This is a very brief overview of the Health and
Social Care Act 2012 and related policy changes:
North of England
Mental Health Development Unit
Health and Social Care Act 2012
Commissioning
for Patients
Regulating
Healthcare
providers
Local
Democratic
Legitimacy in
health
The review of
arms length
bodies
Transparency in
outcomes: a framework
for the NHS
The Health and Social Care Bill received Royal Assent on 27 March 2012, to become the Health
and Social Care Act 2012.
Please note: rather than a traditional power point presentation this document is a visual
adaptation of the Act and its supporting documents and how they are linked together.
To use the document simply use slide two as your home page throughout, using your mouse
to click on each of the light blue highlighted words to take you to a page with a little more
information on that topic or organisation.
From each information page, simply click your mouse on the Back to home box to return to the
diagram on slide two. If you are just using a print out each box in the diagram on page two has a
number in it referring the page where you can find a little more information on that topic.
N.B. This is an interpretation by NEMHDU of the Act and is not a substitute for reading the
Act and supporting documents in full – active web links to documents can be found at the
end of each topic. This document does not cover proposals for the NHS Trust
Development Authority or Health Education England.
PJ-MJ/April 2012/Version 5
1
Secretary of state
NHS Outcomes Framework 3
Public Health Outcomes framework 5
Adult Social Care Outcomes Framework 7
Overlapping frameworks diagram can be found on page 8
NHS
Commissioning
board 10
NICE 9
Public
Health
England 12
CQC 13
Health
Watch
England 14
Monitor
15
Office of Fair
Trading 16
Commissioning outcomes framework 17
National and
Regional Specialist
Commissioning 18
Commissioning
Support
Services 20
Clinical
Commissio
ning groups
Health &
Wellbeing
Boards 27
Local
Authority
21
Public
Health 22
Local
Health
Watch
24
Foundation
Trusts
29
19
JSNA + Joint
Health and
Wellbeing
Strategy 28
Independent sector
Patients carers and the public
2
The NHS Outcomes Framework 2012/13
The NHS Outcomes Framework sets out the outcomes and corresponding indicators
that will be used to hold the NHS Commissioning Board to account for the
outcomes it secures through its oversight of the commissioning of health services
from 2012/13. The indicators used to hold NHS organisations to account during
2011/12 were set out in The Operating Framework for the NHS in England in 2011/12
which provided the financial, business and planning rules that support the delivery of
NHS priorities.
•
For 2011/12, where data was available, this was used to identify baselines. 2011/12
was also used to negotiate levels of ambition with the shadow NHS Commissioning
Board, in light of the NHS settlement following the 2010 Spending Review.
•
In 2012/13, the framework will be used by the Secretary of State for Health to hold
the NHS Commissioning Board to account and for achieving levels of ambition where
they have been agreed. The Framework will also support the integration of NHS,
public health and adult social care outcomes.
Continued on next page
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NHS Outcomes Framework continued...
The NHS outcomes framework is made up of five domains and the following diagram illustrates how
each domain influences the NHS quality improvement system
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Preventing
people from
dying
prematurely
Enhancing
quality of life for
people with
long term
conditions
Helping people
to recover from
episodes of ill
health or
following injury
Ensuring that
people have a
positive
experience of
care
Treating and caring
for people in a safe
environment and
protecting them from
avoidable harm
NICE Quality Standards
(Building a library of approx 150 over 5 years)
Commissioning
Outcomes
Framework
Commissioning
Guidance
Provider payment mechanisms
tariff
Standard contract
CQUIN
QOF
Commissioning/Contracting
NHS Commissioning Board – certain specialist services and primary care
Clinical Commissioning Groups – all other healthcare services
NHS Outcomes Framework information taken from: The NHS Outcomes Framework 2012/13
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131724.pdf
4
Public Health Outcomes Framework for England, 2013-2016
The new public health outcomes framework “Health Lives, Healthy People: improving
outcomes and supporting transparency” is in three parts:
•
Part 1 introduces the overarching vision for public health, the outcomes, and the
indicators that will help us understand how well we are improving and protecting
health.
•
Part 2 specifies all the technical details the DH can currently supply for each public
health indicator and indicates where they will conduct further work to fully specify all
indicators.
•
Part 3 consists of the impact assessment and equalities impact assessment.
The Outcomes Framework details two high level outcomes and four domains, which are
shown on the following page.
Continued on next page
Information taken from: Healthy Lives, Healthy People: Improving outcomes and supporting transparency
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132358
5
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Public Health Outcomes Framework continued…
Outcomes
Vision: To improve and protect the nation's health and wellbeing, and improve the health of the poorest fastest.
Outcome 1: Increased healthy life expectancy
Taking account of the health quality as well as the length of life
(note: this measure uses a self-reported health assessment, applied to life expectancy)
Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities
Through greater improvements in more disadvantaged communities
(Note: these two measures would work as a package covering both morbidity and mortality, addressing withinarea differences and between area differences)
Domains
DOMAIN 1:
DOMAIN 2:
DOMAIN 3:
DOMAIN 4:
Improving the wider
determinants of health.
Health improvement
Health protection
Healthcare public health
and preventing premature
mortality
Objective:
Improvements against
wider factors that affect
health and wellbeing, and
health inequalities.
Objective:
People are helped to live
healthy lifestyles, make
healthy choices and reduce
health inequalities.
Objective:
The population's health is
protected from major
incidents and other
threats, while reducing
health inequalities.
Indicators - across the life
course
Indicators - across the life
course
Indicators - across the life
course
Objective:
Reduced numbers of
people living with
preventable ill health and
people dying prematurely,
while reducing the gap
between communities.
Indicators - across the life
course
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Transparency in outcomes: a framework for adult social care
The adult social care outcomes framework sets out agreed outcome measures in four
domains:
1.
2.
3.
4.
Enhancing quality of life for people with care and support needs
Delaying and reducing the need for care and support
Ensuring that people have a positive experience of care and support
Safeguarding adults whose circumstances make them vulnerable and protecting from
avoidable harm
These outcomes, combined with other resources such as the Adult Social Care Survey,
will inform the ‘local account’, which is a new way for councils and local communities to
have a more detailed and meaningful dialogue. The local account will replace previous
annual publications by the Care Quality Commission.
To further support the closer alignment of the ASCOF with the NHS Outcomes
Framework and the Public Health Outcomes Framework, in future years, the ASCOF will
be published in the autumn of the preceding year, beginning with the publication of the
2013/14 framework in autumn 2012.
View overlapping outcome frameworks diagram
Information taken from: Transparency in outcomes; a framework for quality in adult social care
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133335.pdf
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The three overlapping frameworks for the NHS, public health and adult social care services
Public Health
Adult Social Care and
Public Health
NHS and Public Health
Preventing ill health and lifestyle
diseases and tackling their
determinants.
Maintaining good health and
wellbeing. Preventing
avoidable ill health or injury,
including through reablement
or intermediate care services
and early intervention.
Adult Social Care and
NHS
Adult Social Care
NHS
Adult Social Care, NHS and Public Health
Supported discharge from
NHS to social care.
Impact of reablement or
intermediate care
services on reducing
repeat emergency
admissions. Supporting
carers and involving in
care planning.
The focus of Joint Strategic Needs Assessment: shared
local health and wellbeing issues for joint approaches.
Information taken from: Healthy Lives, Healthy People: Transparency in outcomes; proposals for a public health
outcomes framework – a consultation document
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_123113.pdf
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National Institute for Health and Clinical Excellence (NICE)
•
NICE is to be given greater autonomy to serve patients and professionals through the
provision of clinical advice and information.
•
Commissioners will draw from the NICE library of standards as they commission
care. Clinical commissioning groups and providers will agree local priorities for
implementation each year, taking account of the NHS Outcomes Framework. NICE
quality standards will be reflected in commissioning contracts and financial incentives.
Together with essential regulatory standards, these will provide the national
consistency that patients expect from their National Health Service.
•
Progress on outcomes will be supported by quality standards. These will be
developed for the NHS Commissioning Board by NICE, who will develop authoritative
standards setting out each part of the patient pathway, and indicators for each step.
In March 2012, the Department of Health referred a library of quality standard topics
to NICE for development.
Information on NICE quality standards can be found at:
http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp
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Role of the NHS Commissioning Board
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The NHS Commissioning Board will be established as an independent body, at arms
length to the Government, by October 2012. Initially, it will carry out limited functions such
as establishing and authorising Clinical Commissioning Groups.
The Board will take on its full range of responsibilities, and the new commissioning
system will begin to operate, once it is fully established from April 2013. The Board will
develop:
•
A framework that provides clarity about the outcomes for which clinical commissioning groups
(CCGs) are accountable and the resources available to them;
•
A range of tools to support effective commissioning, but which CCGs can adapt to reflect local
needs – including commissioning guidance, model pathways, and standard contracts – supported
by the best available evidence on how to secure improvements in quality, productivity and health
outcomes;
•
A continuing programme to help CCGs understand their strengths and be aware of areas that need
improvement, along with appropriate development opportunities to address their needs;
•
A robust system of authorisation to ensure that CCGs take on commissioning and budgetary
responsibilities at the right pace, together with ongoing assurance based on the outcomes that
they are achieving for patients; and
•
A transparent and rules-based approach that enables the Board to intervene to support CCGs that
are in difficulty, whilst promoting autonomy and allowing successful commissioners freedom to
innovate.
Continued on next page
NHS Commissioning Board information taken from: Developing the NHS Commissioning Board
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128196.pdf
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NHS Commissioning Board – continued...
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Key frameworks to deliver the work of the NHS Commissioning Board
Secretary of State for
Health
National
mandate
NHS Commissioning Board
NHS Outcomes Framework
• Leadership for clinical improvement
• Improvement for strategies and model
• Quality Standards/NICE
Accountability framework
• Finance and allocations
• Planning and oversight
• Authorisation & assurance
Choice framework
• Choice offer
• Contract design/development
• Tariff design/pricing (with
Monitor)
Emergency planning
framework
Clinical commissioning groups and national and local strategic partners
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Public Health England
Public Health England will be created in 2012, taking on full responsibilities from 2013. Public Health
England will be established as an Executive Agency, within a structure accountable to the Secretary of
State for Health, and bringing together the functions of the current:
•
•
•
•
•
•
Health Protection Agency
National Treatment Agency for Substance Misuse
Regional Directors of Public Health and their teams in DH and SHAs
Regional and specialist Public Health Observatories
Cancer Registries and the National Cancer Intelligence Network
National Screening Committee and Cancer Screening Programmes.
Public Health England is part of the Government’s proposals to develop a radical new approach that
will empower local communities, enable professional freedoms and unleash new ideas based on the
evidence of what works, while ensuring that the country remains resilient to and mitigates against
current and future health threats.
Public Health England will:
• bring together a fragmented system
• do nationally what needs to be done
• have a new protected public health budget
• support local action through funding and the provision of evidence, data and professional leadership.
Information taken from: Healthy Lives, Healthy People: Our strategy for public health in England
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122347.pdf
And Healthy Lives, Healthy People: Update and Way Forward (July 2011)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128120
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Care Quality Commission
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•
The Care Quality Commission inspects providers against essential levels of safety
and quality in a targeted and risk-based way, taking into account information it
receives about a provider. This information will come through a range of sources
including patient feedback and complaints, HealthWatch England, Clinical
Commissioning Groups and the NHS Commissioning Board. Where inspection
reveals that a provider is not meeting essential levels of safety and quality, the Care
Quality Commission will take enforcement action to bring about improvement.
•
In relation to the, NHS the Care Quality Commission (CQC) will, together with
Monitor, operate a joint licensing regime. The Care Quality Commission and Monitor
already have a duty of co-operation in primary legislation to work closely together to
ensure that the regulatory burden of multiple licences is reduced, whilst ensuring
robust and proportionate regulation. Under the Health and Social Care Act 2012, the
CQC also has a duty to co-operate with the NHS Commissioning Board, NICE, the
Health and Social Care Information Centre and Special Health Authorities.
•
HealthWatch England, a new independent consumer champion from October 2012,
which will be an advocate for patients’ rights and concerns, will be constituted as a
statutory committee of the Care Quality Commission and will enjoy the benefits of the
Care Quality Commission’s independence and scale of operations, including avoiding
duplicating work on the assessment of public opinions on health and care issues.
CQC information taken from: Liberating the NHS: Legislative Framework & Next Steps + Health & Social Care Act 2012
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122707.pdf
http://www.legislation.gov.uk/ukpga/2012/7/pdfs/ukpga_20120007_en.pdf
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HealthWatch England
HealthWatch England will be established in October 2012 as the new consumer
champion for health and adult social care in England. For the first time this will clearly
provide a platform for making the NHS and local government accountable to their local
communities, people using care and carers to have their voices heard at a local and
national level.
HealthWatch England will have three main functions:
1. It will provide leadership, guidance and support to local HealthWatch organisations.
2. It will be able to escalate concerns about health and social care services raised by
local HealthWatch to CQC. CQC will be required to respond to advice from its
HealthWatch England subcommittee.
3. It will provide advice to the Secretary of State, NHS Commissioning Board, Monitor
and the English local authorities, and they are required to respond to that advice. The
Secretary of State for Health will be required to consult HealthWatch England on the
mandate for the NHS Commissioning Board.
HealthWatch information taken from: Preparing for Healthwatch – CQCs plan to set up Healthwatch England
http://www.cqc.org.uk/sites/default/files/media/documents/preparing_for_healthwatch.pdf
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Monitor
Under the Health and Social Care Act 2012 Monitor will become the sector regulator for
health. Monitor’s core duty will be to protect and promote patients' interests. Monitor’s
main functions, as described in the Health and Social Care Act (2012), are:
Regulating Prices
The Government has announced that Monitor will take on responsibility for pricing, working together
with the NHS Commissioning Board.
Enabling integrated care and preventing anti-competitive behaviour
Monitor will have a duty to consider how it can enable or facilitate integrated care, alongside ensuring
that competition is fair and that it operates in the interests of patients.
Supporting service continuity
Monitor would support commissioners to ensure that patients could continue to access the care that
they need if a healthcare provider fails.
Licensing Providers
In carrying out its sector regulator role, Monitor will license providers of NHS services in England.
Assessing and regulating NHS Foundation Trusts
Under the Health and Social Care Act (2012) Monitor will have a continuing role in assessing NHS
trusts for foundation trust status, and for ensuring that foundation trusts are financially viable and wellled, in terms of both quality and finances.
Monitor information taken from: Monitor website: http://www.monitor-nhsft.gov.uk/monitors-new-role
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Office of Fair Trading
The Office of Fair Trading (OFT) and Monitor must co-operate with each other in the
exercise of their respective functions under the Competition Act 1998 and the Enterprise
Act 2002.
The OFT plans to work constructively with other government departments and public
bodies, to help them frame and deliver services that work well for citizens and taxpayers.
In particular:
• continuing to work with DH in relation to the Health and Social Care Bill, identifying and
addressing competition and consumer issues across the healthcare sector
• where regulators have been given greater responsibilities for overseeing competition in
their sector, for example, Monitor in relation to healthcare
• continuing to work with public sector bodies to raise awareness of how competition law
applies to them, building on the OFTs recent guidance
Office of Fair Trading information taken from: Office of Fair Trading Annual Plan 2012-13:
http://www.oft.gov.uk/shared_oft/about_oft/ap12/OFT1382.pdf
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Commissioning Outcomes Framework
•
The NHS Commissioning Board, supported by NICE and working with professional
and patient groups, will develop a Commissioning Outcomes Framework (COF) that
measures the health outcomes and quality of care (including patient reported
outcome measures and patient experience) achieved by clinical commissioning
groups.
•
The COF will allow the NHS Commissioning Board to identify the contribution of
clinical commissioning groups to achieving the priorities for health improvement in the
NHS Outcomes Framework, while also being accountable to patients and local
communities. It will also enable the commissioning groups to benchmark their
performance and identify priorities for improvement.
•
The NHS Commissioning Board is engaging with clinical commissioning groups and
patient and professional organisations to develop emerging proposals for the COF.
•
Indicators are being developed either derived directly from the NHS Outcomes
Framework; based on NICE Quality Standards; or from other sources to support the
NHS Outcomes Framework. Publication of the NICE menu of indicators for the COF
is anticipated for summer 2012.
Commissioning Outcomes Framework information taken from the NICE website:
http://www.nice.org.uk/aboutnice/cof/cof.jsp
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National and Regional Specialist Commissioning
Specialised services are defined in law as those services with a planning population of
more than one million people. This means that a specialised service would not be
provided by every hospital in England; generally, it would be provided by less than 50
hospitals.
The Specialised Services National Definitions Set describe these services in more detail.
Specialised Mental Health Services (all ages) Definition:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Specialised Services for eating disorders
Forensic / Secure Mental Health Services.
Specialised Mental Health Services for the Deaf
Gender Dysphoria Services
Perinatal Mental Health Services (mother and baby units)
Complex and/or Refractory Disorder Services.
Specialised Services for Asperger’s Syndrome and Autism Spectrum Disorder
Tier 4 Severe Personality Disorder Services.
Neuropsychiatry Services
Tier 4 Child and Adolescent Mental Health Services.
Mental Health Specialist Commissioning information taken from: Third edition of the Specialised Services National
Definitions Set http://www.specialisedservices.nhs.uk/library/26/Specialised_Mental_Health_Services_all_ages.pdf
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Clinical Commissioning Groups
By April 2013 the whole of England will need to be covered by established Clinical Commissioning
Groups (CCGs). CCGs will be responsible for commissioning a range of services, currently
commissioned by Primary Care Trusts. Commissioning Support Services – to support CCGs and the
NHS Commissioning Board – are being developed.
Qualities required of a successful Clinical Commissioning Group have been identified, broadly
grouped into six domains:
1.
2.
3.
4.
5.
6.
A strong clinical and multi-professional focus which brings real added value
Meaningful engagement with patients, carers and their communities
Clear and credible plans which continue to deliver the QIPP (Quality, Innovation, Productivity
and Prevention) challenge within financial resources, in line with national requirements
(including excellent outcomes), and local joint health and wellbeing strategies
Proper constitutional and governance arrangements, with the capacity and capability to deliver
all their duties and responsibilities including financial control, as well as effectively commission
all the services for which they are responsible
Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS
Commissioning Board as well as the appropriate external commissioning support
Great leaders who individually and collectively can make a real difference.
To be fully authorised CCGs should be able to demonstrate an adequate level of competence across
all of these areas and the potential to achieve excellence in the future.
All GPs are required to become members of a Clinical Commissioning Group.
CCG information taken from: Developing Clinical Commissioning Groups: Towards Authorisation
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130293
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Commissioning Support Services
Discussions with stakeholders confirm that commissioning support is one of the most fundamental and
challenging parts of the reforms. Local and national Commissioning Support Services (CSS) are
being designed to offer an efficient, locally-sensitive and customer-focused service to CCGs. CCGs
are likely to need support in carrying out both the transformational commissioning functions, like
leading change and service redesign, and the more transactional commissioning functions, such as
procurement, contract negotiation and monitoring, information analysis, and risk stratification. CCGs
will always retain legal accountability and responsibility for meeting their statutory functions and their
commissioning decisions cannot be delegated.
Early indications suggest there will be around 20-25 local CSS hosted by the NHS Commissioning
Board in the first instance. Some CSS are already up and running and supporting the 2012-13 NHS
business planning round.
The new CSS will be designed to be effective in a competitive marketplace and will be set up to give
CCGs access to the best possible processes, services and products to enable efficient and evidencebased commissioning. CSS leaders will be responsible for developing these new organisations to be
confident, customer-driven organisations that are capable of being independently sustainable within
the competitive marketplace in no later than three years.
Commissioning Support Services information taken from: Commissioning Support Key Facts:
http://www.commissioningboard.nhs.uk/files/2012/02/01-Commissioning-Support-Key-Facts-Sheet-Feb-2012-webversion.pdf
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Local Authorities
Each local authority will take on the function of joining up the commissioning of local
NHS services, social care and health improvement. Local authorities will therefore be
responsible for:
•
Promoting integration and partnership working between the NHS, social care, public health
and other local services and strategies;
•
Producing in partnership with Clinical Commissioning Groups joint strategic needs
assessments and joint health and wellbeing strategies that will inform locality commissioning
plans which will be done through the health and wellbeing boards
•
Building partnership for service changes and priorities. There will be an escalation process to
the NHS Commissioning Board and the Secretary of State, which retain accountability for NHS
commissioning decisions.
These functions would replace the current statutory functions of Health Overview and Scrutiny
Committees.
•
•
LAs will have an enhanced role in promoting choice and complaints advocacy, through the
HealthWatch arrangements they will commission.
LAs will have nationally set targets to improve population health outcomes. They will employ
Directors of Public Health, who will be jointly appointed with the Public Health Service.
Local Authorities information taken from: Equity and Excellence: Liberating the NHS
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf
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Public Health
From April 2013, upper-tier and unitary local authorities will have a new duty to take steps
to improve the health of their population. While local authorities will be largely free to
determine their own priorities and services, they are required to have regard to the Public
Health Outcomes Framework. Local authorities will also be required to provide a small
number of mandatory services including:
• appropriate access to sexual health service;
• NHS Health Check assessments
• steps to be taken to protect the health of the population, in particular, giving the local
authority the responsibility to make plans are in place to protect the health of the
population;
• weighing and measuring children for the National Child Measurement Programme;
• providing public health advice to NHS commissioners.
To enable them to deliver these new public health functions, local authorities will, acting
jointly with Public Health England, appoint directors of public health who will occupy key
leadership positions within the local authority and will be statutory members of the Health
and Wellbeing Board.
Continued on next page
Information taken from: Healthy Lives, Healthy People: Our strategy for public health in England
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122347.pdf
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Public Health continued…
Key public health milestones in 2012/13
April 2012 – PCTs with local authorities to agree plans for the transfer of public health functions and
teams to local authorities
Spring 2012 – DH will publish a consultation on a public health workforce strategy
Spring 2012 – appointment of chief executive designate and agree Public Health England (PHE)
structures
Early summer – all local areas will agree on the vision and strategy for the new public health role in
local authorities
Summer 2012 – publication of full People Transition Policy (PTP) and establish the PHE staff transfer
process
Autumn 2012 – publication of public health workforce strategy
April 2013 – Public Health England will be created
April 2013 – local authorities will take on new public health responsibilities
Information taken from: The Month: March 12, Special Issue 52
http://www.dh.gov.uk/health/files/2012/03/The-month_Mar-12_FINAL1.pdf
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Local HealthWatch
Local HealthWatch organisations will be funded via local authorities and will be accountable
to local authorities for operating effectively and providing value for money. Local authorities
will have the responsibility for putting in place different arrangements if a local HealthWatch
organisation is not operating effectively.
At least one representative of local HealthWatch will sit on the new local authority health
and wellbeing boards helping to ensure that the consumer voice is integral to the wider,
strategic decision–making across local NHS services, adult social care and health
improvement.
HealthWatch will give local communities a bigger say in how health and social care services
are planned, commissioned, delivered and monitored to meet the health and wellbeing
needs of local people and groups, and address health inequalities. It will strengthen the
voice of local people and groups, helping them to challenge poor quality services.
HealthWatch will have an important role supporting everyone in the community, but
particularly those who are vulnerable or often unheard. Local HealthWatch will provide
information about health and care services and about the choices people can make. From
April 2013 it will provide support for people to complain about the quality of NHS services.
Continued on next page
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Local HealthWatch continued…
It is proposed that local HealthWatch will:
• provide information and advice to the public about accessing health and social care
services and choice in relation to aspects of those services;
• make the views and experiences of people known to Healthwatch England helping it
to carry out its role as national champion;
• make recommendations to Healthwatch England to advise the Care Quality
Commission to carry out special reviews or investigations into areas of concern (or, if
the circumstances justify it, go direct to the CQC with their recommendations, for
example if urgent action were required by the CQC);
• promote and support the involvement of people in the monitoring, commissioning and
provision of local care services;
• obtain the views of people about their needs for and experience of local care services
and make those views known to those involved in the commissioning, provision and
scrutiny of care services; and
• make reports and make recommendations about how those services could or should
be improved.
From April 2013, local authorities will commission NHS complaints advocacy from any
suitable provider, including local HealthWatch, and the service will be accessed through
local HealthWatch.
HealthWatch information taken from: Local HealthWatch: A strong voice for people – the policy explained
http://healthandcare.dh.gov.uk/files/2012/03/Local-Healthwatch-policy.pdf
Continued on next page
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Local HealthWatch – continuing LINk functions and acquiring new functions
Scrutinising quality
of service provision
Seat on the health
and wellbeing
board
Joint Strategic
Needs
Assessment and
Joint Health and
Wellbeing
Strategy
Informing the
commissioning
decision-making
process
LOCAL HEALTHWATCH
‘local consumer voice for health and social care’
Influencing
Signposting
Advisory
Help shape the
planning of
health and social
care services
Help people
access and
make choices
about care
Advocacy for
individuals
making
complaints about
healthcare
From
2013/14
Empowering people – helping
people understand choice
Respected, authoritative, influential, credible and very
visible within the community
Strong LOCAL consumer voice on views and experiences to
influence better health and social care outcomes
Representing
the local voice
Providing local, evidence
based information
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Health and wellbeing boards
The core purpose of the new health and wellbeing boards is to join up commissioning
across the NHS, social care, public health and other services that the board agrees are
directly related to health and wellbeing. Over the next year, shadow boards will continue
to work towards readiness for their statutory responsibility - undertaking joint strategic
needs assessments and joint health and wellbeing strategies as the foundation for
2013/14 commissioning plans, but also looking at how they can take joint action now
ahead of 2013 for example on bringing together services through joint commissioning.
Statutory health and wellbeing boards will have four main functions:
• to assess the needs of the local population and lead the statutory joint strategic needs
assessment;
• to promote integration and partnership across areas, including through promoting joined
up commissioning plans across the NHS, social care and public health;
• to support joint commissioning and pooled budget arrangements, where all parties
agree this makes sense; and
• to undertake a scrutiny role in relation to major service redesign
Health and Wellbeing Boards information taken from: Liberating the NHS: Legislative Framework and Next Steps
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122707.pdf
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Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Strategies
A joint strategic needs assessment (JSNA) is an assessment of the health and wellbeing needs of the
population in a local area. JSNAs aim to establish a shared, evidence based consensus on key local
priorities to support commissioning to improve health and wellbeing outcomes and reduce inequalities.
Since 2007 it has been a statutory duty for primary care trusts and local authorities to undertake
JSNAs; in future Health and Wellbeing Boards will be required to lead enhanced JSNAs, as well as
new joint health and wellbeing strategies (JHWS) which will be informed by the needs and assets
identified through the JSNA. This requirement will:
•
Support commissioners to decide on priorities in a more joined-up, effective and efficient way;
•
Provide a coherent single needs assessment for all services which will identify the scope for
contributions from a wide range of influences such as housing, economic development, spatial
planning etc, through Health and Wellbeing Boards;
•
Strike the right balance between facts and figures about local health and wellbeing, and local
views about what should be done, through local democratic accountability and HealthWatch.
There is a new shared statutory obligation on GP-led clinical commissioning groups and the local
authority (through the health and wellbeing board), to produce JSNA and JHWS and to commission
with regard to them. In doing this, they must consider the use of flexibilities under the NHS Act 2006,
such as pooled budgets. The NHS Commissioning Board will also be expected to have regard for both
JSNA and JHWS.
Information on Joint Strategic Needs Assessments and Health and Wellbeing Strategies can be found at:
http://www.idea.gov.uk/idk/aio/27115491 and http://www.idea.gov.uk/idk/aio/27014541
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Foundation Trusts
The Health and Social Care Act 2012 has put in place the following freedoms for NHS Foundation
Trusts;
•
Greater operational freedom to organise services that deliver better care for patients. Greater
opportunity to develop more innovative services – taking advantage of greater flexibility around
private income so it best supports the Trust’s NHS activity. The ability to merge with, or acquire,
other NHS foundation trusts and NHS trusts without the explicit approval of Monitor, and without a
burdensome legislative process.
•
Genuine operational independence to determine how best to meet the needs of commissioners.
Monitor will cease to have a role focused solely on the performance of foundation trusts, and
instead will regulate all healthcare providers to ensure they remain financially sound and well
governed. Monitor, working with the NHS Commissioning Board, instead of ministers, will set the
national tariff from 2014/15, giving long-term stability in planning income to maximise the
operational independence given by the Act.
•
The Act prevents the Government – or anyone else in the NHS – from discriminating against
Foundation Trusts in favour of the private sector.
All NHS Trusts are working towards Foundation Trust status by April 2014.
Information from: Letters from Secretary of State for Health April 2012 to NHS Foundation Trust and NHS Trust CEOs:
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_133419
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