Role of NHS England in
protecting and maintaining
patient/service user dignity
Arden, Herefordshire &
Worcestershire Area Team
Introduction:
In April 2012, the Health and Social Care Bill passed its final hurdle. At the heart of the
reforms were a radical restructuring of the health service in England, which came into
beginning on 1st April 2013
http://vimeo.com/69224754 , explains the new structures within the NHS. The key
message is that Health is not one organisation, rather it is made up of those who
commission (buy) services, those that provide services and those that monitor services.
Diagram 1 shows how those different organisations fit together.
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PARLIAMENT
Secretary of State and Department of Health
Healthcare, Public Health, Adult Social Care
Policy
Mandate Outcomes Framework
Framework Agreement
Outcome Framework
NHS England
Local Authorities
Public Health
Adult Social care
Local
Accountability
Health and Wellbeing
Board
Local
Accountability
Clinical Commissioning
Groups NHS Care
Framework Agreement
Regulation
Monitor
Regulation
3
Eg. Equality and
Diversity Council
Clinical Senates and
Networks
C
o
n
t
r
a
c
t
s
Framework Agreement
Care Quality
Commission
Advise
Challenge
Regulation
Providers
NHS Trusts, PTI’s and other
providers (VCS, Private
Sector)
CCG’s
• In general, CCGs are responsible for
commissioning health services to meet all the
reasonable requirements of patient care, with the
exception of:
• Certain services commissioned directly by NHS
England
• Health improvement services commissioned by
local authorities
• Health protection and promotion services
provided by Public Health England
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NHS England
NHS England is a commissioning organisation. Its
key functions are:
• Direct commissioning,
• Supporting and assuring CCGs, and
• Managing relationships with local stakeholders.
• The NHS England is a single organisation, one national Board.
There are different layers to NHS England but they act as one
entity.
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• There are National teams who lead of England wide initiatives as
well as supporting the Area teams.
• There are four Regions who operate as part of the national
Operations Directorate, supporting the delivery of key business
processes.
• There are 27 Local Area Teams who carry out the above key
functions. Direct commissioning includes GPs, Optometrists,
Dentists, Pharmacists. It also includes some parts of Public health
such as screening and health visiting.
• In addition, there are some highly Specialised Commissioning
Teams for high cost, low demand services. These teams work on
behalf of the several Area teams.
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The role of Area Teams in
Safeguarding:
• The Area Team has two distinct roles. It holds the CCGs to
account for their Commissioning but also commissions itself.
The region and national teams hold the Area team
accountable for the Direct Commissioning. This is reflected
in the overarching duties for safeguarding:
• The NHS England Regional and Area Teams will each have a
Director of Nursing who is responsible for supporting and providing
assurance on the safeguarding of children and adults at risk of
abuse or neglect.
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Role (2)
• The Area Team are statutorily responsible for ensuring that the
organisations from which they commission services provide a safe
system that safeguards children and adults at risk of abuse or
neglect. This includes responsibilities for looked after children and
for supporting the Child Death Overview process, to include
sudden unexpected death in childhood. Local authorities have the
same responsibilities in relation to the public health services that
they commission.
• The Area Team have a statutory duty to be members of Local
Safeguarding Children Boards (LSCBs) and are expected to be
fully engaged with local Safeguarding Adults Boards (SABs).
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Role (3)
• The Area Team should ensure that robust processes are in place to
learn lessons from cases where children or adults die or are seriously
harmed and abuse or neglect is suspected. This will include
contributing fully to Serious Case Reviews (SCRs) and also, where
appropriate, conducting individual management reviews.
• The Area Team is responsible for ensuring that the health
commissioning system as a whole is working effectively to safeguard
and improve the outcomes for children and adults at risk and their
families. It provides oversight and assurance of CCG safeguarding
arrangements and supports CCGs in meeting their responsibilities.
This includes working with the Care Quality Commission (CQC),
professional regulatory bodies and other national partners.
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Role (4)
• The Area Team and CCGs will work closely together, and, with
local authorities, LSCBs and SABs, to ensure there are effective
NHS safeguarding arrangements across each local health
community, whilst at the same time ensuring absolute clarity about
the underlying statutory responsibilities that each commissioner
has for the services that they commission, together with a clear
leadership and oversight role for the Area Team.
• The Area Team needs to have the capacity to develop it’s
safeguarding responsibilities and support CCGs. CCGs may wish
to approach their Area Team for additional advice.
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Secondary care assurance
• QSG
• Contract monitoring
• Dashboard
• Training compliance
• Safeguarding forum
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Primary care assurance
• Training
• Designated nurse and named doctor
• Safeguarding lead in each practice
• PLDP processes
• Complaints
• FFT
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