- North East Mental Health Development Unit

North of England
Mental Health Development Unit
This is a very brief overview of the Health and
Social Care Act 2012 and related organisational changes:
Health and Social Care Act 2012
for Patients
Legitimacy in
The review of
arms length
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.
PJ-MJ/March 2013/Version 6
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
board 9
England 12
CQC 13
England 14
Office of Fair
Trading 16
CCG Outcomes Indicator Set 17
Local Area
Teams 18
Clinical Senates
& SCNs 19
Support Units
Health &
Boards 28
Health 24
JSNA + Joint
Health and
Strategy 31
Independent sector
Patients carers and the public
The NHS Outcomes Framework 2013/14
The purpose of the NHS Outcomes Framework is threefold:
• to provide a national level overview of how well the NHS is performing;
• to provide an accountability mechanism between the Secretary of State for Health and
the NHS Commissioning Board for the effective spend of some £95bn of public money;
• to act as a catalyst for driving up quality throughout the NHS by encouraging a change
in culture and behaviour.
Indicators in the NHS Outcomes Framework are grouped around five domains, which set
out the high-level national outcomes that the NHS should be aiming to improve. For each
domain, there are a small number of overarching indicators followed by a number of
improvement areas. They focus on improving health and reducing health inequalities:
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.
Continued on next page
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The NHS Outcomes Framework – continued...
The NHS Outcomes Framework sits alongside similar frameworks for public health
and adult social care. The distinct frameworks reflect the different delivery systems
and accountability models for the NHS, public health and adult social care. The three
frameworks have been further aligned to encourage collaboration and integration,
both in terms of how shared and complementary indicators are presented across all
three frameworks, and through an increased and more systematic use of shared and
complementary indicators in the revised Public Health and Adult Social Care
Outcomes Frameworks for 2013/14.
From April 2013, the NHS Outcomes Framework will form part of the way in which
the Secretary of State will hold the new NHS Commissioning Board to account for the
commissioning system in the English NHS. The mandate to the NHS Commissioning
Board represents the first time that the Government has been legally required to set
out the objectives for the NHS, and provides an important degree of transparency.
NHS Outcomes Framework information taken from: The NHS Outcomes Framework 2013/14
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
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
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
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Public Health Outcomes Framework continued…
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)
Improving the wider
determinants of health.
Health improvement
Health protection
Healthcare public health
and preventing premature
Improvements against
wider factors that affect
health and wellbeing, and
health inequalities.
People are helped to live
healthy lifestyles, make
healthy choices and reduce
health inequalities.
The population's health is
protected from major
incidents and other
threats, while reducing
health inequalities.
Indicators - across the life
Indicators - across the life
Indicators - across the life
Reduced numbers of
people living with
preventable ill health and
people dying prematurely,
while reducing the gap
between communities.
Indicators - across the life
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The Adult Social Care Outcomes Framework 2013/14
The adult social care outcomes framework sets out agreed outcome measures in four
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
Safeguarding adults whose circumstances make them vulnerable and protecting from
avoidable harm
The Adult Social Care Outcomes Framework (ASCOF) fosters greater transparency in
the delivery of adult social care, supporting local people to hold their council to account
for the quality of the services they provide. A key mechanism for this is through councils’
local accounts, where the ASCOF is already being used as a robust evidence base to
support councils’ reporting of their progress and priorities to local people;
View overlapping outcome frameworks diagram
Information taken from: The adult social care outcomes framework 2013/14:
Back to home
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
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
Adult Social Care
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
Role of the NHS Commissioning Board
The NHS Commissioning Board take on its full range of responsibilities as from April
2013, and the new commissioning system will begin to operate, 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; (CCG Outcomes Indicator Set)
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
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
Continued on next page
NHS Commissioning Board information taken from: Developing the NHS Commissioning Board
NHS Commissioning Board – continued...
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Key frameworks to deliver the work of the NHS Commissioning Board
Secretary of State for
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
Emergency planning
Clinical commissioning groups and national and local strategic partners
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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.
Recent health reforms have outlined a role for NICE to work alongside the NHS
Commissioning Board, and professional and patient groups, to develop a
commissioning outcomes framework (COF). This will measure the health outcomes
and quality of care achieved by clinical commissioning groups.
Information on NICE quality standards can be found at:
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Public Health England
Public Health England was created in 2012, taking on full responsibilities from 2013. Public Health
England is an Executive Agency, within a structure accountable to the Secretary of State for Health,
and brings together the functions of the former:
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
And Healthy Lives, Healthy People: Update and Way Forward (July 2011)
Care Quality Commission
Back to home
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
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HealthWatch England
HealthWatch England was established in Oct 2012 as the new consumer champion for
health and adult social care in England. From April 2013 Healthwatch England will be part
of a new Healthwatch network giving people who use health and social care services a
powerful voice locally and nationally. For the first time this will clearly provide a platform
for making the NHS and local government accountable to their local communities.
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
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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:
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CCG Outcomes Indicator Set
The Clinical Commissioning Group Outcomes Indicator Set (CCG OIS) (formerly known
as the Commissioning Outcomes Framework) is an integral part of the NHS
Commissioning Board's systematic approach to quality improvement. Its primary aim is to
support and enable clinical commissioning groups (CCGs) and health and wellbeing
partners to plan for health improvement by providing information for measuring and
benchmarking outcomes of services commissioned by CCGs. It is also intended to
provide clear, comparative information for patients and the public about the quality of
health services commissioned by CCGs and the associated health outcomes.
The consultation document ‘Liberating the NHS: Commissioning for Patients' proposed
that the NHS Commissioning Board, supported by NICE, would develop a
‘Commissioning Outcomes Framework' to hold CCGs to account for, and provide
information for the public on the quality of services they commission and the health
outcomes achieved through commissioning. Following engagement with stakeholders,
the NHS Commissioning Board has changed the title to avoid confusion with the NHS
Outcomes Framework and make it clear that the indicators relate to outcomes of
commissioned services, not commissioning itself.
Clinical Commissioning Group Outcomes Indicator Set information taken from the NICE website:
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NHS Commissioning Board Local Area Teams
There are 27 Local Area Teams, with 9 in the North of England:
Cheshire, Warrington & Wirral
Durham, Darlington & Tees
Greater Manchester
Cumbria, Northumberland, Tyne & Wear
North Yorkshire & Humber
South Yorkshire & Bassetlaw
West Yorkshire
All LATs will have the same core functions around:
• CCG development and assurance • emergency planning, resilience and response
• quality and safety
• partnerships
• configuration
• system oversight
There will be variations around the scope of direct commissioning responsibilities,
however all local area teams will take on direct commissioning responsibilities for GP
services, dental services, pharmacy and certain aspects of optical services.
Information from: NHS Commissioning Board Local Area Teams Staff Briefing Pack; June 2012
Clinical Senates
Clinical Senates will bring together a range of professionals to take an overview of health and
healthcare for local populations and provide a source of strategic, independent advice and leadership
on how services should be designed to provide the best overall care and outcomes for patients.
Clinical Senates will draw on a variety of health and wider care perspectives, including those of
professionals who sometimes go unheard.
To support the better integration of services, they will include public health specialists and adult and
children’s social care experts.
They will provide a clinically led and strategically focussed space for commissioners and providers to
come together and determine the most clinically appropriate way to configure services for the future.
Reinforcing the critical importance of clinical leadership in the health service, Clinical Senates will help
Clinical Commissioning Groups, Health and Wellbeing Boards and the NHS Commissioning Board to
make the best decisions about healthcare for the populations they represent by providing clinical
advice and leadership at a strategic level.
Each Clinical Senate area will have a senate and network support team, supporting four nationally
agreed strategic clinical networks.
Continued on next page
Information from: NHS Commissioning Board Clinical Senates Update; January 2013
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Strategic Clinical Networks
SCNs operate as engines for change across complex systems of care, maintaining and
or improving quality and outcomes. They bring primary, secondary and tertiary care
clinicians together with partners from social care, the third sector and patients.
NHS Commissioning Board will host Strategic Clinical Networks (SCNs) from 2013, via Local Area
Four initial network areas operating throughout the country:
 cancer
 cardiovascular
 maternity and children
 mental health, dementia and neurological conditions
SCNs will be non-statutory organisations
SCNs will have an annual accountability agreement with the NHS Commissioning Board for
delivering a programme of quality improvement, as defined by Domain Leads and local partners
Information from: NHS Commissioning Board Strategic Clinical Networks Update; November 2012
http://www.commissioningboard.nhs.uk/wp-content/uploads/2012/11/scn-update.pdf and
NHS Commissioning Board Strategic Clinical Networks Single Operating Framework:
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Clinical Commissioning Groups
From April 2013 the whole of England will be covered by Clinical Commissioning Groups (CCGs).
CCGs will be responsible for commissioning a range of services, previously 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, broadly grouped into six domains,
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.
All GPs are required to be members of a Clinical Commissioning Group.
CCG information taken from: Developing Clinical Commissioning Groups: Towards Authorisation
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Commissioning Support Units
For some support activities, CCGs may choose to appoint their own internal staff while for others they
will have a choice of using new CSUs or other sources of commissioning support, eg. from the
independent or voluntary sectors. CCGs will always retain legal accountability and responsibility for
meeting their statutory functions and their commissioning decisions cannot be delegated to others.
The NHS CB will host all CSUs from April 2013 through to the point at which CCGs procure their choice
of future commissioning support. Initially, the intention is that CCGs will identify a hosted CSU and this
arrangement will operate under a standard contract. This will ensure:
• Stability in the system while CCGs secure ongoing commissioning support
• The experience and expertise of staff in commissioning support roles in PCTs is retained for the
benefit of the NHS
• CSUs, as new organisations, have the time to develop to become customer- driven businesses that
are capable of being independently sustainable within a competitive marketplace.
The host role is in effect a ‘holding company’ which covers:
• Ownership of the NHS CSUs
• Accountability and responsibility
• A legitimate operating framework for CSUs in terms of statutory cover and a financial operating model
• An interim trading environment to support delivering contracted services to CCGs.
• NHS CSUs will legally be part of the NHS CB and have no independent legal status until they are
externalised (by 2016).
Commissioning Support Unit Information from: NHS CB Commissioning Support: Key Facts:
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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
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
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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
• 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.
Information taken from: Healthy Lives, Healthy People: Our strategy for public health in England
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
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
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
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
Joint Strategic
Assessment and
Joint Health and
Informing the
‘local consumer voice for health and social care’
Help shape the
planning of
health and social
care services
Help people
access and
make choices
about care
Advocacy for
complaints about
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
the local voice
Providing local, evidence
based information
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. Health and wellbeing boards will be the engine
room to develop joint strategic needs assessments and joint health and wellbeing
strategies as the foundation for 2013/14 commissioning plans, but also bring together
services through joint commissioning.
Underlying principles of boards
• A number of principles underlie the creation of health and wellbeing boards. These
• shared leadership of a strategic approach to the health and wellbeing of communities
that reaches across all relevant organisations
• a commitment to driving real action and change to improve services and outcomes
• parity between board members in terms of their opportunity to contribute to the
board’s deliberations, strategies and activities
Continued on next page
Health and Wellbeing Boards information taken from: Liberating the NHS: Legislative Framework and Next Steps
Underlying principles of Health and Wellbeing Boards – Continued...
• shared ownership of the board by all its members (with commitment from their
nominating organisations) and accountability to the communities it serves
• openness and transparency in the way that the board carries out its work
• inclusiveness in the way it engages with patients, service users and the public.
The legislation was aimed at allowing considerable flexibility to councils and their
partners on health and wellbeing boards to set up and run boards that conform to these
principles in a way that suits local circumstances. This means that a range of options will be
Functions of Health and Wellbeing Boards
The Health and Social Care Act 2012 gives health and wellbeing boards specific
functions. These are a statutory minimum and further functions can be given to the boards
in line with local circumstances. The statutory functions are:
• To prepare Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing
Strategies (JHWSs), which is a duty of local authorities and clinical commissioning
groups (CCGs).
Continued on next page
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Functions of Health and Wellbeing Boards – Continued...
• A duty to encourage integrated working between health and social care commissioners,
including providing advice, assistance or other support to encourage arrangements under
section 75 of the National Health Service Act 2006 (ie. lead commissioning, pooled
budgets and/or integrated provision) in connection with the provision of health and social
care services.
• A power to encourage close working between commissioners of health-related services
and the board itself.
• A power to encourage close working between commissioners of health-related services
(such as housing and many other local government services) and commissioners of
health and social care services.
Health and Wellbeing Boards information taken from: Health and Wellbeing Boards: A practical guide to governance and
constitutional issues; LGA; March 2013
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Joint Strategic Needs Assessment and Joint Health and Wellbeing
Joint Strategic Needs Assessments (JSNAs) are assessments of the current and future
health and social care needs of the local community – these are needs that could be met
by the local authority, CCGs, or the NHS Commissioning Board. JSNAs are produced by
health and wellbeing boards, and are unique to each local area.
Joint Health and Wellbeing Strategies (JHWSs) are strategies for meeting the needs
identified in JSNAs. As with JSNAs, they are produced by health and wellbeing boards
and are unique to each local area. In preparing JHWSs, health and wellbeing boards
must have regard to the Secretary of State’s mandate to the NHS Commissioning Board
which sets out the Government’s priorities for the NHS. They should explain what
priorities the health and wellbeing board has set in order to tackle the needs identified in
their JSNAs.
Information from: Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies
DH; March 2013
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Foundation Trusts
The Health and Social Care Act 2012 has put in place the following freedoms for NHS Foundation
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: