Armed Forces Health Commissioning Arrangements Melanie Iredale Head of Armed Forces Commissioning Tuesday 11th November 2014

Armed Forces Commissioning Cement the “No disadvantage” requirement as specified in Armed Forces Covenant and Government’s Mandate to the NHS A single, national body commissioning for the serving armed forces with one set of commissioning policies Build commissioning capability in the new system so as to credibly build networks and relationships Standard operating procedures for Armed Forces personnel in development

NHS England - Armed Forces Health NHS England Board NHS England Operations Directorate CCGs Reservists, Veterans’ & Families Commissioning Armed Forces Commissioning Design Principles : Retain: Knowledge, expertise, capability, continuity, skillsets, credibility Ensure: Momentum, partnerships, linkages, AFNs, practical configuration and delivery Area Teams – x 3 CCGs - Veterans, Families, Reservists, Armed Forces Networks lead Health and Wellbeing Boards, AFNs, Community Covenant and partnerships Armed Forces Commissioning Interface between MOD and Providers (Securing Excellence – Military Health) Veterans’ and families commissioning Transition management Veterans, reservists and families

Armed Forces commissioning responsibilities   Serving Armed Forces in England Serving Armed Forces overseas Armed Forces Families registered with DMS med centres in England Armed Forces Families registered with DMS med centres overseas Armed Forces Families registered with NHS GP Practices Reservists while mobilised i Veterans (inc. reservists when not mobilised) Primary Care DMS ii DMS NHS England & NHS England iv Community Mental Health CCGs Secondary acute & community care CCGs iii MOD Enhanced pathways N/A i - Reservists have access to DMS care whilst mobilised ii - Serving personnel can access local GPs on an emergency basis if needing to access care whilst away from the military address iii - The NHS England will commission specialised services for veterans, e.g. limb prostheses, iv - While overseas, serving personnel and families can access DMS-commissioned healthcare where such provision exists, or may be provided with non-DMS healthcare by local Host Nation or other contracted arrangements, or have right of return for NHS England-commissioned NHS care in England

Armed Forces commissioning responsibilities: Structures post-April 2013 NHS England COO DoC (Corporate) Ann Sutton NHS North NHS Mildands NHS South NHS London Hd PH, Armed Forces and Offender Kate Davies DoC Julie Higgins DoC Catherine O’Connell DoC Sue Davies DoC Simon Weldon N Yorks &Humber AT Hd of Spec AF Melanie Iredale Comm Mgr –North Jim Khambatta DoC Julie Warren Notts & Derbs AT Hd of Spec AF Alison Treadgold Comm Mgr - Mids Ann Berry DoC Vicky Taylor Bath, Swindon & Wilts AT Hd of Spec AF Jenny Kirby Comm Mgr -South Sharon Greaves/Karen Beckett DoC Debra Elliott Head of Public Health, Armed Forces and Offender Health Commissioning Alison Frater Kenny Gibson AF Network Lead/Transition Richard Swarbrick Asst Hd Military Andy Bacon Armed Forces Networks Wayne Kirkham National Lead National Veteran Mental Health Network Comm Mgr – James Carter CCGs - Link to JSNA and H&Wb Bds

Armed Forces Governance Structure External Assurance Groups External Partnership Groups NHS England Internal Oversight & Assurance structures Operations & Delivery structures NHS England Board Armed Forces Partnership Board DMS/NHS England Joint Commissioning Group Directly Commissioned Services Committee Clinical Priorities Advisory Group ETM Health Partnership Working Group Armed Forces Oversight Group AF CRG Operations SMT Internal Delivery Groups (Armed Forces) Screening & Immunisations Delivery Group Patient & Public Voice Forum Armed Forces Networks Defence Recovery Steering Group Veterans Mental Health Network CRG sub- groups as required AF Joint Commissioning Task & Finish Groups

DH Future Roles Policy Governmental and inter departmental business 2 Murrison Reports Mental Health Provision: Veterans MH Network Big White Wall Prosthetics: National Funding of Veterans Prosthetics Improved Disablement Support Centres Veterans Information Service

MoD/Joint Medical Command MoD (Chief of Defence Personnel) deliver (support): Tri-service welfare and recovery Chain of Command looks after/owns service personnel under their command (Single Service or Tri Service) Transition Recovery MoD (Joint Medical Command) still commission/provide (supporting) healthcare: Operational Care Primary Care Rehabilitation Community Mental Health Inpatient Mental Health (NHS Provided) n.b. note supporting/supported tension that we understand Joint Medical Command

Obligations “The NHS and its public sector partners need to work together to help one another to achieve their objectives. …. This includes, in particular, demonstrating progress against the Government’s priorities of: upholding the Government’s obligations under the Armed Forces Covenant; The Covenant says: The Armed Forces Community should enjoy the same standard of, and access to, healthcare as that received by any other UK citizen in the area they live. Personnel injured on operations should be treated in conditions which recognise service needs For family members, primary healthcare may be provided by the MOD in some cases (eg when accompanying Service personnel posted overseas). And … should retain their relative position on any NHS waiting list, if moved around the UK due to the Service person being posted. Veterans … should receive priority treatment where it relates to a condition which relates to .. their service, subject to clinical need Those injured in service should be cared for in a way which reflects the Nation’s moral obligation …with professionals who have an understanding of Armed Forces culture

NHS England England (not whilst Overseas), or Devolved Administrations Direct Commissioning: Post Operational Health Care (non-recovery) Community Care Hospital Care (also for MH not in main contract) Specialist IVF IVF on Moves Indirect Commissioning: CCG Assurance DMS – NHS IM&T Connectivity NHS England Other: Dental, “Specialised”, Offenders, Immunization, Vaccination and Screening

Armed Forces Networks All Local Stakeholders: Regional Armed Forces Structures PRUs Local NHS – Commissioners and providers Local Authorities Charities Veterans Organisations Currently 9 in England mapped closely to Brigade structure NHS Armed Forces Charities Local Authorities

Planned Improvements Continuity of Care Pathway redesign (especially roles of 1ry/2ry) Improved Choice Recording and Performance monitoring of quality Referrer Involvement Patient and Carer involvement

Issues Very poor data: £15M or £170M? Philosophical Differences: “The Armed Forces Community is entitled to appropriate recognition for the unique Service which it has given, and continues to give, to the Nation, and the unlimited liability which the Service person assumes” AF Covenant “Only clinical features taken into account: The NHS CB must make decisions fairly about funding treatments and not on the basis of age, sex, sexuality, race, religion, lifestyle, occupation, family status (including responsibility for caring for others) social position, financial status etc. unless these directly affect the expected clinical benefit that an individual will derive from a treatment” NHS England Interim Standard Operating Procedures

So what does this mean for CCG’s Involvement in Armed Forces Networks New North East, Yorkshire & Humber AFN CCG stewardship Rotating chair Multi-agency representation Veteran’s Awareness Identification at practice level RCGP e-learning tool Staff training

Continued ….. Veteran Mental Health Services Outreach services Big White Wall Combat Stress residential

Thank you! http://www.england.nhs.uk/resources /resources-armed/