Policy and Public Affairs update for Southern Network meeting 4 October 2012

Overview 1.The new quality, accountability and improvement architecture 1.1 Secretary of State’s mandate to the NHS Commissioning Board 1.2 NHS Outcomes Framework 1.3 Commissioning Outcomes Framework 1.4 NICE quality standards 2.‘It’s time for a better deal for neurology’ campaign 2.1 Public Accounts Committee follow up hearing 2.2 Developing relationships with the NHS Commissioning Board 2.3 Implications of the Government’s reshuffle 3.Strategic clinical network (SCN) for mental health, dementia and neurological conditions 3.1 Role of SCNs 3.2 Operation 3.3 Development timetable

1. The new quality, accountability and improvement architecture 1.1 Secretary of State’s mandate to the NHS Commissioning Board Purpose The mandate will set a series of objectives for the NHS Commissioning Board and describe the Government’s expectations of what it will achieve. It will act as a key means through which the Secretary of State for Health will hold the Board to account for its performance. Consultation on the draft mandate and the Neurological Alliance’s response The Department of Health has just concluded its consultation on the draft mandate, to which the Neurological Alliance responded at the end of September. Key issues drawn out in our response included the need for the madate to: reference neurology and other similarly large condition areas to ensure that the Commissioning Board has explicit responsibility to monitor and support commissioners in respect of these substantial patient populations highlighting the necessity of achieving early and accurate diagnosis, particularly in relation to complex, less common and rare conditions stress the importance of the relationship between the Board and patient representative and other third sector organisations position strategic clinical networks as key sources of advice and insight, with which commissioners have a duty to engage on an ongoing basis and will be assessed against

1. The new quality, accountability and improvement architecture 1.2 NHS Outcomes Framework Purpose The NHS outcomes framework sets out the outcomes and corresponding indicators that will be used to hold the NHS Commissioning Board (NHS CB) to account for the outcomes it delivers through commissioning health services from 2012/13. Indicators in the NHS Outcomes Framework are a basis for indicators in the Commissioning Outcomes Framework. Neurological Alliance’s work around the NHS Outcomes Framework Given the virtual omission of neurology from the NHS Outcomes Framework, the Alliance worked with the Neurology National Leadership Group and MHP Health Mandate to develop a report, Intelligent Outcomes, identifying a range of key neurological outcomes for use in future versions of the NHS Outcomes Framework. Intelligent Outcomes also makes a series of practical policy solutions to enable enhanced monitoring of neurological outcomes including: Commissioning of a national survey for people with neurological conditions to gather insights into patient care Appointment of a lead public health observatory for neurology Development of neurology specific patient reported outcome measures (PROMs)

1. The new quality, accountability and improvement architecture 1.3 Commissioning Outcomes Framework (COF) Purpose The COF will measure the health outcomes and quality of care achieved by clinical commissioning groups, allowing the NHS CB to hold clinical commissioning groups to account for their contribution towards achieving the priorities for health improvement set in the NHS Outcomes Framework. Developments on the COF NICE has made a final recommendation to the NHS Commissioning Board on the 42 indicators it suggests should populate the 2012/13 COF; of these indicators, of the 10 neurology-relevant indicators, 8 relate to stroke. The NHS Commissioning Board will make a final decision on the COF indicators in autumn Given that indicators in the COF are sourced from the NHS Outcomes Framework and published NICE quality standards, of which there are only 2 for neurology to date, it is highly unlikely that the 2012/13 COF will include further neurology indicators in addition to those relating to stroke, dementia and epilepsy recommended by NICE.

1. The new quality, accountability and improvement architecture 1.4 NICE quality standards Purpose Quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care. Like indicators in the NHS Outcomes Framework,, they are a basis for inclusion in the COF. A key function if to enable commissioners to be confident that the services they are purchasing are high quality and cost effective and focussed on driving up quality. Developments on quality standards There are currently 15 confirmed neurological quality standards due to be published by 2015, including one for rarer neurological conditions. Only 2 to date have been published, for stroke and dementia. Quality standards for epilepsy in children and in adults are due to be published by the end of 2012 and development of the headache and migraine quality standard is scheduled for next year. Development timescales for the remaining neurology quality standards is not yet confirmed, although those conditions with a NICE guideline will be developed prior to those without.

2. ‘It’s time for a better deal for neurology’ campaign update 2.1 Public Accounts Committee (PAC) follow up hearing Following the Government’s response to the PAC’s report on neurological services in April 2012, the Committee called Sir David Nicholson back in September to explain the contrast between his oral evidence to the Committee at the beginning of the year and the Government’s formal response to the PAC’s recommendations. In preparation for the hearing, the Neurological Alliance: briefed a number of key PAC members, including the Committee’s Chair met with Dr Martin McShane, the new NHS Commissioning Board lead for long term conditions developed a joint evidence submission for the PAC with the Association of British Neurologists Outcomes of the hearing The PAC has asked that Sir David Nicholson sends formal notes to the Committee on: 1.what neurological data will be captured by the new neurology dataset and when the first version will be published; 2.the new clinical leadership arrangement at national level; 3.available data on readmissions to assess what proportion are reasonable and clinically required; 4. the timetable for development of NICE quality standards.

2. ‘It’s time for a better deal for neurology’ campaign update 2.2 Developing relationships with the NHS Commissioning Board Relevant individuals appointed to the NHS Commissioning Board to date: Professor Sir Bruce KeoghMedical Director Jane CummingsChief Nursing Officer Dr Martin McShane Lead for long term conditions Professor Sir Mike Richards Lead for preventing premature death Professor Keith WilletsLead for acute episodes of care The Commissioning Development and Patient and Public Involvement Directorates will also be a focus for the Alliance as it develops an effective working relationship with the Board. Forward role of the Department of Health Interactions with Departmental representatives in recent months suggest that the Department is keen to remain informed on issues that the Alliance is working on and, where relevant, to partner with us to present a united case to the NHS Commissioning Board. However, the Department is abundantly clear that it no longer has responsibility for giving strategic direction to the NHS and that matters for the NHS Commissioning Board should not be addressed to Departmental officials.

2. ‘It’s time for a better deal for neurology’ campaign update 2.3 Implications of the Government’s reshuffle Jeremy Hunt MP - Secretary of State for Health (Con) Elected as MP for South West Surrey in May 2005; Shadow Minister for Disabled People ; Shadow Culture Secretary ; Secretary of State for Culture, Olympics, Media and Sport Norman Lamb MP - Minister of State (Lib Dem) Elected as MP for North Norfolk in May 2001; roles include Liberal Democrat Shadow Health Secretary ; Assistant Government Whip, Chief Parliamentary and Political Adviser and Parliamentary Private Secretary to the Deputy Prime Minister, Nick Clegg Other members of the ministerial team: Dr Daniel Poulter MP (Con, Central Suffolk and North Ipswich) - Parliamentary Under Secretary of State Anna Soubry MP (Con, Broxtowe) - Parliamentary Under Secretary of State Earl Howe (Con) - Parliamentary Under Secretary of State

3. Strategic clinical network (SCN) for mental health, dementia and neurological conditions 3.1 Role of SCNs SCNs are groups of multidisciplinary health professionals, patients and the public that the NHS Commissioning Board (NHS CB) is establishing in areas of major healthcare challenge for defined conditions or groups of patients. SCNs will focus on areas where large scale change is needed across very complex pathways of care to achieve improvement in quality and outcomes of care. SCNs will:  Provide clinical advice and support to clinical commissioning groups (CCGs)  Help commissioners reduce unwarranted variation in services  Assist commissioners in improving outcomes and ensuring best value for money  Encourage innovation and support change projects  Form close partnerships social care and the voluntary sector  Engage patients and the public in all their work

3. Strategic clinical network (SCN) for mental health, dementia and neurological conditions 3.2 Operation The NHS Commissioning Board will fund SCNs and administer each via support teams across England. The Board will set out what it expects each SCN to achieve in an individual improvement programme. Each SCN will sit under one of the five domains of the NHS Outcomes Framework and will be overseen by the national clinical lead for that domain. A new improvement body will also provide national support for SCNs, including  sharing and disseminating good, innovative practice, training, development, coaching and support and trouble shooting. Under the SCN model England will be divided into 12 patches mapping onto CCG and local authority boundaries. Each patch will contain a SCN support team led by a part-time clinical director and an overall network director. The teams will perform a number of functions including:  helping networks to develop an annual programme of quality improvement based on local and national priorities  enabling quality assurance processes, including clinical audits  supporting the assessment of network activity

3. Strategic clinical network (SCN) for mental health, dementia and neurological conditions 3.3 Development timetable

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