The ‘New’ NHS – The Challenges for Children’s Service Chris Sharratt Chief Executive Sheffield Children’s NHS Foundation Trust November 2010

Contents Department of Health: NHS White Paper “Equity and Excellence: Liberating the NHS”: July 2010 A Review by Professor Sir Ian Kennedy: “Getting it Right for Children and Young People”: September 2010 Department of Health: “Achieving Equity and Excellence for Children”: September 2010 Challenges for Children’s Services Opportunities for Change - Discussion

Equity and Excellence: Liberating the NHS

Summary- Main areas of change Organisational change Future of providers Regulation and inspection Efficiency and bureaucracy Quality and outcomes Choice and Control Workforce Information Patient Public Engagement

Organisational change and commissioning GP Consortia to commission healthcare- full responsibility 2013/14 All GP’s to be in consortia – set up from 2011/12 NHS Commissioning board (NHSCB) set up- from April 2011, becoming statutory body from April 2012 NHSCB to commission GP, dental and ophthalmic services GP consortia accountable to NHSCB for managing within annual revenue limit GP Consortia to have accountable officer PCT’s cease to exist from April 2013

Organisational Change Strategic Health Authorities- no longer exist from 2012/13 Local authorities assume responsibility for local health improvement (from PCT’s) Health and Wellbeing Boards to be created within local government to coordinate commissioning of NHS South social care and health improvement

Future of Providers All NHS Trusts to become Foundation Trusts by 2013 with abolition of NHS Trust model New FT models with staff-only membership (social enterprise) for community and other FT’s FT’s ‘will not be prioritised’ Increased freedoms for FT’s: Abolition of cap of income from other sources Greater ease to merge Tailoring of governance arrangement

Regulation and Inspection Monitor to regulate all NHS providers from April 2013 CQC and Monitor to deliver a joint licensing regime to cover essential safety and quality standards CQC to use ‘targeted and risk based’ approach to assessment Monitor to regulate pricing ‘where necessary’

Quality and Outcomes New NHS Outcomes Framework- national goals relating to quality, safety and patient experience GP consortia to have commissioning outcomes framework NICE to develop quality standards- to inform contracts NHSCB to be responsible for payment system structure- with economic regulations dealing with prices PbR to be refined- best practice tariffs CQINS extended locally Cancer drug fund from April 2011

Getting it Right for Children and Young People

“ Many GPs have little or no experience of paediatrics as part of their professional training. Given that the majority of their patients are adults, caring for children and young people is low on most GP’s priorities. Accident and emergency (A&E) has become the default option. While A&E departments dedicated to children and young people provide good care, the experience of children entering adult A&E departments can be quite different.” Source: Getting it Right for Children and Young People

The Relative Priority Given to Children and Young People “ There is a real sense among professionals and organisations that service for children and young people in the NHS have a low priority. Children and young people receive a disproportionately lower priority than adults in the imperatives of management and delivery, in the relative funding allocated, and in the realisation that investment in the care of children and young people will reduce the cost of care later in life.” Source: Getting it Right for Children and Young People

Changing the NHS “ The starting point must be a network of arrangements. The obvious candidate is the general practice. The practice must be the single point of access, open at all times, at which the child or young person, with a parent or carer alone, is assessed and routed to the most appropriate professional (for example nurse, counsellor, doctor) for the most appropriate treatment, wherever it is best provided. The general practitioner will take on a more positive role: not so much the ‘gatekeeper’ of the past, more the ‘navigator’ of the future. The general practice must be at the hub of the network of services that the Local Partnership has determined are necessary. The general practice has a particularly important role, as the hub of a network of services, to ensure that the services are sustainable over time.” Source: Getting it Right for Children and Young People

Finally, at the centre of any system for providing services are the professionals. The challenge for them is to re-engage with the system so as to change it for the better. It cannot change without them. The prize at stake is the chance to be the professionals they want to be. The greater prize is services for children and young people that they and the NHS can be rightly proud of. Source: Getting it Right for Children and Young People

Achieving Equity and Excellence for Children

Key Messages Support for the conclusions of the Professor Sir Ian Kennedy Report Reinforce the changes in the “White Paper”. Acknowledge the challenges concerning the quality of services and suggest that child health services have received “disproportionately low priority” Committed to improving outcomes for children and young people

Challenges for Children’s Services Increased demand for specialist care Improvements in outcomes for long-term conditions Developing highly specialised services Improving service for vulnerable children Increasing efficiency Improving safety

Opportunities for Change New commissioning arrangements? Transforming models of care, working with GPs and community services? Pharmacist independent prescribing? Research and Development? New business opportunities?