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Understanding the NHS reforms Jo Webber, Deputy Policy Director 20 th March 2012.

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Presentation on theme: "Understanding the NHS reforms Jo Webber, Deputy Policy Director 20 th March 2012."— Presentation transcript:

1 Understanding the NHS reforms Jo Webber, Deputy Policy Director 20 th March 2012

2 What will be covered? What was the system like before the reforms? Summary and analysis of reforms to date What will it be like going forward?

3 Current structure of NHS in England Secretary of State for Health Responsible for provision of a comprehensive health service Department of Health (DH) & chief executive of NHS Funds, directs and supports the NHS Strategic Health Authorities (SHA): acts as link between DH and NHS Currently 4 (from previous 10) but will cease to exist from 2013 Primary Care Trusts (PCTs) responsible for assessing local health needs, public health and commissioning services for patients and public Currently 50 (from 150) but will cease to exist by 2013 PROVIDERS of NHS CARE Primary Care GP practices, Pharmacies, Dentists, Opticians NHS trusts and NHS foundation trusts: Acute Mental health Ambulance Community Other NHS services NHS Walk-in centres NHS Direct ( online/ telephone advice ) Independent sector providers

4 Current challenges facing the NHS (1) Demand pressures Rising expectations Demography Changing patterns of disease e.g. survival from cancer and other illnesses/ conditions Impact of lifestyle behaviours on health Increasing costs associated with new treatments & drugs

5 Current challenges facing the NHS (2) Drive to improve quality and outcomes Pockets of poor-quality care and patient experience Poor co-ordination of care Pressure on public finances Drive to reduce public sector borrowing requirement Growth limited to 0.1% above general rate of inflation Need to achieve £20bn productivity gains by 2015 Disconnect between health and social care Local authority responsibility with similar financial pressures Long term funding issues for social care

6 Current challenges facing the NHS (3) Need to improve efficiency/ reduce costs Moving care closer to home Improving co-ordination of networked services Making integration a reality Need to adapt current patterns of service provision Closure/reconfiguration of some unsustainable services Over-capacity of some types of provision in some areas

7 NHS Reforms: a brief overview Early priority for Conservative/ Liberal coalition government : White paper with main proposals published July 10 Bill introduced to Parliament 11 January, 2011 Considerable opposition – political and from professions Parliamentary process paused April, 2011 for further discussions and proposals amended Still going through Parliament Some structural change happening in advance of final legislation e.g. changes to PCTs and SHAs

8 Objectives of NHS Reforms Key themes Patients/public at the centre of the NHS Focus on quality and improving outcomes Empowering health professionals, particularly general practitioners to lead commissioning Also Shift from NHS as commissioner/provider to NHS as funder of care Greater plurality of provision and more competitive market-place Emphasis on local planning and decision making Focus on improving accountability of the NHS Shift of responsibility for public health to local authorities

9 Key elements of reforms Major structural reforms Abolition of Strategic Health Authorities and PCTs by 2013 Shift of some DH responsibilities to new NHS Commissioning Board Transfer of main commissioning responsibilities to new local clinical commissioning groups (CCGs) Transfer of responsibility and budget for public health to local authorities Creation of local health and wellbeing boards Increased competition and choice NHS provision opened up to competition New sector regulator Expectation all provider trusts become foundation trusts by 2014 Focus on outcomes: Outcome frameworks for NHS, public health, social care and commissioning

10 Key concerns about the reforms (1) Competition: Privatisation of provision Fragmented services/ undermining integration New commissioning arrangements: Complexity/ split responsibilities Capacity and capability of local clinical commissioning consortia Privatisation of commissioning: commissioning support organisations Health and wellbeing boards underpowered Some existing NHS providers will struggle to achieve FT status: Mergers and acquisitions will be needed

11 Key concerns about the reforms (2) Clarity on some of the detail still needed: Commissioning responsibilities Roles and responsibilities for quality Defining essential services and how they should be protected Accountability for decision-making: Inadequate and insufficiently democratic Do not address the main challenges facing the NHS Financial challenge of delivering £20bn productivity gains by 2015 Disruption associated with reforms

12 Will they work? Focus on increased clinical input to commissioning and outcomes welcome Clinical support vital to make the reforms work: Develop clinical commissioning capacity Secure GP buy-in to drive clinical commissioning Building effective partnerships and relationships key: Nationally between regulators and the Commissioning Board Locally: across NHS providers; NHS and local government; & health and social care (providers and commissioners) Difficult decisions will be needed to secure NHS sustainability Are the right incentives in place?

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