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.