The New NHS & Local Health Economies Michael Sobanja UK Vision Strategy Networking Day 29 April 2014

Historical Principles of the NHS A common risk pool A Nationalised Industry

The NHS is no longer a single organisation Northern Ireland – Pooled Budgets across Health and Social Care – No Provider competition England – Quasi market – Complex funding systems – Market entry and exit – Patient choice and competition – Means tested social care Wales No quasi market in health care No Prescription charges Scotland No quasi market in health care No Prescription charges State funded personal care

The NHS In England The Health and Social Care Act 2012

What does the Act really do? Establishes an independent NHS Board to allocate resources and provide commissioning guidance Increases GPs’ powers to commission services on behalf of their patients Transfers Public Health to Local Authorities and Public Health England All Hospitals to become Foundation Trusts Installs robust regulation (Monitor and CQC) Frees Market entry and market exit – AQP and Failure Regime

The architecture... 1 NCBA 4 Regions 27 Local Area Teams 19 Commissioning Support Services 10 Specialised Commissioning LATs 211 Clinical Commissioning Groups 12 Clinical Senates 4 Strategic Clinical Networks 130+ Health & Wellbeing Boards

NHSE Mandate Treasury 110bn DH Public Sector Agreement Specialist commissioning Primary Care Contracting LA PH HWB 5-6% Hospitals Prescribing CCG 55% Follow the money Trail – Now...

An example of a Local Health Economy from April 2013

Purpose Improve Health and wellbeing of the population within available resources...

Personal Health Budgets

Multiple and sometimes conflicting priorities...

Future Scenarios Consolidation of Health Bodies – CCGs – LATs – CSUs Recreation of HAs/PCTs Overt Centralisation – NHS England takes commissioning Local Authorities assume responsibility for health budgets Healthwatch as mutuals take funding decisions