Implications of the Health and Social
Care Act
Cheryl Davenport
Director of Business Development
Leicestershire Partnership Trust
Equity and Excellence:
Liberating the NHS
Overview of the Act - 1
•
The Health and Social Care Act received Royal Assent in March 2012. It contains a
series of powers and structural changes to modernise and improve the health and
care system.
•
The Act is based on Equity and Excellence: Liberating the NHS, (published July
2010) and the Government’s Response to the NHS Future Forum (published June
2011).
– Current local commissioning organisations (primary care trusts) will be
abolished in April 2013 along with strategic health authorities.
– The majority of local health sector commissioning will be led by clinical
commissioning groups (CCGs) and local authorities who take over local
public health responsibilities
– The NHS Commissioning Board (national body) will be established in October
2012 and will commission some services on behalf of CCGs. It will have 4 main
hubs, supported by a number of Local Area Offices.
– Local democratic accountability is being improved through the creation of Health
and Wellbeing Boards (in shadow form by April 2012, formally established by
April 2013), and the establishment of Local Healthwatch organisations to be in
place by April 2013) – work being led by local authorities
(Information on this slide is supported by the “Fact Sheet” handout)
Overview of the Act - 2
– A number of other national bodies are being established including:
• Healthwatch England (October 2012)
• Public Health England (April 2013, incorporating current Health Protection
Agency functions)
• Health Education England (June 2012)
• NHS Property Services Ltd (April 2013)
– Monitor - an existing organisation regulating existing NHS Foundation Trusts
has revised regulatory duties including licensing all healthcare provider
organisations, - balancing choice, competition and integration to improve care
– The NHS Trusts Development Agency (to be established June 2012) will be
responsible for preparing all remaining NHS Trusts for Foundation Status
– CCGs will go through a process of authorisation in four waves between June
and December 2012.
– A small number of Commissioning Support Services organisations (CSS) are
being created and evaluated during 2012/13 to provide specialist/shared/back
office support services to multiple CCGs
THE MAJORITY OF THE CHANGES WILL HAVE BEEN COMPLETED BY APRIL 2013
(Information on this slide is supported by the “Fact Sheet” handout)
Changes in Commissioning
April 2010
National
Department of Health
Regionall
Strategic Health
Authorities
Local
Primary Care Trusts,
working with practice
based commissioners
Local authorities (for
elements of public
health)
April 2013
NHS Commissioning
Board (NHS CB)
Public Health
England (for public
health protection)
Clinical
commissioning groups
for NHS services
Local Area Teams
(LATs) of the NHS
CB
Local authorities (for
public health
improvement)
Who commissions
in the new health system?
NHS Commissioning
Board
•Primary care
•GPs
•Dentists
•Pharmacists
•Optometrists
•Specialised
commissioning
•Prison health
•Immunisation
•Public Health 0-5yrs
•Screening
Clinical
Commissioning
Groups
Local government
•Most commissioning
of healthcare services
locally
•Public health
•Health and Wellbeing
Board
•Health
improvement
•Health
protection
•Healthcare PH
Public Health
England
•Health Protection
•Emergency
Preparedness
•National Treatment
Agency functions
•Evidence and
information
•JSNA
•Cancer registries
•Joint health and
Wellbeing Strategy
(with CCGs)
•Advocacy
•Promote integrated
commissioning
Health and Wellbeing Board
•National campaigns
•Observatories
The Role of Local Authorities
• Democratic accountability in health
• Public Health
• Commission Local Healthwatch
• Health and Wellbeing Boards
• Scrutiny Functions
• Relationships with Districts and Borough Councils
Role of Health and Wellbeing Boards
• Improve local democratic accountability
• Promote integration and partnership working between
the NHS, Social Care, Public Health and other local
services
• Publish joint strategic needs assessments
• Develop and deliver a joint health and wellbeing strategy
• Engage with local people about health and wellbeing
In order to….improve outcomes for health and wellbeing in
the local population
Example of Board Composition Leicestershire
• Cabinet Lead Members for:
– Health (Chair)
– Adult Social Care and Communities
– Children and Young People
• 2 representatives of each Clinical Commissioning Group
• Local Authority Directors of:
– Public Health
– Adults and Communities
– Children and Young People
• 2 LINk representatives (later Local HealthWatch
• Chief Executive NHS Commissioning Board Local Team
• 2 District Council representatives
• 1 Police representative
The Role of the
NHS Commissioning Board
•
•
•
•
Improve Outcomes
Deliver the Mandate
Develop Clinical Commissioning Groups
Commission Primary Care Services, Specialist
Services, (plus some public health functions and prison
healthcare)
• Operate nationally and through Local Area Teams
(LATs) - single operating model
• Concordat with Local Government
NHS Commissioning Board Mandate
April 2013-March 2015
Development of
Clinical Commissioning Groups (CCGs)
• One of the main aims of the NHS reforms is to ensure
clinical leadership is at the heart of commissioning.
• The NHS CB’s role is to support CCGs to develop locally
and provide assurance that CCGs are able to:
– Commission safely
– Use the their budgets responsibly
– Exercise their functions to improve quality, reduce
inequality and deliver improved outcomes within the
available resources.
The Role of Healthwatch England
• Healthwatch England was created in October 2012. The
role of Healthwatch England is to:
– Assist in the creation of Local Healthwatch
organisations and provide them with a coordinating
network.
– Make sure the voices of people who use health and
social care services are heard by the Secretary of
State for Health, the Care Quality Commission (CQC),
the NHS Commissioning Board, Monitor and every
local authority in England.
The Role of Local Healthwatch - 1
• The role of Local Healthwatch is to:– Engage with local people about local NHS and social
care commissioning and provision
– Involve patients, services users and the public to
ensure the voice of local people plays a central and
active role in the planning and delivery of local
services, including through representation at the local
health and wellbeing board.
The Role of Local Healthwatch - 2
• They will:
– Have the power to enter and view services.
– Influence how services are set up and commissioned
by having a seat on the local health and wellbeing
board.
– Produce reports which influence the way services are
designed and delivered.
– Provide information, advice and support about local
services.
– Pass information and recommendations to
Healthwatch England and the Care Quality
Commission.
Implications for Provider Trusts
• Foundation Trust Status – requirement by 2014
• Monitor - the new economic regulator
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–
–
–
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Licensing (with CQC)
Prices
Integration
Competition
Service continuity
• NHS Trust Development Authority
• Complexities for providers interacting with the new landscape
What’s Happening Locally?
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All 3 local CCGs are in shadow form applied for authorisation in the first
wave (June 2012). Decision expected December.
Shadow Health and Wellbeing Boards are now in place across LLR
There is likely to be a Commissioning Support Service covering CCGs in
the Greater East Midlands area (this will include Leicester, Nottingham,
Lincoln, Derby, Northampton, Milton Keynes)
Public Health transition plans are progressing in line with national
requirements
The NHS Commissioning Board Local Area Team was established in
shadow form in October 2012 and covers Leicestershire and Lincolnshire
Leicestershire Partnership Trust is currently applying for Foundation Trust
Status
University Hospitals of Leicester intends to apply for Foundation Trust
Status in line with national timescales (by April 2014)
Some of the challenges in the new
system…
• Overlaps in roles and accountabilities?
• Fragmentation of commissioning?
• The tension between integration and competition?
• Spotlight on contracts, efficiencies and specifications
• New markets and mechanisms e.g. any qualified
provider
Burning platform for integration?
 Ageing population requiring greater levels of integrated “wrap around”
care
 Consumer expectations – e.g. on quality, involvement, choice, and the
channels by which care will be planned and delivered in the future
 Funding flatlined in public sector / Nicholson Challenge
 Monitor efficiency target for FTs
 Scale of enterprises that might be needed to withstand market
conditions and tariff efficiencies
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Some Integration Definitions

“Health and social care provision that is seamless, personalised and flexible”
Jennifer Dixon, Nuffield Trust

“Smoothness with which a patient or carer can navigate the NHS and social
care systems in order to meet their needs”
Frontier Economics

“Care organised around the needs of individuals”
National Voices

“A tool to improve outcomes for individuals or communities”
Health Select Committee

“People want care and coordination, not necessarily organisational
integration, where it comes from is secondary”
The Richmond Group of Charities
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Integration in the reformed NHS
 Health and Social Care Act places duties on CCGs,
Health and Wellbeing Boards, Monitor and the NHS
Commissioning Board to promote integration
 Monitor’s role is defined as supporting integration of
services where it improves care (at the same time as
taking action against anti-competitive behaviour)
 Integration therefore will be delivered by commissioners
and providers operating in an increasingly complex
market for healthcare
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What do we mean by competition?
 Competition for the market – where providers are
invited to tender for the provision of integrated
services
 Competition within the market – where patients
are offered a choice from a menu of providers,
and (soon) where patients commission for
themselves through holding personal healthcare
budgets
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Issues, risks and concerns
 Understanding what consumers need and want in terms of integrated
care
 More definition / guidance / regulation? – what are the boundaries to
avoid collusion and conflicts of interest in the new commissioner /
provider landscape?
 Understanding the implications and differences between organisational
level / transactional integration and integration at care pathway levels
 New tariffs to promote integrated pathways
 Learning Lessons –the UK’s Integrated Care Organisation (ICO) pilots,
Accountable Care Organisations and vertical integration models (such
as Kaiser) in the USA, and from healthcare mergers
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Questions
&
Signposting to other resources
cheryl.davenport@leicspart.nhs.uk
0116 295 0815
07770 281 610