2. Capacity, Diversity & Choice

3. What is all this for? To improve the patient experience by providing fast, fair, convenient high quality services which respond to their needs.

4. Fast, Fair, Convenient High Quality Services: How the elements of system reform fit together Financial Framework Price tariff Contracts based on volume and quality Payment by results NHS Bank Strengthened devolution NHS Foundation Trusts 3 year planning and allocations Patient Choice Booked appointments More information Diversity DTCs Independent providers NHS Foundation Trusts Service redesign Strengthened accountability CHAI Franchising PCT prospectuses Increase Capacity DTCs More day surgery Systematic use of independent sector and Europe Workforce Agenda for change Consultant contract GMS contract Standards NSFs NICE SYSTEMREFORMSYSTEMREFORM

5. How the system worked 2001 DH Health authorities PCG/Ts NHS Trusts Patients performance management accountability CHI Inspection Finance CHI Driven top-down from DH centrally Patients are owned by the system

6. How the system will work: 2006 Performance management accountability Finance Inspection Standards Patients NHS Providers Trusts PCTs Non NHS Providers Foundation Trusts Independent Providers PCT Commissioners CHAI Inspection Regulation and CHAI inspection Strategic Health Authorities DH The patient will have more choice and control over their care. The system has to be designed to be responsive to this The PCT role in contracting with these providers will be vital

7. Capacity Patient Experience Diversity Choice Three Main Elements to Focus on Today

8. 1. Capacity Need to deliver key maximum waiting time targets: 4 hours in Accident & Emergency (2004) 3 months outpatient consultation (2005) 6 months for treatment (2005) NB: Challenging milestones (12 months for treatment by March 2003)

9. Capacity (contd) Key Issues: Much existing capacity used sub-optimally: NHS run too hot (95-98% occupancy) Poor streaming of workload Independent sector capacity/Europe seen as last resort ad hoc use Capacity gaps (and performance) skewed geographically and by specialty (orthopaedics) Workforce = limiting factor Lead times (cant afford traditional solutions)

10. Capacity (contd) Solutions: Rapid expansion in day surgery (375,000 FCEs) Diagnosis & Treatment Centres (250,000 FCEs) Incremental NHS growth (175,000 FCEs) Redesign & Modernisation (productivity) Systematic use of independent sector and Europe (50,000 FCEs) Blitz orthopaedics (DTCs, workforce, accelerated orthopaedic improvement programme 30+ Trusts)

11. Capacity (contd) Diagnosis & Treatment Centres: Delivers scheduled care in an environment which is not affected by emergencies Focus on high volume, low variation elective cases Streamlined patient pathways 100% booking Size (1,500 - 9,000 FCEs; average 4,000) Rapid spread (9 open in 2002; 50 by 2004)

12. 2. Diversity of Provision Policy goal to increase diversity to: Provide additional capacity Conduct for innovation Catalyst for increased productivity and working practices in NHS Challenge UK independent sector Facilitate Choice

13. NHS Foundation Trusts Overarching objectives Plurality Devolution Freedom Incentive

14. Freedoms Wider agenda to provide freedoms for all NHS Trusts Earned Autonomy for 3* Trusts Additional freedoms for NHS Foundation Trusts NHS Foundation Trusts

15. Incentives Local entrepreneurialism and innovation to deliver better services for patients encouraged by Financial flows and payment by results links to freedoms agenda NHS Foundation Trusts

16. NHS Foundation Trusts: Accountability mechanisms Registered as a holder of an FT licence and regulated against it Governance structure and Constitution Inspection by CHAI against nationally agreed Standards Commissioning via legally binding contracts

17. NHS Foundation Trusts Wont be subject to performance management by StHAs Will be held to account for delivering outputs agreed with PCTs through legally binding contracts As NHS FTs not subject to SofS Direction, they are fully responsible for outcomes achieved Will require clarity and transparency in NHS FT and PCT relationship

18. Agreeing Contracts with NHS FTs Some issues to consider: Range of services to be provided Volumes Penalty and incentive clauses Service development programmes Specialist packages of care for specific complex cases Information requirements and timeliness and data sharing Standards of quality and safety Risk sharing and risk management provisions

19. 3. Choice 2 versions: (a) 2002-2004 (Managed Choice) Choice of hospital after 6 months wait on list (3 or 4 choices, including Europe) Cardiac and London Choice pilots (help manage demand/capacity) Website (consultant/waits) (b) 2005> (Full Choice) Choice at the point of referral

20. Key Issues Identify the elements of this programme that are most likely to apply locally - e.g. is there a potential Foundation Trust, a new DTC being developed or an overseas establishment scheme being set up? What will the impact of these developments be? How can we get the most benefit from these developments in conjunction with the financial flows reforms?