NHS Handbook 2012/13 -Chapter 4

Contents

Forewords 6

NHSConfederation 8

Introduction:onesystem–fourstructures 9

01 The new structure of the NHS in England Parliament 12

DepartmentofHealth 15

Othergovernmentdepartments 17

Arm’s-lengthbodies 17

NHSCommissioningBoard 18

Clinicalcommissioninggroups 20

Healthandwellbeingboards 22

Foundationtrusts 23

Independentproviders 25

Managingthetransition 30

02 Commissioning Thebasics 34

Clinicalcommissioninggroups’role 35

NHSCommissioningBoard’srole 38

Healthandwellbeingboards’role 39

Commissioningandcompetition 42

Publichealth 45

03 Providing services Primarycare 60

Communityhealthservices 69

Integratedcare 72

Secondarycare 77

Urgentandemergencycare 84

Maternityservices 91

Mentalhealth 92

Careforspecialgroups 99

04 Policy and strategy: creating a ‘vision’ for the NHS

Theplanningframework 106

Equalityanddiversity 110

05 Quality and safety Ensuringquality 116

Ensuringpatientsafety 127

06 Accountability and regulation Theroleofboardsandgoverningbodies 132

Engagingpatientsandthepublic 137

Complaints 143

Regulationandinspection 147

Professionalregulation 150

07 Financing the NHS Sourcesoffunding 158

Resourceallocation 161

Capital 163

NHSspending 166

Buyinggoodsandservices 169

08 Staffing and human resources Workforceplanning 176

Payandpensions 180

TheNHSasanemployer 183

09 Evidence, research and development Government,strategyandinfrastructure 188

FundingR&D 193

Researchorganisations 194

Nurturinginnovation 195

10 Information technology ITpolicyandtheinformationstrategy 200

ITinfrastructure 202

Collectingandusingdata 206

11 The NHS in Scotland ThestructureofNHSScotland 210

Strategyandpolicy 218

12 The NHS in Wales ThestructureofNHSWales 222


13 The NHS in Northern Ireland ThestructureoftheNHSinNorthernIreland 232


14 The NHS in Europe EUhealthpolicy 243

Cross-borderhealthcare 244

CurrentEUpolicyinitiatives246

Acronymbuster 248

Index 259

Acknowledgements 267

Please contact us on 0870 444 5841 for more information about the versions of The NHS handbook 2012/13 suitable for those with a visual impairment.

7

Foreword

The NHS has changed so significantly in recent years that the

traditional model of NHS care is, in many cases, no longer

recognisable. Our healthcare system is more fluid and diverse

than ever before and the NHS needs to continually adapt to meet

the changing needs and expectations of patients and taxpayers.

The NHS handbook 2012/13 is the must-have guide to help you

navigate and make sense of the changing shape of the NHS. With the Government’s

Health and Social Care Bill receiving royal assent in spring 2012, we have updated

the guide to cover:

• the structure of the NHS

• clinical commissioning groups

• the changing provider landscape

• the NHS Commissioning Board

• health and wellbeing boards.

There’s also a handy acronym buster to help you find your way around the names of

the new organisations, which is also available online at

www.nhsconfed.org/nhshandbook

The NHS handbook is supported by advertising from a number of organisations

we work alongside, and I am particularly grateful to NHS Professionals for kindly

agreeing to support this landmark edition.

I hope you find this timely guide invaluable in 2012/13. At the NHS Confederation

we will continue our work to join up the views, perspectives and opinions of each

and every part of the healthcare system over the coming year. If you have any

comments or suggestions for future editions of The NHS handbook, please contact our

publications team on 020 7074 3200 or email [email protected]

MikeFarrarCBE

Chief executive

NHS Confederation

FOrEWOrD

THE NHS HANDBOOK 2012/138

Who we areThe NHS Confederation represents all organisations that commission and provide NHS services.

We are the only membership body to bring together and speak on behalf of the whole of the NHS.

We have offices in England, Wales (the Welsh NHS Confederation) and Northern Ireland (Northern Ireland Confederation for Health and Social Care) and provide a subscription service for NHS organisations in Scotland.

What we doWe work with our members and health and social care partners to help the NHS guarantee high standards of care for patients and best value for taxpayers by:• making sense of the whole health system• influencing health policy• supporting our members to share and implement best practice• delivering industry-wide support functions such as the NHS Employers

organisation and the NHS European Office.

We represent the NHS as a whole and have a range of networks and forums to support our members on issues of specific concern to their part of the NHS.

Ambulance Service Network • Primary Care Trust Network • NHS Partners Network

• Mental Health Network • Community Health Services Forum

We also offer the opportunity for organisations working across the wider health and social care industry to be a part of the NHS Confederation as associate partners.

FurtherinformationTo find out more about the NHS Confederation, please visit our website atwww.nhsconfed.org

04 Policy and strategy: creating a ‘vision’ for the NHS

The planning framework 106

Equality and diversity 110


MakingandimplementingpolicyisakeystrandoftheDepartmentofHealth’swork,andduringagovernment’stermofofficeitwillpublishaplethoraofmajorpolicydocumentsdesignedtoimprovehealthandsocialcare,turningpoliticalvisionintoaction.

Policy and strategy are aimed both at the long term – for example, setting out a ‘vision’ of how the NHS might look in five or ten years’ time – the medium term, such as the three-year cycle of the NHS’s operational plans, and the short-term, such as the annual operating framework. And apart from initiatives specific to the health and social care system, the NHS is influenced by cross-government policy and strategy frameworks such as the spending review and structural reform plans.

The planning frameworkThe Government set its long-term strategy for public services in the 2010 spending review. It also decided the financial settlement for every government department and published structural reform plans that contain its priority outcomes for the spending review period. In turn, the DH published its priorities in its business plan, while the NHS operating framework outlines priorities for the health service over a three-year planning cycle.

Spending reviewsEvery government carries out a long-term and fundamental review of all its expenditure soon after coming to power. The spending review is a Treasury-led process to allocate resources across all departments, according to the Government’s priorities. Spending reviews set firm and fixed budgets over several years for each department. It is then up to departments to decide how best to manage and distribute this spending within their areas of responsibility. Before spending reviews were introduced in the 1990s, departmental budgets were set on a year-by-year basis, making multi-year planning more difficult.

The previous Labour Government held comprehensive spending reviews in 1998 and 2007. Following the coalition Government’s first Budget in June 2010, setting out the overall level of public spending until 2014/15, it announced details of its spending review in October 2010, fixing budgets for each government department for the four years to 2014/15. The NHS settlement is contained within the DH’s budget.

POlICy AND STrATEgy: CrEATINg A ‘VISION’ FOr THE NHS 107

Key text: Liberating the NHSTwo months after the coalition Government came to power it published its first health white paper, Equity and excellence: liberating the NHS, together with a suite of complementary documents. The white paper outlined the far-reaching structural reorganisation now underway (see chapter 1), reinforced the importance of the market in the NHS in England and announced that the DH’s role would be reduced. On its launch, Liberating the NHS was greeted as representing potentially the most significant change in the NHS’s history. It contained the promise: ‘In the next five years, the coalition Government will not produce another long-term plan for the NHS’.

Principles underlying the white paper include: • the Government is committed to an NHS available to all, free at the point

of use and based on need, not ability to pay• health spending will increase in real terms annually for five years• the Government’s vision for the NHS is rooted in the coalition’s ‘core

beliefs of freedom, fairness and responsibility’ • while the Government will be clear about what the NHS should do, it will

not stipulate how to do it • funding must be used efficiently: ‘the single greatest priority for the next

Parliament will be to reduce the deficit’.

It aimed to empower clinicians while rendering the NHS free from frequent and arbitrary political interference. Such was the scale of public and professional disquiet about the white paper that the Government held a ‘listening exercise’ led by the NHS Future Forum (see page 108) to consult on the changes as the Health and Social Care Bill was passing through Parliament. After some adjustment, the bill resumed its passage and has since become the Health and Social Care Act 2012.

Further information

Equity and excellence: liberating the NHS, DH, July 2010.

Liberating the NHS: legislative framework and next steps, DH, December 2010.


Key organisation: NHS Future ForumBy early 2011, concern among the public, healthcare professionals and MPs about the Government’s plans for reorganising the NHS led ministers to resume consultation on the proposals while the bill intended to make them law was still being considered by Parliament. The Secretary of State announced that the Government was ‘to take advantage of a natural break in the legislative process to pause, listen and reflect’.

The NHS Future Forum, a group of 45 senior professionals from health and social care, was set up to carry out an intensive eight-week ‘listening exercise’ during April and May. Its brief was to act as an independent advisory panel noting people’s concerns, reporting on what was heard and offering advice to the Prime Minister, Deputy Prime Minister and Secretary of State on how the plans might be improved.

Its four core themes were:• choice and competition• public accountability and patient involvement• clinical advice and leadership• education and training.

Forum members attended 250 events and heard opinions from over 8,000 people, including 250 organisations. The Government accepted its recommendations and altered the Health and Social Care Bill accordingly.The Government then asked the Forum to continue its conversations with patients, service users and professionals to provide independent advice on how to: • make information improve health, care and wellbeing • develop the healthcare workforce • ensure the reorganisation leads to better integration of services • ensure the public’s health remains at the heart of the NHS.

For this, the Forum held more than 300 events, which attracted 12,000 people. Once again, the Government accepted its recommendations.The Forum also influenced the 2012/13 NHS operating framework (see page 110).

Further information

Summary report on proposed changes to the NHS, NHS Future Forum, June 2011.

Government response to the NHS Future Forum report, DH, June 2011.

Summary report – second phase, NHS Future Forum, January 2012.


The scale of the deficit provided the main context for the 2010 spending review, prompting the Government to take radical action to limit public expenditure. However, to honour its commitment to protect health spending, the NHS budget is planned to increase by 0.4 per cent in real terms to 2014/15 (see page 168). The Chancellor’s Autumn Statement in 2011 implied that the NHS would not see higher spending for a long time, with current funding levels set to persist into the next Parliament.

Further information

Spending review 2010, HM Treasury, October 2010.

Autumn Statement 2011, HM Treasury, November 2011.

Structural reform plans Until the 2010 general election, the DH’s medium-term objectives were defined by its public service agreement (PSA) made with the Treasury. The coalition Government abolished PSAs, replacing them with structural reform plans (SRPs). The DH’s SRP is included in its business plan for 2011–15. Its five main priorities are to:• integrate health and care systems around the needs of patients and users• promote better health outcomes• revolutionise NHS accountability• promote public health• reform social care.

The DH also agreed four ‘major responsibilities’ to:• maintain performance on waiting times• run an efficient and effective department of state• help prepare for emergencies• devolve leadership of information technology development.

A monthly report on progress in meeting the SRP commitments appears on the DH website.

Further information

Business plan 2011–2015, DH, July 2011.

Department of Health annual report and accounts 2010–11, TSO, September 2011.

www.dh.gov.uk


NHS operating frameworkThe annual operating framework sets out the business and planning arrangements for the NHS for the coming year. The framework for 2012/13 describes the national priorities and system levers the NHS needs in order to change services while maintaining and improving quality and finance. It assigns four ‘key themes’ for all NHS organisations during the year:• putting patients at the centre of decision-making • completing the last year of transition to the new system • increasing the pace of the quality, innovation, productivity and

prevention (QIPP) challenge (see page 170)• maintaining and improving performance, including ensuring the NHS

Constitution right to treatment within 18 weeks is met.

Key areas for improvement are dementia and care of older people, carers support and military and veteran health. Allocations to primary care trusts will grow by at least 2.5 per cent in 2012/13, while the running cost of clinical commissioning groups will be £25 per head of population.

Further information

The operating framework for the NHS in England 2012/13, DH, November 2011.

Briefing 232: Operating framework for the NHS in England 2012/13, NHS Confederation,

December 2011.

Equality and diversityEliminating discrimination and disadvantage in the healthcare workforce and reducing health inequalities in the population are major policy aims of the DH and the NHS. Like all other public bodies, both have a legal duty to eliminate discrimination, harassment and victimisation, advance equality of opportunity and promote good community relations.

Equality Act 2010 The Equality Act 2010 outlaws discrimination on grounds of:• age • disability • gender reassignment • marriage and civil partnership • pregnancy and maternity • race • religion or belief • sex • sexual orientation.


The Act includes a new public sector equality duty, which demands equality issues be taken into account when developing policy. DH officials must analyse all available evidence to establish whether their policies or practices meet the aims of the public sector equality duty. Boards of NHS organisations are required to explicitly provide assurance, and disclose any non-compliance with equality legislation, through their annual statement on internal control.

The DH’s equality and human rights assurance group has set up a two-year transformation programme to develop a long-term cultural shift in the health and adult social care system with the aim of embedding equalities across policies, programmes and service delivery.

Further information

Briefing 74: The Equality Act 2010: employment implications for the NHS, NHS Employers,

October 2010.

NHS Equality and Diversity CouncilThe NHS Equality and Diversity Council (EDC), set up in 2009, has a strategic role to help the NHS comply with the Equality Act 2010, ensuring services and workplaces are fair and diverse, with equality of opportunity and treatment for all. Its vision is: ‘a personal, fair and diverse health and care service that draws the best from its communities and understands, respects and caters for all using and working within it’. Its aims are that:• services focus on improvements in health outcomes and experiences,

for all their community • services are held to account by their communities for responding to the

differing needs of all within them • talent flourishes, free of discrimination with everyone having fair

opportunities to progress • all staff feel their contributions are recognised and that they count as

part of their organisations • services are demonstrably compliant with statutory duties, in letter and

spirit, striving to go beyond these.

Membership includes representatives from the NHS, DH, trade unions, patient groups, regulators and voluntary sector.


Key text: NHS Constitution‘The NHS belongs to the people...’ The NHS Constitution, which applies only to the health service in England, comprises:• seven key principles that govern how the NHS operates, such as providing

a comprehensive service and value for money• rights and pledges to patients and the public about matters such as

access, quality, respect, choice and complaints• responsibilities that patients and public owe the NHS, such as keeping

appointments and treating staff with respect• staff rights concerning issues such as working environment, fair pay,

representation and equal treatment• staff responsibilities, including patient confidentiality and professional

accountability• six values, including respect and dignity, commitment to quality and

compassion.

The Constitution attempts a balance between the need for clarity and avoiding litigation, between enshrining enduring values and principles while ensuring the NHS has flexibility to change. The Health Act 2009 placed a duty on all NHS organisations, private and third sector providers in England to take account of the Constitution. By law the Government must renew the Constitution every ten years, so that changes cannot take place without debate.

In its Liberating the NHS white paper (see page 107) the coalition Government pledged: ‘We will uphold the NHS Constitution’, although it has introduced several changes:• NHS staff are expected to raise concerns about safety, malpractice or

wrongdoing at work that may affect patients, public, other staff or the organisation as soon as possible

• the NHS will support all staff who raise such concerns, responding to and investigating concerns

• highlighting the Constitution’s existing legal right for staff to raise such concerns without suffering any detriment.

Staff with concerns about patient care can call a free whistle-blowing helpline on 08000 724 725 weekdays between 8am and 6pm, with an out-of-hours answering service.


Equality Delivery System The EDC initiated the NHS Equality Delivery System. Launched in 2011, its purpose is to help the NHS deliver personal, fair and more diverse health services, and ensure staff from all backgrounds can thrive and develop. EDS is a framework tool that will enable NHS organisations to:• prioritise better access to screening and other services for disabled people• provide better primary care experiences for people from black and

minority ethnic backgrounds• ensure everyone, no matter what their sexual orientation or religious

beliefs, can talk in confidence to clinicians about their identity• make adjustments in the workplace for staff who need support in caring

for younger and older dependants.

EDS supports NHS organisations in meeting various equality requirements, including those of the public sector equality duty, the NHS Constitution and the NHS outcomes framework (see page 126).

Further information

The NHS Constitution for England, NHS, March 2012.

The handbook to the NHS Constitution for England, DH, March 2012.

The NHS Constitution and whistleblowing – consultation report: September 2011,

DH, October 2011.

NHS Handbook 2012/13 -Chapter 4

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