives and the Standard Contract Direction of travel agreed Main wording changes drafted Improved eContract being developed Publication of the final Contract and Technical Guidance before Christmas NHS England | Presentation to RCPA Seminar 20 November 20138

9. There will be changes for 2014/15 The current three-part structure will remain, and many clauses will see little alteration But there will be revised provisions, for example, to implement recommendations from the Francis report update the payment section to reflect the new National Tariff system adjust the sanctions that apply for poor performance reflect new guidance on information governance and staff pensions NHS England | Presentation to RCPA Seminar 20 November 20139

10. What feedback did we get? 10 There are provisions in the contract which are unreasonably burdensome for small providers We need some continuity – please dont re- write the whole Contract again! CQUIN can be a problem for very low-value contracts The Contract is overwhelming for small providers – too long, too complicated, not all relevant Some of the financial sanctions in the contract are unworkable or disproportionate We need to be able to agree contracts with a longer duration The Contract focusses too much on acute services Commissioners dont pay us as quickly as the Contract says they should

11. How are we trying to make things better? Allow flexible longer-term contract duration Remove some of the disproportionate requirements on small providers (emergency planning, carbon reduction, counter-fraud, formulary, Prevent) Clarify which sanctions should apply and how they operate (for example, Never Events) Commissioner discretion on low-value CQUIN Minimise nationally-mandated reporting requirements Try to resolve the late payment problem NHS England | Presentation to RCPA Seminar 20 November 201311

12. Encourage wider use of the eContract Simple for providers – just log in and download the proposed contract More work for commissioners – but the 14/15 version will be easier to use Automatically produces a tailored PDF contract – so all the clauses that dont apply are filtered out Results in a shorter, clearer, more relevant contract – which is what smaller providers say they want NHS England | Presentation to RCPA Seminar 20 November 201312

13. The Contract in practice The contract gives both parties clarity – about the service to be provided, the quality standards, the price, the rules … But what really matters is having sensible, mature working relationships between commissioner and provider at local level If both behave in a reasonable, proportionate and co-operative manner, they will probably not need to rely on all the detailed provisions of the Standard Contract NHS England | Presentation to Foundation Trust Network 16 October 201313