healthier horizons the white paper and its implications city university london 7 december 2010

Healthier Horizons

The White Paper and its implicationsCity University London

7 December 2010

Better Care Better Health Better Life

• White Paper – where we are

now

• Approaching implementation

• Keys to success

• Next steps – walking the talk


“In 2009 most managers and

doctors, given a chance to

brainstorm ideas about how to

improve the NHS, would have

proposed the changes

proposed by the White Paper”


But failure is not an option for us or the people of

England


Keys to Success (1)

• Managing the Transition

• Good timing and choreography/ synchronising the old and the new

- Commissioning

- Provision

- Public Health/LA relationship

- Patient Revolution


Transition Architecture NHS Management Board

Mike Farrar Bridge

Jane Cummings

Mark Ogden

• NCB• Day to day management• QIPP

Commissioning Development

Board

? Provider Development Board

Provider Development Director

Caroline Shaw

Provider Board

• TCS• FT Pipeline• Healthcare Groups

Commissioning Development

Director

Joe Rafferty

PCT CEOs GPs

• Consortia Facilitation• Leadership Development• Commissioning Business Support • National Commissioning Board

Public Health

Ruth Hussey

LAs PCTs

• Health and Wellbeing Boards• Joint Commissioning• Strategic Planning

Choreography, Coherence and

Synchronisation


Emerging Architecture NCB - Shadow Special HA 1/4/2011

(subregional elements?)

- Chair/CEO appointments Sept-October

2011

Consortia - Formal Pathfinders Jan 2011

- Authorisation from 2012 onwards

Provider - Transforming Community Services by

April 2011

- Foundation Trusts by 2013

- (Special HA running non FT group

2012-14?)


There are three main pillars of the national commissioning development programme, overseen by Dame Barbara Hakin

National Commissioning

Development Programme

General practice-led

commissioning

NationalCommissioning

Board

Commissioningsupport


Pathfinders

Commissioning support

PCT facilitation

Local authorityliaison

PCT transition

GP commissioningdevelopment programme


Provider Development

• Radical changes and developments for all providers moving to a market orientated system

• Competition is exercised by any willing provider• Variety of public, not for profit and private

provision• Voluntary and independent sector providing care• Encouragement of a social enterprise model to

encourage greater engagement and innovation


• All NHS hospitals and other providers FT’s by 2013• Monitor established as “economic regulator”• - promotes competition and apply competition

law

- sets prices

- power to intervene• Patients to have more choice, more information to

empower the public• Providers will have to react to a different commissioning

landscape• Robust transition plans in place for the SHA


LA/Public Health

• Much more than Health and Wellbeing (but key legacy issue)

• Strategic Commissioning

• Social Care- Adults and children/TCS provision

• Shared logistical support

• Community development

• Joint commissioning


Local Government / Public Health and the NHS

• Public Health White paper due soon – published for consultation

• Transfer of resource and responsibility for Public Health to Local Government an opportunity to transform local govt and actions on health outcomes (includes health protection, health improvement and strategic planning with NHS)

• Public Health grant (ring fenced) to LG confirmed in CSR


NHS Prevention spend Audit 09/10 by PCT

Note: spend includes clinical prevention services e.g. maternity, children, dental etc

£473.3 million spent in NW on prevention activities, which on average, represents 4.04% of recurrent baseline allocation.


Place based approach

Development of Health and Wellbeing Boards– Issues raised by Local Government

• Generally positive and already moving• The scope of Health and Well Being Boards• Relationship with GP consortia / co-terminosity• Accountability and the relationship with National Board• Separation of scrutiny and executive function• The boundaries of place – local to city / sub region• NHS and placed based budgeting

Separate Outcome Frameworks proposed for – Public Health– Social Care – NHS


Patient Revolution – turning rhetoric into reality

“because saying it, or promising it, doesn’t necessarily make it so………..”

“and no one tries to provide poor quality services deliberately……”


• Turning rhetoric into reality won’t happen by chance

• Quality improvement benefits from a systematic approach (at organisational level and at a ‘system level’) …… will the market be sufficient?

• Patient Experience is an essential driver but is not straightforward and needs to be nurtured intelligently

• There are babies in the bathwater


Creating the Climate for success

Context Courage

Inspiration

Engagement of staff

Compelling business case

Structured Support

Intelligent analysis and data

management

Alignment of the incentives

Investment

Engagement of Patients

AQuA

Leadership Academy

Inspiration North West


Patient Experience as the key driver…….

• Score vs expectation • Local trumps all • Lack of comparable data (Quality Accounts)• Quality ‘minefield’ (HSMR)• Understanding the language of quality• Creating a ‘patient friendly’ approach • Patient education and patient coaching• Outcomes and processes


Keys to Success (2)

• Stable financial platform

• QIPP

Better Care Better Health Better LifeBetter Care Better Health Better Life

Month 5 ActivityNHS North West

Activity Monitoring

66

23

84

38

95

65

10

51

94

9

92

21

91

10

26

58

31

97

81

42

24

39

34

32

91

64

50

96

38

60

89

10

31

18

5

90

29

99

99

08

4

30

77

94

40

68

78

34

61

39

69

93

23

42

05

17

11

19

84

0

98

32

21

10

04

38

33

47

02

43

51

40

36

17

24

0

200000

400000

600000

800000

1000000

1200000

GP

re

ferr

als

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r firs

t G

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irst

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lective

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Planned Activity Previous Year Actual Activity

August 10

NHS NORTH WEST

Cumulative

Back

Better Care Better Health Better LifeBetter Care Better Health Better Life

Month 5 Workforce - Full time equivalent Movement From Sept 08

All - % FTE Change from Sep-08

-2.0

0.0

2.0

4.0

6.0

8.0

10.0

Sep-

08

Oct-0

8

Nov-

08

Dec-

08

Jan-

09

Feb-

09

Mar

-09

Apr-0

9

May

-09

Jun-

09

Jul-0

9

Aug-

09

Sep-

09

Oct-0

9

Nov-

09

Dec-

09

Jan-

10

Feb-

10

Mar

-10

Apr-1

0

May

-10

Jun-

10

Jul-1

0

Aug-

10

%

North West

PCT

Acute

Mental Health

FT

Non-FT


Keys to Success (3)

• Imagining the future and behaving well

• Minding the gap between power and statutory authority

• Shortcutting the immaturity of behaviours and new systems


Keys to Success (4)

• Building resilience and protecting the legacy

“differentiating the baby from the bathwater”………


Resilence and Legacy• Clustering• Forward financial commitments

- PFI- LIFT

• Healthcare Groups• Improvement Support • Commissioning Support Services (WCC best of

the best)• Social Value


Walking the Talk

• Collective action/agreement

• Flexibility in the leadership teams

• Communication/communication/

communication• Overarching binding principles


• Keeping our shape

• Making best use of set pieces

• Maintaining our fitness

• Team spirit

• Smart substitution

• Desire to win

healthier horizons the white paper and its implications city university london 7 december 2010

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