Commissioners and other key stakeholders Leeds : 1st February 2012 (Cllr) Jan Smithies

What will the ‘big picture’ look like?

Health and Wellbeing Boards, JSNAs, joint Health & Wellbeing Strategies H&WB Boards as the fulcrum for all commissioning plans JSNAs should include ‘bottom up’ information and assessed needs should feed into > H&WB Strategy – i.e. what will be commissioned and delivered by all partners to meet those assessed needs Interface of Social Care, Public Health and CCG commissioning plans H&WB Boards to sign off CCG plans Additional (?) funds to areas based on delivering outcomes (CCG and Public Health)

Marmot key policy objectives Some Health and Wellbeing Boards are using the 6 Marmot policy objectives to drive their Health & Well Being Strategies: Give every child the best start in life. Enable all children, young people and adults to maximise their capabilities and have control over their lives. Create fair employment and good work for all. Ensure a healthy standard of living for all. Create and develop healthy and sustainable places and communities. Strengthen the role and impact of ill health prevention. Implications for who are key stakeholders!

Clinical Commissioning Groups Groups of GPs that will, from April 2013 (for most), be responsible for designing and commissioning local health services in England including: Elective hospital care Rehabilitation care Urgent and emergency care Most community health services Mental health and learning disability services (in partnership with local govt) Wider public health ??? Names of CCGs must clearly indicate locality and use the NHS brand Governing body (must meet in public and publish all documents) GPs at least one registered nurse (from non commissioned body) a doctor who is a secondary care specialist (from non commissioned body) 2 lay people (1 governance & 1 patient engagement) : one of lay members will be chair or vice-chair NB: NHS COMMISSIONING BOARD AND COMMISSIONING SUPPORT ORGANISATIONS WILL ALSO COMMISSION – ESP SPECIALIST SERVICES

CCGs and patient and public engagement* Individual involvement Shared decision making- in the surgery and in commissioned services Patients involved in their care Choice Collective involvement Ensuring the population, care specific groups, minority groups are engaged, know what you are doing and can shape services Patient Experience Individual and collective feedback on service experience Patient role in the Governance of the CCG Two lay members on their governing body: one lay member acting as a champion for engagement and experience; one lay member overseeing key elements of CCG governance LA involvement Via H&WB Board Scrutiny Open public meetings

Commissioning and service integration NHS Future Forum*: focused on the frail elderly with multiple long term conditions; children with complex needs; adults with long term mental health problems. Integrate around the patient, not the system. Make it easier for patients and carers to coordinate and navigate. Information is a key enabler of integration. You can only improve what you measure. Health and wellbeing boards must become the crucible of health and social care integration. Providers need to be able to work with each other to improve care. Clarify the rules on choice, competition and integration. Freedom and flexibility to “get on and do” Allow the funding to follow the patient National level support for local leadership is essential Sharing best practice and breaking down barriers

QIPP: Quality, Innovation, Productivity, Prevention* The Quality, Innovation, Productivity and Prevention programme is a national Department of Health strategy involving all NHS staff, patients, clinicians and the voluntary sector. It aims to improve the quality and delivery of NHS care while reducing costs to make £20bn efficiency savings by 2014/15. These savings will be reinvested to support the front line. Many case studies focus on empowerment of patients/ coproduction/co-creating/shared decision- making/personalisation/personal budgets CHALLENGE – FROM PILOTS TO MAINSTEAM CHANGE AT A TIME OF WHOLE SYSTEM CHANGE

HealthWatch : Govt’s Statement of Intent/Vision HealthWatch will be the independent consumer champion for the public - locally and nationally - to promote better outcomes in health for all and in social care for adults. HealthWatch will be representative of diverse communities. It will provide intelligence - including evidence from people's views and experiences - to influence the policy, planning, commissioning and delivery of health and social care. Locally, it will also provide information and advice to help people access and make choices about services as well as access independent complaints advocacy to support people if they need help to complain about NHS services. HealthWatch will have credibility and public trust through being responsive and acting on concerns when things go wrong, and operating effectively and efficiently.*

LINks to HealthWatch Focus on health and social care LINks – established about 5 years back HealthWatch Pathfinders across country - rest continuing as LINks ….’consumer champion’ Funded nationally: commissioned by local govt 2012/13 additional funding to aid set up of Local HealthWatch Duty will be placed on local authorities with social care responsibilities to secure that a local HealthWatch organisation carries out activities in their areas effectively and value for money

HealthWatch roles and duties Statutory body at local and national levels HealthWatch England > committee of the Care Quality Commission (CQC) Local level > place on H&WB Boards Key roles: –Influencing - help shape the planning of health and social care services –Signposting - help people access and make choices about care –Advisory - advocacy for individuals making complaints about healthcare

Patient Choice agenda (information underpinning) Any qualified provider concept – widen choice available (commissioners and patient): includes choice of GP practice ‘no decision about me without me’ must mean going beyond offering choice of provider to actively involving patients in decisions about their treatment – this needs to be systematically embedded in clinical practice* To support choice, information must be relevant, accessible and presented in a way that patients can understand.**

What role for the private sector in commissioning?

NHS Foundation Trusts (FTs): ‘providers’ FTs have a significant amount of managerial and financial freedom when compared to the historic NHS Trusts – fundamental change in the way in which acute, mental health, community, ambulance services are managed and provided. Central hub of government's programme to create a "patient-led" NHS. Stated purpose is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes. Foundation Trusts are considered mutual structures akin to co- operatives; local people, patients and staff can become members and governors and hold the Trust to account. Appointed, Public and Staff Governors act as a key link between patients and the public and the Board of Directors. Authorised and regulated by Monitor, the independent regulator. Can raise income through selling skills and services from wider range of commissioners and directly to the public Much more business oriented in order to survive in competitive market … any qualified provider…doing things differently

VCS as providers Where are the boundaries re ‘3rd sector’ ? – new, big social enterprises Any qualified provider – help or hinder? Challenge re small community organisations and formality of commissioning and tendering Alliances and consortia Partnerships with FTs ? LA commissioning? PH commissioning ? CCG commissioning?

What role for the private sector in service provision?

Contact Jan Smithies