1 Commissioning a Patient-Led NHS – Consultation

2 This presentation will cover: Why consult? Context and the need for change Roles of the new organisations ( SHA, PCT and Ambulance) Proposals, decisions and outcomes Learning and areas of concern Benefits/disadvantages Financial issues Boundary issues How you can have your say

3 Why consult? We want to listen to those who use, fund (as tax payers) or are partners working with the NHS, in order to enhance the decision making process and make the NHS work for you Your views are important to us

4 Context Part of an ongoing reform process In line with the NHS Plan Shifting the balance of power and Creating a Patient-Led NHS and ‘Taking Health Care to Patients’ ‘Choosing Health’ Purpose of changes - improvements in health and in services Organisations - ‘fit for purpose’

5 The need to change In order to:  strengthen commissioning and health improvement and free up resources to invest in front line services  Adapt to the formation of Foundation Trusts and New ways of paying for health services (Payment by results)  Forge strong partnerships with Local Authorities, Voluntary Sector and other key agencies.  Realise a Patient Led NHS  Improve the health of the population

6 What do we mean by ‘Commissioning’? How the NHS spends its money Planning and paying for services whilst assuring quality, fairness and value for money Developing services in response to the preferences, lifestyles and needs of the local population

7 Practice Based Commissioning GP practices ( or groups of practices) commissioning services on behalf of their local population Designing patient pathways Working in partnership with the PCT to create local convenient community services Responsible for a delegated budget which will cover acute, community and emergency care

8 Role of the ambulance service ‘….. from a service focusing primarily on resuscitation, trauma and acute care to becoming a mobile health resource to the whole NHS’ Patients receive improved care More treated in the community More effective use of NHS resources Greater job satisfaction for staff Improvements in self care and health promotion

9 Role of new SHA ‘Builders’ – commissioning,organisations and systems Maintaining a local strategic overview of the NHS Performance Management Responsible for ensuring services are high quality safe and fair Working with Department of Health,Regional offices & Learning and Skills Council Leading Emergency and Resilience Planning

10 Role of new PCT Stronger Commissioning bodies Particular focus on Practice based commissioning Integrated commissioning of health and social care Health Improvement /partnership working Clinical engagement Public engagement/involvement Emergency planning

National CriteriaLocal Considerations Secure high quality services Provision of clear/consistent patient pathways; Compliance with Standards for Better Health; Clinical Governance. Clinical Networks. Integration opportunities Improve the engagement of GP’s and rollout of Practice Based Commissioning with demonstrable practice support Relationship maintenance. Improved clinical engagement. PEC considerations. Working in partnership to create community based services Improve health Public Health Capacity. Congruence with Local Authority/Social Services boundaries. Local Strategic Partnerships. Opportunities for joint working/posts. Long Term Conditions management. Children’s Trust plans. Mental Health Services. Alignment of health needs and access to services Improve public involvement Zone/patch/neighbourhoods arrangements. Management Capacity/ Critical mass. Maintaining the local Face of the NHS/sense of identity the public can understand. PPI forum relationships Improve commissioning and effective use of resources Management capacity/Critical Mass. Commissioning and Public Health Expertise. Local Area Agreements and LSP’s, joint working opportunities. Potential for pooled or aligned budgets with key partners Manage financial balance and risk Management capacity. Scale of budget. Risk management arrangements Improve co-ordination with social services through greater congruence of PCT and Local Government boundaries Boundary/Geographical considerations of new organisation. Deliver at least 15% reduction in management and administrative costs

12 Proposals – Decision making process SHA - Joint SHA decision for 2 SHAs to be replaced by one PCT - option appraisal process and multi- stakeholder event SHA Board decision - 29 th Sept Ministerial review of proposals and decision on consultation options - 30 th Nov Ambulance service - outcome of a national review of ambulance services

13 Outcome – SHA and Ambulance We are therefore consulting on: 1 SHA for the East Midlands (combining Leicestershire Northamptonshire and Rutland SHA with Trent SHA) 1 Ambulance Trust for East Midlands (combining Lincolnshire, East Midlands and Half of Two Shires Ambulance services) Each new organisation is coterminous with the government regional office boundaries

14 Outcome PCTs – 2 options Option 1 One PCT for the city of Leicester One PCT for the counties of Leicestershire and Rutland One PCT for the county of Northamptonshire Option 2 One PCT for the city of Leicester One PCT for the counties of Leicestershire and Rutland Two PCTs for the county of Northamptonshire

15 For Leicestershire and Rutland 1 PCT for Leicester City (combining the current 2 PCTs - Eastern Leicester PCT and Leicester city West 1 PCT for Leicestershire and Rutland (combining Charnwood and North West Leicestershire,Hinckley and Bosworth, Melton Rutland and Harborough and South Leicestershire PCTs and Bottesford, Croxton and Kegworth) Each new PCT will be coterminous with its respective Local Authority which provides Social Services

16 Northamptonshire 1 One PCT for Northamptonshire - combining Northampton, Daventry and South Northamptonshire plus Brackley and Byfield and Northamptonshire Heartlands PCTs plus Oundle and Wansford This solution provides complete co-terminosity with Northamptonshire County Council Social services and all 7 Borough/District Councils

17 Northamptonshire 2 or 2 PCTs 1 PCT for South Northamptonshire combining Northampton and Daventry and South Northamptonshire PCTs (inc Brackley and Byfield) 1 PCT for North Northamptonshire Northamptonshire Heartlands PCT plus Oundle and Wansford Each PCT would be co-terminous with its respective borough/district councils

Geographical area

19 Option 1

20 Option 2

21 Learning points - from the engagement and option appraisal processes Generally importance of: ‘Localness’ Clinical and public engagement/involvement Partnership working Particularly in Northamptonshire: Equitable resource allocation

22 Potential benefits of fewer PCTs Stronger commissioning functions Increased support to General practice for Practice Based Commissioning Coterminosity with local authorities providing social services (esp. LSPs and LAAs) Stronger more effective public health function Enhanced opportunities to achieve 15% cost savings Minimisation of financial risk

23 Potential disadvantages Loss of ‘localness’ Risk to clinical engagement Potential inequitable application of funds – for those areas that experience the greatest public health challenge Impact on relationships with District/Borough Councils

24 Financial issues Target of 15% saving in management and admin HR applied in accordance with national framework For LNR savings required= £7 million Savings recurrent from 2008/09 Where will the money come from? £4.5m PCT reconfiguration £2.5m SHA reconfiguration

25 Boundary issues Realignment of GP Practices whose contracts are administered by PCTs outside of their respective county boundaries to enable co-terminosity with Social Services. Brackley and Byfield Oundle and Wansford Kegworth Bottesford Croxton This is an administrative change and will not affect the services that your GP provides.

26 What are your views? On: The proposed creation of a single SHA for the East Midlands? The proposed reconfiguration of new Ambulance Trust for the East Midlands? The proposed PCT reconfigurations?

27 Please also consider How can PCTs Maintain their local touch? Maintain and develop  Clinical Engagement and Involvement  Public Engagement and Involvement  Partnership working Ensure equitable resource allocation

28 How you can have your say In writing – by March 22 nd 2006 using the reply sheet in the consultation document Via the website – from the Consultations section at or direct – R Or now - through questions/sharing of views For further copies of the proposal either contact Robert Walker on the e mail above or download a copy from the website or tel:

29 Following the consultation Within 21 days for SHAs and PCTs from the end of the consultation period: Responses analysed and presented to the LNR SHA Board for a decision Onwards to the Department of Health and Ministerial approval If agreed the Secretary of State authorises the dissolution of the current organisations and the formation the new, with associated asset transfer (inc staff)

30 Following the consultation Ambulance consultation Within 14 days from the end of the consultation process, the results will be analysed and submitted to the Secretary of State (on whose behalf the SHA are consulting) If agreed the Secretary of State authorises the dissolution of the current organisations and the formation the new, with associated asset transfer (inc staff)

31 Time scale If recommendations accepted: Shadow SHA Chief Executives - Jan/March 06 PCTs, SHAs and Ambulance services established towards latter end of 2006

32 Remember The aim is to deliver a better, more responsive health service that gives people the control and choice they have a right to expect as patients and taxpayers

33 Any further questions