Armed Forces Health Commissioning Arrangements

Melanie Iredale

Head of Armed Forces Commissioning

Tuesday 11th November 2014

Armed Forces Commissioning• Cement the “No disadvantage”

requirement as specified in Armed Forces Covenant and Government’s Mandate to the NHS

• A single, national body commissioning for the serving armed forces with one set of commissioning policies

• Build commissioning capability in the new system so as to credibly build networks and relationships

• Standard operating procedures for Armed Forces personnel in development

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Health and Wellbeing Boards, AFNs, Community Covenant and partnerships

NHS England - Armed Forces Health

NHS England Board

NHS England Operations Directorate

NHS England Operations Directorate

Area Teams – x 3Area Teams – x 3

Armed Forces Commissioning Interface between MOD and Providers(Securing Excellence – Military Health)

CCGs - Veterans, Families, Reservists, Armed Forces Networks

lead

Armed Forces Commissioning

Veterans’ and families commissioning Transition management

Veterans, reservists and families

Veterans’ and families commissioning Transition management

Veterans, reservists and families

Reservists, Veterans’ & Families Commissioning

Design Principles :Retain: Knowledge, expertise, capability, continuity, skillsets, credibilityEnsure: Momentum, partnerships, linkages, AFNs, practical configuration and delivery

CCGsCCGs

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Armed Forces commissioning responsibilities

 Serving Armed Forces in England

Serving Armed Forces overseas

Armed Forces Families registered with DMS med centres in England

Armed Forces Families registered with DMS med centres overseas

Armed Forces Families registered with NHS GP Practices

Reservists while mobilised i

Veterans (inc. reservists when not mobilised)

Primary CareDMS ii DMS DMS DMS NHS England

DMS&NHS England iv

NHS England

Community Mental Health DMS DMS NHS England DMS CCGs DMS CCGs

Secondary acute & community care NHS England

DMS&NHS England iv

NHS EnglandDMS&NHS England iv

CCGsDMS&NHS England iv

CCGs iii

MOD Enhanced pathways DMS DMS N/A N/A N/A DMS N/A

i - Reservists have access to DMS care whilst mobilisedii - Serving personnel can access local GPs on an emergency basis if needing to access care whilst away from the military addressiii - The NHS England will commission specialised services for veterans, e.g. limb prostheses, iv - While overseas, serving personnel and families can access DMS-commissioned healthcare where such provision exists, or may be provided with non-DMS healthcare by local Host Nation or other contracted arrangements, or have right of return for NHS England-commissioned NHS care in England4

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NHS England

COO

NHS North

Comm Mgr – James Carter

Asst Hd Military

Andy Bacon

DoC (Corporate)Ann Sutton

CCGs - Link to JSNA and H&Wb Bds

Armed Forces

Networks

N Yorks &Humber AT

N Yorks &Humber AT

Hd of Spec AF Melanie IredaleHd of Spec AF Melanie Iredale

Comm Mgr –North

Jim Khambatta

Comm Mgr –North

Jim Khambatta

DoC Julie Warren

DoC Julie Warren

NHS Mildands NHS South

Bath, Swindon & Wilts AT

Bath, Swindon & Wilts AT

Hd of Spec AF Jenny Kirby

Hd of Spec AF Jenny Kirby

Comm Mgr -South

Sharon Greaves/Karen

Beckett

Comm Mgr -South

Sharon Greaves/Karen

Beckett

DoC Debra Elliott

DoC Debra Elliott

Notts & Derbs AT

Notts & Derbs AT

Hd of Spec AFAlison TreadgoldHd of Spec AF

Alison Treadgold

Comm Mgr -Mids

Ann Berry

Comm Mgr -Mids

Ann Berry

DoC Vicky Taylor

DoC Vicky Taylor

Hd PH, Armed Forces and

OffenderKate Davies

DoCJulie Higgins

DoCCatherine O’Connell

DoCSue Davies

NHS London

DoCSimon Weldon

AF Network Lead/Transition

Richard Swarbrick

Head of Public Health, Armed

Forces and Offender Health Commissioning

Alison Frater

Kenny Gibson

Wayne KirkhamNational Lead

National Veteran Mental Health

Network

Armed Forces commissioning responsibilities: Structures post-April 2013

NHS England Internal

Oversight & Assurance structures

Operations & Delivery structures

External Assurance Groups

Armed Forces Governance Structure

Clinical Priorities

Advisory Group

Clinical Priorities

Advisory Group

Internal Delivery Groups (Armed Forces)

AFCRGAF

CRG

Armed Forces Partnership

Board

Armed Forces Partnership

Board

External Partnership

Groups

Health Partnership

Working Group

Health Partnership

Working Group

Defence Recovery Steering

Group

Defence Recovery Steering

Group

DMS/NHS England Joint

Commissioning Group

DMS/NHS England Joint

Commissioning Group

Veterans Mental Health Network

Veterans Mental Health Network

AF JointCommissioning Task & Finish

Groups

AF JointCommissioning Task & Finish

Groups

Screening & Immunisations Delivery Group

Screening & Immunisations Delivery Group

Patient & Public Voice Forum

Patient & Public Voice Forum

Armed Forces Networks

Armed Forces Networks

ETMETM

Directly Commissioned

Services Committee

Directly Commissioned

Services Committee

Armed Forces Oversight

Group

Armed Forces Oversight

Group

Operations SMT

Operations SMT

NHS England Board NHS England Board

CRG sub-groups as required

CRG sub-groups as required

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DH Future Roles• Policy

• Governmental and inter departmental business

• 2 Murrison Reports

• Mental Health Provision:

• Veterans MH Network

• Big White Wall

• Prosthetics:

• National Funding of Veterans Prosthetics

• Improved Disablement Support Centres

• Veterans Information Service

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MoD/Joint Medical Command

Joint Medical Command

• MoD (Chief of Defence Personnel) deliver (support):• Tri-service welfare and recovery• Chain of Command looks after/owns service

personnel under their command (Single Service or TriService)

• Transition• Recovery

• MoD (Joint Medical Command) still commission/provide (supporting) healthcare:

• Operational Care• Primary Care• Rehabilitation• Community Mental Health • Inpatient Mental Health (NHS Provided)

n.b. note supporting/supported tension that we understand8

Obligations

• “The NHS and its public sector partners need to work together to help one another to achieve their objectives. …. This includes, in particular, demonstrating progress against the Government’s priorities of: upholding the Government’s obligations under the Armed Forces Covenant;

• The Covenant says:• The Armed Forces Community should enjoy the same standard of, and access to,

healthcare as that received by any other UK citizen in the area they live.

• Personnel injured on operations should be treated in conditions which recognise service

needs

• For family members, primary healthcare may be provided by the MOD in some cases (eg

when accompanying Service personnel posted overseas). And … should retain their relative

position on any NHS waiting list, if moved around the UK due to the Service person being

posted.

• Veterans … should receive priority treatment where it relates to a condition which relates

to .. their service, subject to clinical need

• Those injured in service should be cared for in a way which reflects the Nation’s moral

obligation …with professionals who have an understanding of Armed Forces culture9

NHS England

• England (not whilst Overseas), or Devolved Administrations

• Direct Commissioning:

• Post Operational Health Care (non-recovery)

• Community Care

• Hospital Care (also for MH not in main contract)

• Specialist IVF

• IVF on Moves

• Indirect Commissioning:

• CCG Assurance

• DMS – NHS IM&T Connectivity

• NHS England Other: Dental, “Specialised”, Offenders, Immunization, Vaccination and Screening

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Armed Forces Networks• All Local Stakeholders:

• Regional Armed Forces Structures

• PRUs

• Local NHS – Commissioners and providers

• Local Authorities

• Charities

• Veterans Organisations

• Currently 9 in England mapped closely to Brigade structure

NHS

Charities Armed Forces

Local Authorities

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Planned Improvements• Continuity of Care

• Pathway redesign (especially roles of

1ry/2ry)

• Improved Choice

• Recording and Performance monitoring of quality

• Referrer Involvement

• Patient and Carer involvement

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Issues

• Very poor data:

• £15M or £170M?

• Philosophical Differences:

• “The Armed Forces Community is entitled to appropriate recognition for the

unique Service which it has given, and continues to give, to the Nation, and the unlimited liability which the Service person assumes” AF Covenant

• “Only clinical features taken into account: The NHS CB must make decisions fairly about funding treatments and not on the basis of age, sex, sexuality, race, religion, lifestyle, occupation, family status (including responsibility for caring for others) social position, financial status etc. unless these directly affect the expected clinical benefit that an individual will derive from a treatment” NHS England Interim Standard Operating Procedures

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So what does this mean for CCG’s• Involvement in Armed Forces Networks

• New North East, Yorkshire & Humber AFN

• CCG stewardship

• Rotating chair

• Multi-agency representation

• Veteran’s Awareness

• Identification at practice level

• RCGP e-learning tool

• Staff training

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Continued …..• Veteran Mental Health Services

• Outreach services

• Big White Wall

• Combat Stress residential

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Thank you!

http://www.england.nhs.uk/resources/resources-armed/

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