Equity and Excellence: Liberating the NHS What does it mean for North Somerset? Chris Born Chief Executive

No decision about me, without me Best outcomes not targets Empower clinicians New Health Partnership Patients empowered through transparent information

Local authority leads the Health & Wellbeing Board from 2012 New Healthwatch to replace the Local Involvement Network (LINk) Public health department moves to the Council

GP Commissioners (GPC) North Somerset GPC Consortium Shared commissioning of hospitals (and mental health?) across wider area National Commissioning Board for some services

All existing PCT community services New social enterprise from April 2011 Focus on integrating care with social services and hospitals Comments by 23 February

PCTs abolished 2013 NHS South West (SHA) abolished 2012 PCTs will work as a cluster as management reductions occur Stronger external regulation of the system as now

Operating Framework 2011/12 Mental Health Strategy due out 2011 –Public health –Better service outcomes –Early intervention and prevention (e.g. offenders) –Drug services –IAPT expansion to young, old, severe mi, long term conditions –Victims of violence

Greater choice of treatment and provider Improve services for veterans Support for carers Fines for mixed sex accommodation (including day areas) Key measures (e.g. early intervention, crisis/home treatment, CPA, IAPT) remain for 2011/12 Operating Framework 2011/12

New outcomes for 2012/13 (e.g. preventing premature death in people with severe mi, employment, experience of service)

Finance Service providers: 4% efficiency per year Commissioners: similar amount via service redesign Total: £20bn savings over 4 years (e.g. £12m for NS in 2011/12) North Somerset: 4.1% growth (vs. average of 2.2), but 7.2% below target (£22m) Management reductions Pay freeze if earning > £21k Mandatory use of mental health clusters

Payment by Results and Care Clusters THE CURRENCIES AND A TARIFF WILL BE VITAL TO MAKE THE FLOW OF MONEY HAPPEN IT WILL BE ESSENTIAL IN THE EXPECTED TOUGH CLIMATE TO QUANTIFY BOTH NEEDS AND THE BENEFITS AND COSTS OF INTERVENTIONS TO MEET NEEDS. OTHERWISE THERE MAY BE PRESSURE TO STOP FUNDING.

WORKING AGE ADULTS AND OLDER PEOPLE WITH MENTAL HEALTH PROBLEMS Non- psychotic Psychosis Organic Very severe and complex Substan ce misuse First episode Severe ongoing Acute emergen cy Very severe engagement Mild/ moderate/ severe Cognitive impairme nt

THREE KEY BENEFITS FROM PBR : 1.BECAUSE CURRENCIES ARE NEEDS BASED THEY SHOULD GIVE COMMISSIONERS A CLEAR IDEA OF THE BALANCE OF NEED AMONGST THOSE ACCESSING SECONDARY SERVICES AND HELP SERVICE PLANNING/PRIORITISATION 2.PBR SHOULD ENSURE A REGULAR AND TIMELY FLOW OF INFORMATION TO THE COMMISSIONER ON WHAT IS HAPPENING TO THEIR USERS AND ON INDIVIDUAL USER OUTCOMES 3.BY THE USE OF STANDARDISED CURRENCIES AND POTENTIALLY TARIFFS, VFM CAN BE BETTER EVALUATED, COMPARED WITH BENCHMARKS AND IMPROVED