five new health strategies for pharma

7/31/2019 Five New Health Strategies for Pharma

1/13

AccountabilityQuestionsabouttheNHSReformsareaplentyfasttrackyourwaythroughkeydocumentsanddiscussionsonhow

governanceandaccountabilitycouldrollout

NEW

HEALTHSTRATEGIES

DrPaulZollinger-Read,TheKingsFundRodWhile,LutonClinicalCommissioningGroup

GeorginaCraig,NHSAllianceExecutive

5


2/13February 2012 3 New Health Strategies - Accountability

Editor: Sylvie WoottonJunior designer: Stefanie Hinkley

PMGroupMansard House, Church Road,Little Bookham, Surrey KT23 3JG UKTel: +44 (0)1372 414200Fax: +44 (0)1372 414201

2012 PMGroupAll rights reserved. No part of this publication maybe copied, reproduced, transmitted, photocopied,recorded or stored on any retrieval system withoutthe prior written consent of the publishers. Viewsexpressed by the contributors do not necessarilyrepresent those of the publisher, editor or staff.

4 Foreword

Emma Haselhurst, associate director,

Open Road

5-7 Introduction

Dr Paul Zollinger-Read,

medical adviser and lead onprimary care, The Kings Fund

8-10 Governance and accountability

in the new NHS

Rod While, head of strategy and service

improvement, Luton Clinical

Commissioning Group

11-13 Why great governance matters

Georgina Craig, NHS Alliance Executive,

co-lead patient and public involvement

network

New Health Strategies Accountability

Above, a short excerpt from Prime

Mininsters Questions, February 1, reflecting

the level of dissent over the NHS Reforms.

Some say, however, that it will be in the

rolling out of the sweeping changes

that it all unravels. One thing is for sure,

governance and accountability will be at

the heart of the new structure so what

form will they take?

http://www.youtube.com/watch?v=bXoHNm9yLvg


3/13New Health Strategies - Foreword 4 February 2012

Since the last edition, the anti-Reformistshave made their thoughts plain and clear

Andrew Lansley might have

been hoping for a reprieve

in the New Year. The Health

and Social Care Bill had survived

the expected challenges from the

House of Lords, and roars of dissent

seemed to have subsided into

murmurs of resigned acquiescence.

The Department of Health (DH)

had regained momentum once

again, giving us more detail on the

make-up of the NHS Commissioning

Board, the Public Health OutcomesFramework and the Commissioning

Outcomes Framework. The machinery

of Government was marching on.

But just these few weeks on, and

the engine is spluttering again. More

Royal Colleges followed the BMA into

full-throated opposition to the Bill.

Stephen Dorrell produced a fairly

damning report on the reformsimpact on the Nicholson challenge.

And the HSJ, BMJand Nursing Times

published a joint editorial for the

first time, lambasting the DH on its

botched communication and delivery

of the reforms.

All this, supported by Andy

Burnhams quietly effective Drop

the Bill campaign, has culminated in

the DH offering further concessions

over key crunch points. Amendments

Emma Haselhurstspecialises in public affairs and

stakeholder engagement programmes for clients

including Bristol-Myers Squibb, AstraZeneca and

Bayer Healthcare. She has also worked previously

with Janssen and the ABPI. Before joining Open

Road, Emma worked at Weber Shandwick, where

her clients included Abbott, Marie Curie Cancer

Care, the National Pharmacy Association and the

NHS Community Foundation Trusts.

Foreword

relating to accountability, health

inequalities and integration,among others, were tabled by the

Government in the last few weeks.

But this still wasnt enough to head off

the RCGPs decision to call for the Bill to

be scrapped. Its president, Clare Gerada,

has been building up to this moment

for months and has chosen the Bills

imminent return to the Lords to inflict

what she hopes will be a fatal blow.We should now keep an eye on

the NHS Confederation. A relatively

supportive voice to date, it will be

interesting to see if its support can

be relied upon now. Achieving Royal

Assent by April remains as uncertain

as its ever been.

the author

Emma Haselhurst

associate director, Open Road



introductionWe are in exciting times clinical commissioninggroups (CCGs) areemerging and developing to become

commissioning organisations. These

new organisations will be well placed

to improve the outcomes in the NHS.

However it is crucial that we now

spend some time reflecting upon how

we ensure the foundations of our new

organisations are secure. We have an

opportunity, not afforded to most,

to design supportive governance

structures that will help organisations

to safely discharge their duties.The word governance has a very

long history; it is derived from the

Greek verb to steer and can be traced

all the way back to Plato. Governance

initially developed as the ownership

and management of organisations

began to separate; consequently

systems started to evolve to ensure

that the interests of the owners wereprotected from detrimental managerial

actions.

All organisations are aware of the

need for sound governance, yet the long

shadows of governance failures have

all too frequently darkened corporate

history, be they in the banking, health or

industrial sector; sadly they are all too

prevalent.Much has been written on good

governance with one of the most

Paul Zollinger-Read, CBE, became a GP partner

at Braintree Essex in 1991 (to date), having

trained at Cambridge and Guys Hospital, London.

Following publication of the NHS White Paper he

was appointed the East of England SHA director,

responsible for implementation of GP commissioningand is involved in some of the national development

work on GP consortia, including authorisation and

the learning network. In February 2011, Paul was

made the medical adviser and lead on primary care

to The Kings Fund.

In the past Paul has led the Fund HoldingConsortium for Braintree, been chief executive of

the Braintree Care Trust for adult social care as well

as CEO of Chelmsford, North East Essex and Great

Yarmouth PCTs. In January 2010 he became chief

executive of NHS Cambridgeshire; and in July 2010,

of NHS Peterborough.

http://www.linkedin.com/pub/paul-

zollinger-read-cbe/15/704/96a


5/13New Health Strategies - Accountability 6 February 2012

important frameworks for the public

sector being the Nolan Principles [1].

These seven principles: selflessness,

integrity, objectivity, accountability,openness, honesty and leadership

describe how those of us in public

service should discharge our duties.

These are the seven values we

should espouse. Many will live by these

principles and we all recognise their

importance. However, how do we ensure

that these principles are replicated in

the way our organisations undertake

their business? It is crucial that such

an important part of our organisational

design is not left to chance.

Governance at the heart of anorganisations DNAClinicians have a deep understanding

of the importance of clinicalgovernance and this has been

developed immeasurably over recent

decades but the light of governance

must shine in all the areas of our work

be they corporate or clinical, or in the

management of information.

All too frequently governance is

mentioned as an afterthought, rather

than an organisational foundation.Governance is far more than a passive

noun and it must become part of our

organisational DNA.

The elements of effective

governance are multiple. Most

organisations start with the

development of a clear vision, enabling

the members of the organisation

and external partners to be clearlyaware of their direction. To deliver the

vision there needs to be a carefully

[2] The General Medical Councils

guidance on probity

[3] The National Association of Primary

Care/KPMGs Good Governance for Clinical

Commissioning Groups: An Introductory

Guide (December 2011), written by

members of The Kings Fund

http://www.gmc-uk.org/guidance/good_

medical_practice/probity.asp

http://www.kingsfund.org.uk/publications/

articles/napc_ccg_governance.html

[1] Link to the Committee on

Standards in Public Life website

www.public-standards.gov.uk



thought-out strategy, that is then

translated into a plan of action.

Assurance is a central part of

governance. This enables the

organisation to gauge if it is delivering

its strategy. The assurance process

must determine what the risks are,

be they service risks or financial risks

and enable the organisation to develop

plans to manage those risks, should

they arise.

Stewardship is an important aspect

of governance in order that there areeffective decision-making processes,

and protective checks and balances

to ensure the sound use of the

organisational resources.

Finally, it is crucial that the

organisation discharges its functions

within acceptable standards of

conduct and acts in an open and

transparent manner; it needs todemonstrate probity [2].

Governance is not merely confined

internally within an organsiation and

careful thought must given to how

effective structures can support

partnerships between different

organisations.

There is no one-size-fits-all; and

indeed governance must be more than

just a structure or a set of processes.

The principles of sound governance

Clinical commissioning groups will be well placed to

improve the outcomes in the NHS. We have an opportunity

not afforded to most organisations to designsupportive governance structures

must reside within the culture of the

organisation.

The issues surrounding governance

within the newly defined CCGs

were explored in detail in a recent

publication by The Kings Fund [3].

Additionally, the Good Governance

Institute [4] is a very useful resource

in these matters.

Sound organisational governance

will provide the foundation on which to

develop high-performing organisations

that are able to demonstrate goodstewardship of public money.

the author

Dr Paul Zollinger-Readmedical adviser and lead on

primary care, The Kings Fund

[4] Link to the Good

Governance Institute website

www.good-governance.org.uk



Up and down the land the great

and the good are wrestling

with some very basic issues

how does the new NHS fit together,

who are the decision makers, who

are they accountable to and where

does the power lie? I am supposed to

be an insider with knowledge at my

fingertips, coiled like a spring ready to

impart this knowledge to an industrydesperate to know what is going on. Let

me be honest with you. I have not met

anyone yet who has all the answers,

maybe you should ask Mr Lansley.

So if we in the NHS dont know, I

guess those of you in pharma could be

a tad confused right now.

Lets keep this simple. As a relative

NHS novice I am told by those incommissioning who were around when

PCTs first materialised that they were

supposed to utilise robust local data to

identify local health needs and respond

to those needs by commissioning the

right services for the local population.

The reality is somewhat different. Our

public health colleagues, working in

collaboration with local authorities,do indeed spend a great deal of time

and energy producing a magnificent

Rod has been at the Primary Care Trust,

NHS Luton since 2008. In his current role

he is responsible for strategy development,

operational planning, service improvement

and re-design, demand management and

coordinating decision-making processes around

major investments and disinvestments. Prior

to this, Rod spent more than 20 years in thepharmaceutical industry in a variety of sales

and senior marketing roles with Lundbeck,

Merck Serono and Cephalon.

Rod While

http://www.linkedin.com/

pub/rod-while/7/659/603

Governancein the New NHS

Accountabilityand



Health and Wellbeing Boards will be accountable to local

communities and that in essence is what will give them

the power. CCGs will not be allowed to do their own thing

document called the Joint Strategic

Needs Assessment (JSNA) which tells

us what these key local health needs

are and recommends services that

need to be implemented or improved

to address the local issues.

What happens in reality is that we

pretty much ignore all of this because

the DH via the Strategic Health

Authorities (SHA) tells us exactly whatservices we should commission, how

we should commission them, and what

targets and outcomes we are going to

be performance-managed against.

Integration via the Health andWellbeing BoardsThe NHS is very centre driven. PCTs

are currently accountable to SHAs,the Care Quality Commission (CQC)

and to a small extent local people via

Local Involvement Networks (LINKs)

and Overview and Scrutiny Committees

(OSC). Local government however

works differently; it is primarily

accountable to local people to deliver

what matters to the local electorate.

For the future, there is a master planwhich to me is understandable and,

even more surprisingly, makes sense.

Enter the Health and Wellbeing Boards,

hosted by local authorities, populated

by elected councillors, lay people,

clinicians and senior managers.

Health and Wellbeing Boards are

currently developing their strategies

that will essentially take the local

JSNA and turn it into a clear set of

expectations of local commissioners. [1]

The Boards will most likely driveforward the integration of services

across health, social care and

beyond, so that local people can

expect joined-up, seamless services

through the pooling of budgets and

integrated workforces.

[1] Operating Principles for Health and

Wellbeing Boards (published October 2011)

http://www.local.gov.uk/c/document_library/get_

file?uuid=c40f27d7-7208-4dc1-9120-fa5fd67e52

53&groupId=10161



the author

Rod While

head of strategy and service improvement,Luton Clinical Commissioning Group

[3] NICEs Consultation on potentialCommissioning Outcomes Framework(COF) indicators. (Consultation datesFebruary 1-29, 2012)

http://www.nice.org.uk/media/2F5/CF/

NICECOFIndicatorConsultationDocument.pdf

If Health and Wellbeing Boards

emerge with the genuine ability to

hold commissioners of all services to

account, they give us the opportunityto begin to tackle some of the wider

determinants of health, such as the

environment, unemployment, housing

and family poverty.

Health and Wellbeing Boards will be

accountable to local communities and

that in essence is what will give them

the power. CCGs will not be allowed

to do their own thing: they will be

effectively answerable to the man in

the street.

But (there is always a but), there

is a new beast on the horizon called

the NHS Commissioning Board [2]

which will pick up a SHA-type role;

performance managing CCGs using

well over 100 nationally mandatedindicators [3]. This will leave CCGs

caught between two masters placing

potentially conflicting demands

on health commissioners. Let the

juggling commence.

So where does this leave those in

pharma? Possibly relieved that they

arent the only people who dont know

whats going on? The key word for meis localism. The Coalition Government

is committed to devolving the power

to localities. The top-down imperatives

wont go away but remember the mantra

from the NHS White Paper no decision

about me without me? Local people and

communities should have more influence

on local health services and treatments.

So get to know them, be part of them andget your hands dirty.

[2] Creating Responsive and AccountableClinical Commissioning Groups (NHSCommissioning Board February 2012)

https://www.gpc.eoe.nhs.uk/downloadFile.

php?doc_url=1327917168_qVHB_towards_

establishment_-_final_feb_12.pdf

Towards establishment:

Creating responsive andaccountable clinicalcommissioning groups



I

understand that governance is

important especially within the

NHS where we are dealing with

public money but I guess I have been

turned off by the fact that in the NHS

it often seems disconnected from

what I see as the core task caring

for people. It feels as if it has been

reduced to a tick-box exercise, and

that the process poses more obstacles

than it supports change happening.

That is why I was so struck by apresentation on governance I heard at

The NHS Alliance Conference last year.

It really resonated. So I made a mental

note to refocus on the subject.

Darren Thorne from The Good

Governance Institute (see link page 7)

opened by asking delegates to identify

their touchstone the thing that

keeps you going on the bad days. Heexplained that this touchstone should

be an organisations starting point when

designing great governance that drives

the right behaviours.

It makes so much sense. Yet, that

touchstone question stopped me in

my tracks when I reflected on the

NHS organisations I am familiar with.

For many, the main focus of theirgovernance seems to be financial

balance with maybe a little bit of

governance matters

Georgina is a member of the NHS Alliance

Executive; leads on pharmacy commissioning and

is co-lead of the patient and public involvementnetwork. Georgina runs her own healthcare

consultancy and recently completed a DH-funded

pilot of a new approach to clinical commissioning

called experience led commissioning. She also

works with the University of Oxford to turn

patient insights into commissioning data for

clinical commissioning groups.

Georgina Craig

http://uk.linkedin.com/in/

georginacraig

Why great



quality thrown in. The patient is

nowhere to be seen.

All of a sudden, it became really clear

to me why clinicians and managers inthe old system so often failed to identify

any common ground and why the

public often feels disconnected from the

NHS. Their touchstones are different.

An opportunity foran enabling cultureClinical commissioning groups freedom

to redesign governance suddenly

seemed like a golden opportunity

to get it right and identify a shared

touchstone. Great governance could

potentially unite everyone. A shared

focus across the system and within

governance on the person would be

a paradigm shift. It would influence

culture and drive different decisionmaking behaviour.

Clinical commissioning groups (CCGs)

have considerable freedom to define

their governance. Sadly, thus far, the

mantle of learnt behaviour is yet to be

shed. Most have focused first on their

organisational form and committee

structure rather than asking the more

fundamental touchstone question;although there are some notable

exceptions such as Principia Rushcliffe

CCG [1] and Sandwell and West

Birmingham CCG [2].

Dr John Bullivant, chair of the Good

Governance Institute said in a feature

for The Guardian [3] recently: As part

of this evolution to good governance,

some new CCGs are seeking to designsystems built around purpose and task

rather than adopting traditional NHS

[1] Link to Principia CCG

http://www.principia.nhs.uk/about-us

http://westminsterresearch.wmin.ac.uk/10257/

EVALUATION OF THE EXPERIENCELED COMMISSIONING FOREND OF LIFE CARE PROJECT

ANNA CHESHIRE AND DAMIEN RIDGE

RIGOUR

RESEARCH

RESULTS

[2] Link to research Healthworks (nowpart of Sandwell and West BirminghamCCG) has done on experience-ledcommissioning in end of life care

[3] Better governance key to making NHS

reforms work an article in The Guardian,January 25 2012, by John Bullivant, chair

of the Good Governance Institute

http://www.guardian.co.uk/healthcare-network/2012/

jan/25/better-governance-nhs-reforms-work



committee and reporting systems. We

applaud this approach.

Now that times are lean and

management budgets slashed by 40

per cent, we need a wide-ranging

debate about good governance the

process and principles. Does good

governance mean that every decision

over a set financial limit needs to be

approved by the CCG Board? Or does

good governance mean putting a

process in place that is proportionate

to the task and relative risk; enables

good decisions and a timely response;

protects corporate reputation, and

engages public confidence?The big win would be to harness

governance to drive an enabling culture

where organisations find collaboration

easy because they are united in a

common purpose where people matter

most. Achieving this would see many

of the current barriers to integration

and partnership-working fall away

as managers, clinicians, and thepharmaceutical industry united with the

local community around the needs of

the person.

Great governance would also help

commissioners be fully effective and

enable them to delegate responsibility

for achieving outcomes. Commissioners

will only ever be the conductors.

Providers are the musicians. Unless

commissioners delegate to providers,

backed by good governance

arrangements, they will end up being

held to account for things they cannot

possibly influence. When success is

dependent on improving quality and

outcomes, governance is rarely going

to be about what to do (which is

prescribed by National Standards) and

always about explaining how decisions

were made.

Governance, person-centredcare and value-basedYou could argue that the proposed

move towards value-based pricing is

part of this agenda too. After all, when

a pharmaceutical product is prescribed,the supplier is entering into a contract

whose implicit message is, if you treat

this person with this medicine, their

health will improve. If the product fails

to deliver, what does that mean?

Presenting the value of medicines in

terms of cost-effectiveness, safety and

patient experience, offers a platform

for the industry to engage in a differentdebate, where delivering person-centred

care is the touchstone that matters

most and that would be a great

shared focus to keep us all moving in

the same direction through the tough

times ahead.

the authorGeorgina Craig

NHS Alliance Executive, co-lead patient

and public involvement network

Achieving an enabling culture would see many of the current

barriers to integration and partnership-working fall away


13/13

Phone: 0870 850 1234

[email protected]

www.asheldin2focus.com

The Asheld Group Asheld House

Resolution Road Ashby de la Zouch

Leicestershire LE65 1HW

Going the extra mile for our clients...

five new health strategies for pharma

Documents