Health reform in England: update and commissioning framework DRAFT Health reform in England Health reform in England: update and commissioning framework Anthony Kealy Head of Commissioning Policy 18/04/2019 20:52

Commissioning and the health reforms DRAFT Health reform in England Commissioning and the health reforms Money following the patients, rewarding the best and most efficient providers, giving others the incentive to improve (transactional reforms) More diverse providers, with more freedom to innovate and improve services (supply-side reforms) Better care Better patient experience Better value for money More choice and a much stronger voice for patients (demand-side reforms) At its simplest, the way we see the role of the NHS is very straightforward: Our patients have demands for healthcare – they deserve a much stronger voice and the ability to choose providers We supply healthcare in response to those demands through more diverse providers with more freedom to innovate and improve services As well as handling those demands and supplying appropriate healthcare, the healthcare system also needs mechanisms for transacting within itself, and with its partners, in the overall provision of healthcare. Money should “follow the patient” to reward the best and most efficient providers and incentivise others to improve. And we need the service to operate within an overall environment of management and regulation that ensures the overall goals are met – that will guarantee safety and quality, fairness, equity and value for money. The combined effect will be: better care, better patient experience and better value for money A framework of system management, regulation and decision making which guarantees safety and quality, fairness, equity and value for money (system management reforms) 18/04/2019 20:52

The health reform programme Completed Health reform in England: update and next steps (December 2005) Our health, our care, our say (January 2006) The NHS in England: operating framework (January 2006 Health reform in England: update and commissioning framework (July 2006) Next stages Future of PbR System Management and Regulation Commissioning Framework second phase: joint commissioning and health and wellbeing Provider development

Update and commissioning framework Updates: Reform programme Choice and commissioning Provider development System management and regulation Tariff, incentives and information And publishes the commissioning framework

The commissioning framework Main Themes Better clinical and community engagement Better information to support commissioning Incentives and contracts Securing the cash limit Developing capacity and capability

Better clinical engagement through PBC Clearer procurement requirements – no tendering Pump-priming loans available Local incentive schemes Payment at tariff for services moved from hospitals Proposals on governance and accountability Approval of PBC plans for service redesign Contributing to restoring financial balance Demonstrating accountability

Stronger community engagement A stronger voice for patients and communities: A new PCT Prospectus Role of LINks Third sector involvement Proposals on triggering community action

Better information to support commissioning Sets out the approach to improving information: Using the insights provided by patients, providers, communities and local authorities Developing strategic solutions such as CfH SUS

Incentives and contracts Using open tendering to attract new providers where services are unavailable or of poor quality No tendering requirement for PBC developments Using time-limited financial incentives and activity guarantees where appropriate Makes proposals for a national model contract

Securing the cash limit Using techniques such as referral management, prior approval, and utilisation management alongside Choice, PBC and PbR Applying interim measures permitted by the Operating Framework in exceptional circumstances: Clear activity assumptions and agreed profiles in contracts Clear apportionment of financial responsibility where balance is at risk

Developing capacity and capability PCT development, building on Fitness for Purpose Developing an evidence base of effective commissioning Development of PBC Supporting PCTs to buy-in private sector skills

Next Steps Consultation until 6 October Engagement with the NHS via SHAs Development of national model contract Final guidance on Contracting for NHS care PBC governance and accountability Triggering community action Phase 2 of the Commissioning Framework

The Commissioning Framework Phase 2 Joint Commissioning for Health & Well-being (December 2006): Health improvement Commissioning for LTCs (including mental health) Commissioning for Children and Maternity Future of joint commissioning Interface PBC & Social Care (individual budgets) Commissioning Primary Care

Tackling Barriers in Phase 2 Spending between health and social care budgets Financial flows and incentives for preventative spending Empowering individuals, eg health/ soc care plans Service provision models Getting the metrics right Improving data sharing Accountability mechanisms Simplifying points of access / gateways