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Implementing the NHS reforms Implementing the NHS reforms Implementing the NHS reforms Implementing the NHS reforms ––––
overview and local updateoverview and local updateoverview and local updateoverview and local update
May 2012
6.
What’s covered
• Context and new structures
• Process of authorisation
• Health and Well Being Board role
• Commissioning Support Services
• Round up
Refresh on the reforms
July 2010 – White Paper published
Dec 2010 – Health and Social Care Bill published
July 2011 – Listening exercise, followed by Future Forum report
Mar 2012 – Royal Assent – now the Health and Social Care Act
Aim is to enable clinical leaders, patients’ reps and local government to
take new roles in shaping services. The principles are that:
• Patients should share in every decision about their care
• Those responsible for patient care – i.e. GPs - should have the ‘freedom
and power to lead an NHS that delivers continually improving care’
• LAs will lead on promoting the health of their population – new public
health responsibilities
3
“The�Act will deliver more power to clinicians, it will put patients
at the heart of the NHS, and it will reduce the costs of
bureaucracy. We now have an opportunity to secure clinical
leadership to deliver improving quality and outcomes; better
results for patients is our objective.”
Context
• We are moving to a new commissioning support system
fully implemented from 1st April 2013:
• Clinical Commissioning Groups (CCGs)
• NHS Commissioning Board
• Commissioning Support Services (CSS)
• Public Health England
• Public health transition to local authorities
• Health and Wellbeing Boards
• April 2013 - PCTs abolished and CCGs will have statutory
responsibility for commissioning health services.
Recruiting to the governing body
• Chair elected/selected. Competency affirmed through
assessment centre. May 2012
• Accountable officer. Assessment centre and interview.
May/June 2012
• Chief Financial officer – Assessment centre and interview.
June/July 2012
• GPs elected/selected as per the constitution
• Secondary care doctor, independent nurse: adverts out
• Lay members – process being confirmed.
Process of ‘authorisation’
CCG Authorisation Timescale –
Waltham Forest CCG going in wave 3
along with Newham, City & Hackney
and Tower Hamlets of the NELC CCGs
April May June July August September October November / December
NHS Commissioning Board and NHS London
Final application guide released to CCGs 13
th April
Stakeholder survey information pack published w/c 16 April
Authorisation decision returned to CCG 31 December
NHS CB led assessment and desk top review date tbc
Application submitted to NHSCB 1 October
NHS L delegation stock takes 11 May
One day site visit informed by the desk top review date tbc
Proposed configurations concluded 30 April
360 stakeholder survey period 13/08 – 07/09
CCG authorisationAuthorisation will look at a number of facets of the CCG-LA relationship:
IntegrationCCG plans aligned with JHWS, and opportunities identified to integrate
commissioning and reduce health inequalities, depending on local timeframes
HWBEvidence of participation in HWB, and in development of draft JSNA and JHWS
Provision of adviceArrangements to get advice from social care and public health professionals
Public healthArrangements in place between LA and CCG specifying how public health advice will
be delivered
EngagementEvidence of engagement with LA, LINKs/local Healthwatch
SafeguardingArrangements in place for safeguarding children and vulnerable adults
Role of LAs in authorisation
Support CCGs to develop
arrangements for
safeguarding
Make arrangements for
provision of public health
and other specialist advice
to CCGs
Work with CCGs to
develop effective shadow
HWBs, and prepare draft
JSNAs and JHWS
Agree plans for
collaborative and
integrated commissioning
Local authorities
will be asked for
their views on
their
relationship
with aspiring
CCGs, their
views of CCG
potential to
deliver, as well
as some
question on
specific topics
The NHSCB may
seek LA/PH input
into the
assessment of
CCGs with
specific
challenges in
these areas
Preparation Views Assessment
How will Local Authorities give
their views?• The LA CEO, Director of Adults and Children’s, 3 councillors , two
of whom the LA nominates and the third must be the Chair of Overview and Scrutiny will be asked for their views.
• In addition the Chair and two other members of the Health and Well Being Board will be asked to respond.
What will be asked? 3 types:
1) Specifics: the arrangements for providing public health advice to CCGs; can the LA see sufficient clarity re: accountability in the CCG structure for safe-guarding internally and co-operatively.
2) Engagement: How the CCG has engaged LAs. Collaboration on shared plans and integrated commissioning. Is this reflected in the Joint Health and Wellbeing Strategy
3) Vision: Has the CCG demonstrated its vision and priorities to partners, via clinical leaders through the HWBB.
What will the CCG do and how.
• It is estimated that the CCG will have a budget of
approximately £330m (this compares to £430m currently –
the difference being primary care contracting, transfer to LA
and specialist commissioning which goes to the NHS CB). This
will be used to commission acute hospital care, mental health
services and community health services.
• In addition it will have a £25.00 per head management
allowance based on list size, with this it will:– Pay for its Governing Body and a high level of clinical engagement throughout primary care.
– Employ its own staff ( approx 25)
– Share Finance and IT staff with other CCGs (4)
– Buy-in support from a Commissioning Support Service provided at CCG, provider and pan-provider
levels.
Commissioning support services (CSS)
• CCGs need support beyond in-house teams
• Can choose where they buy services from
• CSS - new organisations being set up to provide
services to CCGs
• Around 26 CSS in England, with three in London
• North Central and East London CSS will offer
services to 12 ‘foundation’ CCGs in north central
and north east London and the city
• The CSS will support CCGs to make decisions
about health services to improve the health and
health services for local communities.
• Reason – efficiency of providing services ‘at scale’
• Provide ‘end to end’ service to CCGs
• To succeed, CSSs will need to be much more
customer-focused, innovative and efficient.
How will the CSS support the CCG’s
big strategic issues.
NHS national commissioning board (NCB)
• NHS Commissioning Board Special Health Authority, established 31
October 2011
• Making necessary preparations for successful establishment of NCB.
• In the meantime, all current NHS planning and delivery responsibilities
remain with Dept of Health, strategic health authorities and PCTs
• NCB will:
• agreed and deliver improved outcomes
• oversee the commissioning budget
• directly commission primary care and some specialised services
• support quality improvement and integrated services
• promote equality and diversity
• develop commissioning guidance, standard contracts
• support and hold CCGs to account
• host CSS in interim
• Four branches, including one in London
Key milestones
2012
April – final authorisation guidance issued
May - June – development support for prospective CCG leaders; recruitment of
CSS leaders and remaining NHS CB senior posts
July – first wave of CCG authorisation applications (then waves - Sept, Oct, Nov)
July - Dec – recruitment to remaining posts in CCGs, CSSs and NHS CB and
agreement on when appointed staff will take up formal employment
Aug – third checkpoint for CSSs (submission of final business plan)
Oct – the NHS CB becomes a formal Public Body; first set of authorisation decisions
(subsequent decisions in Nov, Dec and Jan); decisions on hosting of CSSs
2013
Jan – completion of authorisation decisions
April – the Board and authorised CCGs take on full statutory powers
From 1 April 2012 we became NHS North East London and the City – a cluster of seven primary care trusts with a jointboard arrangement and single executive team
In the meantime�
• NHS NELC will oversee the transition to the new system
• Over this final year we are focusing on: maintaining grip
on performance across the local NHS, improving the
quality of care at BHRUT, managing the transition and
planning effectively for/securing a healthy legacy from the
Olympic and Paralympic Games.