The new NHS landscape Author: Debbie Kennedy, Programme and Project Manager, with thanks to Lawrence Tyler, Commissioning Development, NHS South of England 13/09/2012

Two systems 1.Overview of the new commissioning system; –Clinical Commissioning Groups (CCGs) –Commissioning Support Units (CSUs) –NHS Commissioning Board / 2. Overview of new Provider system; –National Provider Development Authority –Clinical Networks –Clinical Senates –Academic Health Science Networks –Foundation Trusts –Monitor 2

HEALTH WARNING: This is a 29 slide presentation but please stick with it as it describes most of the NHS organisations that inhabit the new landscape! 3

Department of Health 10 Strategic Health Authorities 152 Primary Care Trusts Healthcare providers NHS commissioner landscape (before Health and Social Care Act 2012) 4

Department of Health NHS Commissioning Board 212 Clinical Commissioning Groups (£25/head) NHS commissioner landscape from 1st April Commissioning Support Services Healthcare providers 5

Commissioner System –Clinical Commissioning Groups (CCGs) –Commissioning Support Units (CSUs) –NHS Commissioning Board, Regional Offices & Local Area Teams (LATs) 6

Clinical Commissioning Groups (CCGs) Clinical Commissioning Groups are groups of clinicians that will, from 1 April 2013, be responsible for commissioning local health services across England. These services include planned and emergency hospital care, rehabilitation, most community services and mental health and learning disability services. 7

Clinical Commissioning Groups (CCGs) They must have governing bodies in place: Chair of the governing body Accountable officer and Chief finance officer Lay member (lead role in overseeing key elements of governance) Lay member (lead role in championing patient and public involvement) and; Secondary care doctor and registered nurse. 8

Clinical Commissioning Groups (CCGs) There is a national authorisation process that will test Clinical Commissioning Groups to ensure that they have the capacity and capability they need in order to take responsibility from 1 April 2013: Wave 1 (July 12) Wave 2 (Sept 12) Wave 3 (Oct 12) Wave 4 (Nov 12) Desktop review 360 feedback Site visits 9

Clinical Commissioning Groups (CCGs) proceeding to authorisation 50 CCGs across NHS South of England 10

Clinical Commissioning Groups (CCGs) Current priorities: Recruitment to senior leadership roles and governing body Governance structures + constitution Commissioning support development Collaboration and federated agreements Delivery/building a track record and; Getting ready for authorisation! 11

Commissioning Support Units (CSUs) Most Clinical Commissioning Groups will buy in services from Commissioning Support Units Commissioning Support Units are being set up by PCT Clusters These services may include (as examples) contract monitoring, performance management, contract negotiation, medicines management and prescribing services. 12

Commissioning Support Units (CSUs) Clinical Commissioning Groups have been working with Commissioning Support Units to decide what services they will build themselves, what they will buy from CSUs or others and what they will share with other CCUs (their build/buy/share arrangements). 13

Commissioning Support Units (CSUs) Across NHS South of England, there are five emerging Commissioning Support Units They are currently being tested through a national assessment process Commissioning Support Units that pass through the national assessment process will be hosted by the NHS Commissioning Board from 1 April 2013 In the future, they are expected to become commercial organisations. 14

Commissioning Support Services (CSUs) 1. Best West (Bristol, North Somerset, South Gloucestershire and Somerset) 2. Central Southern (Gloucestershire and Swindon, Berkshire, Buckinghamshire and Oxfordshire) 3. Commissioning Support South (Southampton, Hampshire, Isle of Wight and Portsmouth) 4. Surrey and Sussex 5. Kent and Medway N.B. There are no CSUs yet covering Devon, Cornwall and Dorset 15

NHS Commissioning Board The NHS Commissioning Board will be nationally accountable for the outcomes achieved by the NHS, and will provide leadership for the new commissioning system The NHS Commissioning Board will have overall responsibility for a budget of £80bn, of which it will allocate £60bn directly to Clinical Commissioning Groups. 16

NHS Commissioning Board There will be: 1 Board 4 regions (South, London, Midlands and East, North) 27 Local Area Teams (7 across the South) 17

Local Area Teams of the NHS Commissioning Board (LATs) across NHS South of England 1. Devon and Cornwall 2. Bristol, North Somerset and South Gloucestershire 3. Bath and North East Somerset, Wiltshire, Gloucestershire, and Swindon 4. Bournemouth, Poole, Dorset, Southampton, Hampshire, Isle of Wight and Portsmouth 5. Berkshire, Buckinghamshire and Oxfordshire 6. Surrey and Sussex 7. Kent and Medway 18

NHS Commissioning Board The 27 Local Area Teams will have the same core functions around CCG development and assurance, Emergency Planning Resilience and Response, quality and safety, partnerships, configuration and system oversight, but will have variations in their direct commissioning responsibilities. 19

NHS Commissioning Board All Local Area Teams will take on direct commissioning responsibilities for GP services, dental services, pharmacy and optical services Around 10 will lead on specialised commissioning across England A small number will carry out the direct commissioning of military health NHS services. 20

Provider System –NHS Trust Development Authority –Clinical Networks –Clinical Senates –Academic Health Science Networks –Foundation Trusts –Monitor 21

NHS Trust Development Authority Following the abolition of Strategic Health Authorities (SHAs), the NHS Trust Development Authority (NHS TDA) will be responsible for overseeing the performance management and governance of NHS Trusts, including clinical quality, and managing their progress towards foundation trust status The NHS Trust Development Authority is a short- term body which will cease to exist when all Trusts are Foundation Trusts. 22

Academic Health Science Networks AHSNs were recommended in “Innovation Health and Wealth” which was launched by Prime Minister alongside the Life Sciences Strategy December 2011 They will provide a systematic delivery mechanism for local NHS, universities working with industry and other partners such as local government to transform the identification, adoption and spread of innovations and best practice Application will be by prospectus which the AHSNs need to prepare themselves. 23

Clinical Senates Clinical senates will have a close relationship with strategic clinical networks. Each geographical area will have one clinical senate, taking a broader, strategic view on the totality of healthcare within that patch Clinical senates will provide evidence-based advice to help commissioners put the needs of patients above those of organisations or professions. They are likely to play a key role in providing a strategic overview of major service change – for example, on service redesign and reconfiguration. 24

Clinical Networks Many different type of clinical networks are in existence and this is valued by the DH However, only Strategic Clinical Networks (SCNs) will be established and hosted by the National Commissioning Board from April 2013 – the remainder will be have to secure their own resources from providers or commissioners The SCNs will be: Cancer, Cardiovascular disease, Maternity and Children, Mental Health, Dementia and Neurological Conditions. 25

Foundation Trusts NHS foundation trusts are firmly part of the NHS and subject to NHS standards, performance ratings and systems of inspection However, NHS foundation trusts are different from existing NHS trusts in the following ways: –They are independent legal entities - Public benefit corporations –They have unique governance arrangements and are accountable to local people, who can become members and governors. 26

Foundation Trusts Foundation Trusts are different from NHS Trusts: –They are set free from central government control and are no longer performance managed by health authorities. As self-standing, self-governing organisations, NHS foundation trusts are free to determine their own future –They have new financial freedoms and can raise capital from both the public and private sectors within borrowing limits determined by projected cash flows and therefore based on affordability. They can retain financial surpluses to invest in the delivery of new NHS services –They are overseen by Monitor. 27

Monitor Monitor is an independent regulator of NHS Foundation Trusts The Health and Social Care Act 2012 makes changes to the way health care is regulated in order to strengthen the way patients interests are promoted and protected Monitor will become the sector regulator for all health care and will need to work closely in this role with the Care Quality Commission (CQC) which is the current regulator for both health and social care services. 28

Other Health Bodies (not explained in this presentation) Health and Wellbeing Boards Public Health England Health Education England Health watch England 29