The new health system and
new ways of working
Shelagh Morris
Deputy Chief Allied Health Professions Officer
CSP English Regional Networks
17 September 2013
The Health and Care System from April 2013
2
http://media.dh.gov.uk/network/18/files/2012/09/final-system-overview.pdf
The New
System….
Patients
CCGs
CQC
AHSN
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NTDA
H&WB
Board
NHS
England
Monitor
PHE
NHSIQ
HEE
Networks
Senates
DH
Others
(and
important!)
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http://www.nhsemployers.org/Aboutus/latest-news/Pages/The-new-NHS-in-2013-infographic.aspx
Department of Health
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Meet the Ministerial
Team!
Jeremy Hunt - (SofS)
The Rt Hon Jeremy Hunt MP is the Secretary of State for Health
Norman Lamb - MS(CS)
Norman Lamb MP is the Minister
of State for Care and Support
MS(CS).
Daniel Poulter - PS(H)
Dr Daniel Poulter MP is Parliamentary Under
Secretary of State for Health PS(H).
Anna Soubry - PS(PH)
Anna Soubry MP is the Parliamentary
Under Secretary of State for Public Health
PS(PH).
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Earl Howe – PS(Q)
Earl Howe is the Parliamentary Under Secretary of State for Quality (Lords).
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NHS England
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Purpose of NHS England
Improve health
outcomes
Promote the NHS
Constitution
Promote equality
and reduce health
inequalities
Operate within
resource limits
High quality care for all, now and for future generations
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NHS ENGLAND
Aims of NHS England
• Improved health outcomes as defined by the NHS Outcomes
Framework
• People’s rights under the NHS Constitution are met
• NHS bodies operate within resource limits
These will enable:
• patients and the public to have more choice and control over
their care and services;
• clinicians to have greater freedom to innovate to shape
services around the needs and choices of patients; and
• the promotion of equality and the reduction of inequality in
access to healthcare.
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Commissioning Assembly
What is it?
• It is the community of leaders for NHS commissioning; the ‘one team’ which will deliver better outcomes for patients.
Why have we got it?
• Because we have a greater chance of maximising the impact of commissioning on outcomes working together than
apart.
What is its purpose?
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Create shared leadership nationally and locally.
Co-produce national strategy and direction.
Embed principles for working together and create a common voice.
Connect leaders, both within the NHS commissioning system and beyond.
What will it do in practice?
•
•
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Facilitate networking and communication.
Sponsor and oversee key pieces of work, and policy development on priority areas.
Be a repository of expertise and views.
Come together once a year to review progress, share best practice and explore challenges together.
Organisational development of the commissioning system
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The Mandate
• First Mandate published on 13th November
2012
• Sets out what the Government expects in
return for handing over £95bn of tax payers
money to NHS England
• The NHS Outcomes Framework sits at the
heart of this Mandate and the Board is
expected to demonstrate progress across the
entire framework
• In turn, the NHS Outcomes Framework sits at
the heart of NHS England’s planning
guidance ‘Everyone Counts’, published in
December 2013
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NHS Mandate
13https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127193/mandate.pdf.pdf
Tools and levers of the Quality Framework
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How we align these tools and levers
will be key to success
NHS OUTCOMES FRAMEWORK
Domain 2
Domain 3
Domain 4
Domain 5
Preventing
people from
dying
prematurely
Enhancing
the quality
of life for
people with
LTCs
Recovery
from
episodes of
ill health /
injury
Ensuring a
positive
patient
experience
Safe
environment
free from
avoidable
harm
Duty of quality
Duty of quality
Domain 1
NICE Quality Standards
(Building a library of approx 150 over 5 years)
Commissioning
Outcomes
Framework
Provider payment mechanisms
Commissioning
Guidance
tariff
standard
contract
CQUIN
Commissioning / Contracting
NHS Commissioning Board – certain specialist services and primary care
GP Consortia – all other services
Duty of quality
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QOF
NHS ENGLAND
Our focus – delivering improved outcomes
The NHS
Outcomes
Framework
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Domain 1
Domain 2
Domain 3
Preventing
people from
dying
prematurely
Enhancing
quality of life
for people
with longterm
conditions
Helping
people to
recover from
episodes of ill
health or
following
injury
Domain 4
Ensuring people have a positive
experience of care
Domain 5
Treating and caring for people in a safe
environment and protecting them from avoidable
harm
Effectiveness
Experience
Safety
NHS Outcomes Framework; 5.4 Reducing harm from error
NHS Outcomes Framework
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Preventing people from dying prematurely
Overarching indicators
1a Potential Years of Life Lost (PYLL) from causes considered amenable to
healthcare
i Adults ii Children and young people
1b Life expectancy at 75
i Males ii Females
Improvement areas
Reducing premature mortality from the major causes of death
1.1 Under 75 mortality rate from cardiovascular disease* (PHOF 4.4)
1.2 Under 75 mortality rate from respiratory disease* (PHOF 4.7)
1.3 Under 75 mortality rate from liver disease* (PHOF 4.6)
1.4 Under 75 mortality rate from cancer* (PHOF 4.5)
i One- and ii Five-year survival from all cancers
iii One- and iv Five-year survival from breast, lung and colorectal cancer
Reducing premature death in people with serious mental illness
1.5 Excess under 75 mortality rate in adults with serious mental illness* (PHOF 4.9)
Reducing deaths in babies and young children
1.6 i Infant mortality* (PHOF 4.1)
ii Neonatal mortality and stillbirths
iii Five year survival from all cancers in children
Reducing premature death in people with a learning disability
1.7 Excess under 60 mortality rate in adults with a learning disability
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Enhancing quality of life for people with long-term
conditions
3
Helping people to recover from episodes of ill health or
following injury
Overarching indicators
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Ensuring that people have a positive experience of care
Overarching indicators
3a Emergency admissions for acute conditions that should not usually require
hospital admission
3b Emergency readmissions within 30 days of discharge from hospital* (PHOF 4.11)
Improvement areas
Improving outcomes from planned treatments
3.1 Total health gain as assessed by patients for elective procedures
i Hip replacement ii Knee replacement iii Groin hernia iv Varicose veins
v Psychological therapies
Preventing lower respiratory tract infections (LRTI) in children from becoming
serious
3.2 Emergency admissions for children with LRTI
4a Patient experience of primary care
i GP services
ii GP Out of Hours services
iii NHS Dental Services
4b Patient experience of hospital care
4c Friends and family test
Improvement areas
Improving people’s experience of outpatient care
4.1 Patient experience of outpatient services
Improving hospitals’ responsiveness to personal needs
4.2 Responsiveness to in-patients’ personal needs
Improving people’s experience of accident and emergency services
4.3 Patient experience of A&E services
Improving recovery from injuries and trauma
3.3 Proportion of people who recover from major trauma
Improving recovery from stroke
3.4 Proportion of stroke patients reporting an improvement in activity/lifestyle on the
Modified Rankin Scale at 6 months
Improving recovery from fragility fractures
3.5 Proportion of patients recovering to their previous levels of mobility/walking ability
at i 30 and ii 120 days
Helping older people to recover their independence after illness or injury
3.6 i Proportion of older people (65 and over) who were still at home 91 days
after discharge from hospital into reablement/ rehabilitation service***
(ASCOF 2B)
ii Proportion offered rehabilitation following discharge from acute or
community hospital
Improving access to primary care services
4.4 Access to i GP services and ii NHS dental services
Improving women and their families’ experience of maternity services
4.5 Women’s experience of maternity services
Improving the experience of care for people at the end of their lives
4.6 Bereaved carers’ views on the quality of care in the last 3 months of life
Improving experience of healthcare for people with mental illness
4.7 Patient experience of community mental health services
Improving children and young people’s experience of healthcare
4.8 An indicator is under development
Improving people’s experience of integrated care
4.9 An indicator is under development *** (ASCOF 3E)
Overarching indicator
2 Health-related quality of life for people with long-term conditions** (ASCOF 1A)
NHS Outcomes
Framework 2013/14
Improvement areas
Ensuring people feel supported to manage their condition
2.1 Proportion of people feeling supported to manage their condition**
Improving functional ability in people with long-term conditions
2.2 Employment of people with long-term conditions** * (ASCOF 1E PHOF 1.8)
at a glance
Reducing time spent in hospital by people with long-term conditions
2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive
conditions (adults)
ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under
19s
Enhancing quality of life for people with mental illness
2.5 Employment of people with mental illness **** (ASCOF 1F & PHOF 1.8)
Enhancing quality of life for people with dementia
2.6 i Estimated diagnosis rate for people with dementia* (PHOF 4.16)
ii A measure of the effectiveness of post-diagnosis care in sustaining
independence and improving quality of life*** (ASCOF 2F)
Treating and caring for people in a safe environment and
protect them from avoidable harm
Overarching indicators
5a Patient safety incidents reported
5b Safety incidents involving severe harm or death
5c Hospital deaths attributable to problems in care
Improvement areas
Alignment across the Health and Social Care System
Enhancing quality of life for carers
2.4 Health-related quality of life for carers** (ASCOF 1D)
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*
**
Indicator shared with Public Health Outcomes Framework (PHOF)
Indicator complementary with Adult Social Care Outcomes
Framework (ASCOF)
*** Indicator shared with Adult Social Care Outcomes Framework
**** Indicator complementary with Adult Social Care Outcomes
Framework and Public Health Outcomes Framework
Indicators in italics are placeholders, pending development or identification
Reducing the incidence of avoidable harm
5.1 Incidence of hospital-related venous thromboembolism (VTE)
5.2 Incidence of healthcare associated infection (HCAI)
i MRSA
ii C. difficile
5.3 Incidence of newly-acquired category 2, 3 and 4 pressure ulcers
5.4 Incidence of medication errors causing serious harm
Improving the safety of maternity services
5.5 Admission of full-term babies to neonatal care
Delivering safe care to children in acute settings
5.6 Incidence of harm to children due to ‘failure to monitor’
Our shared
purpose
1. Analyse the
prob & opp’ty
2. Understand
the evidence
3. Enable and
drive change
4. Sustain
improvement
NHS England
The role of National Clinical Directors
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•
End of life care
Major trauma
Mental health
Chronic disability and
neurological conditions
Learning disability
Cardiovascular disease
Cancer
Musculoskeletal disorders
Spinal disorders
GI and liver
Respiratory
Obesity and diabetes
Pathology services
Health and Justice (offenders)
• Children and young people, and
transition to adulthood
• Maternity and women’s health
• Diagnostics, including imaging
• Urgent care
• Rural and Remote Care and Services
• Dementia
• Integration and frail elderly
• Enhanced recovery and acute surgery
• Rehabilitation and recovering in the
community
• Emergency preparedness and critical
care
NHS ENGLAND
Commissioning structures
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Regions
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North of England
Midlands and East of England
London
South of England
http://www.networks.nhs.uk/nhs-networks/respiratoryleads/documents/NHSCB%20LATs%20-%20Specialised%20Commissioning.pdf
North of England – 9 LATs
Midlands and East – 8 LATs
London – 3 LATs
South of England – 7 LATs
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Specialised Commissioning
10 LATs responsible for specialised commissioning
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Cumbria, Northumberland, Tyne and Wear
South Yorkshire and Bassetlaw
Cheshire, Warrington and Wirral
East Anglia
Leicestershire and Lincolnshire
Birmingham and Black Country
Bristol, North Somerset and South Gloucestershire
Wessex
Surrey and Sussex
London
Specialised Commissioning
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Provided in
relatively few
hospitals to
catchment
populations of
more than one
million people
10% of total
NHS budget
(approx £11.8bn
per annum)
34 – Specialised
Services
National
Definition Set
(SSNDS)
High cost, low
volume
interventions
and treatments
Clinical Reference Groups
Key delivery mechanism
for the development of
specialised services
contract products for
2013/14 and beyond.
Bringing together
specialised expertise
and advice with views of
patients and carers
Service specific - 74
Co-ordinated through 5
National Programmes of
Care (PoC)
Work of CRGs closely
aligned to the NHS
Outcomes Framework
Membership
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Programmes of Care
Group together the prescribed specialised services
• Internal medicine – digestion, renal, hepatobiliary and
circulatory system
• Cancer and blood – infection, cancer, immunity and
haematology
• Trauma – traumatic injury, orthopaedics, head and neck, and
rehabilitation
• Women and children – women and children, and congenital
and inherited diseases
• Mental health
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Clinical Senates
Clinical senates will help Clinical Commissioning Groups (CCGs), Health and
Wellbeing Boards (HWBs) and the NHS CB to make the best decisions about
healthcare for the populations they represent by providing advice and leadership at a
strategic level.
• Engage with commissioners to identify areas with potential to
improve outcomes
• Mediating with their population about how to implement best
practice
Purpose • A source of clinical leadership
• Proactive role in promoting major service change
• Link clinical expertise and local knowledge i.e. on patient pathways
• Engage with clinical networks
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12 Clinical Senates
North East, north Cumbria,
and the Hambleton &
Richmondshire districts of
North Yorks
Yorkshire &
The Humber
Greater
Manchester,
Lancashire and
south Cumbria
East
Midlands
Cheshire &
Mersey
East of
England
West
Midlands
Thames
Valley
London
South West
South East
Coast
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Wessex
Strategic Clinical Networks (SCNs)
Established within 12 geographical areas covered by Clinical Senates
Help local
commissioners
to:
First SCNs
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Reduce variation in services
Encourage innovation
Define evidence-based best practice pathways
Operate as engines of change across complex systems of care
To maintain and/or improve quality and outcomes
Cancer
Cardiovascular disease
Maternity and children’s services
Mental health, dementia and neurological conditions
Geographical Alignment
A key principle of the design work for both LATs and clinical senates has been that there should
be alignment of boundaries between structures wherever relationships are important.
The 27 local area teams have boundaries largely aligned within those of the clinical senates.
There are only three areas where the senate boundaries cut across those of the local area
teams. This has been necessary to ensure that the senate boundaries recognise the pattern of
patient flows, particularly with tertiary centres.
Similarly, close alignment has been sought between the NHS CB’s specialised commissioning
arrangements and the clinical senates. As a result, the boundaries of the 10 specialised
commissioning hubs will be aligned entirely with the 12 senates.
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Innovation
‘An idea, service or product,
new to the NHS
or applied in a way
that is new to the NHS,
which significantly improves
the quality of
health and care
wherever it is applied.’
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http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131299
Academic Health Science Networks
• 15 – designated and licensed
• 5 year contracts
• Systematic delivery mechanism for diffusion of innovation
and best practice and collaboration between partners
including industry
• Align education, clinical research, informatics, training and
healthcare delivery
• Improving patient and population health by translating
research into practice and developing and implementing
integrated health care systems
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AHSNs
Academia
Industry
Oxford
Eastern
Wessex
UCL Partners
South London
East Midlands
West Midlands
West of England
North West Coast
Greater Manchester
Yorkshire and Humber
South West Peninsula
Kent, Surrey and Sussex
North East and North Cumbria
Imperial College Health Partners
NHS
CHPO team work
• Rehabilitation
• Non-medical prescribing
• NAHPIST
• 6 programmes of work:
• Prevention, early diagnosis and intelligence
• Community services
• Acute services
• Integrated care and support
• Patients in control
• Parity of esteem
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Questions to consider
• How best to exert influence and where?
• How to inform clinical commissioning?
• National versus local?
• Together and/or separately?
• Others……………….?
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Thank you
shelagh.morris@nhs.net
0113 825 1168
0777 182 5939
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