1. Health reform in England: update and commissioning framework
DRAFT
Health reform in England
Health reform in England: update and commissioning framework
Anthony Kealy
Head of Commissioning Policy
18/04/ :52

2. Commissioning and the health reforms
DRAFT
Health reform in England
Commissioning and the health reforms
Money following the patients, rewarding the best and most efficient providers, giving others the incentive to improve
(transactional reforms)
More diverse providers, with more freedom to innovate and improve services
(supply-side reforms)
Better care
Better patient experience
Better value for money
More choice and a much stronger voice for patients
(demand-side reforms)
At its simplest, the way we see the role of the NHS is very straightforward:
Our patients have demands for healthcare – they deserve a much stronger voice and the ability to choose providers
We supply healthcare in response to those demands through more diverse providers with more freedom to innovate and improve services
As well as handling those demands and supplying appropriate healthcare, the healthcare system also needs mechanisms for transacting within itself, and with its partners, in the overall provision of healthcare. Money should “follow the patient” to reward the best and most efficient providers and incentivise others to improve.
And we need the service to operate within an overall environment of management and regulation that ensures the overall goals are met – that will guarantee safety and quality, fairness, equity and value for money.
The combined effect will be:
better care,
better patient experience and
better value for money
A framework of system management, regulation and decision making which guarantees safety and quality, fairness, equity and value for money
(system management reforms)
18/04/ :52

3. The health reform programme
Completed
Health reform in England: update and next steps (December 2005)
Our health, our care, our say (January 2006)
The NHS in England: operating framework (January 2006
Health reform in England: update and commissioning framework (July 2006)
Next stages
Future of PbR
System Management and Regulation
Commissioning Framework second phase: joint commissioning and health and wellbeing
Provider development

4. Update and commissioning framework
Updates:
Reform programme
Choice and commissioning
Provider development
System management and regulation
Tariff, incentives and information
And publishes the commissioning framework

5. The commissioning framework
Main Themes
Better clinical and community engagement
Better information to support commissioning
Incentives and contracts
Securing the cash limit
Developing capacity and capability

6. Better clinical engagement through PBC
Clearer procurement requirements – no tendering
Pump-priming loans available
Local incentive schemes
Payment at tariff for services moved from hospitals
Proposals on governance and accountability
Approval of PBC plans for service redesign
Contributing to restoring financial balance
Demonstrating accountability

7. Stronger community engagement
A stronger voice for patients and communities:
A new PCT Prospectus
Role of LINks
Third sector involvement
Proposals on triggering community action

8. Better information to support commissioning
Sets out the approach to improving information:
Using the insights provided by patients, providers, communities and local authorities
Developing strategic solutions such as CfH SUS

9. Incentives and contracts
Using open tendering to attract new providers where services are unavailable or of poor quality
No tendering requirement for PBC developments
Using time-limited financial incentives and activity guarantees where appropriate
Makes proposals for a national model contract

10. Securing the cash limit
Using techniques such as referral management, prior approval, and utilisation management alongside Choice, PBC and PbR
Applying interim measures permitted by the Operating Framework in exceptional circumstances:
Clear activity assumptions and agreed profiles in contracts
Clear apportionment of financial responsibility where balance is at risk

11. Developing capacity and capability
PCT development, building on Fitness for Purpose
Developing an evidence base of effective commissioning
Development of PBC
Supporting PCTs to buy-in private sector skills

12. Next Steps Consultation until 6 October
Engagement with the NHS via SHAs
Development of national model contract
Final guidance on
Contracting for NHS care
PBC governance and accountability
Triggering community action
Phase 2 of the Commissioning Framework

13. The Commissioning Framework Phase 2
Joint Commissioning for Health & Well-being (December 2006):
Health improvement
Commissioning for LTCs (including mental health)
Commissioning for Children and Maternity
Future of joint commissioning
Interface PBC & Social Care (individual budgets)
Commissioning Primary Care

14. Tackling Barriers in Phase 2
Spending between health and social care budgets
Financial flows and incentives for preventative spending
Empowering individuals, eg health/ soc care plans
Service provision models
Getting the metrics right
Improving data sharing
Accountability mechanisms
Simplifying points of access / gateways