1. The ‘New’ NHS – The Challenges for Children’s Service
Chris Sharratt
Chief Executive
Sheffield Children’s NHS Foundation Trust
November 2010

2. Contents
Department of Health: NHS White Paper “Equity and Excellence: Liberating the NHS”: July 2010
A Review by Professor Sir Ian Kennedy: “Getting it Right for Children and Young People”: September 2010
Department of Health: “Achieving Equity and Excellence for Children”: September 2010
Challenges for Children’s Services
Opportunities for Change - Discussion

3. Equity and Excellence: Liberating the NHS

4. Summary- Main areas of change
Organisational change
Future of providers
Regulation and inspection
Efficiency and bureaucracy
Quality and outcomes
Choice and Control
Workforce
Information
Patient Public Engagement

5. Organisational change and commissioning
GP Consortia to commission healthcare- full responsibility 2013/14
All GP’s to be in consortia – set up from 2011/12
NHS Commissioning board (NHSCB) set up- from April 2011, becoming statutory body from April 2012
NHSCB to commission GP, dental and ophthalmic services
GP consortia accountable to NHSCB for managing within annual revenue limit
GP Consortia to have accountable officer
PCT’s cease to exist from April 2013

6. Organisational Change
Strategic Health Authorities- no longer exist from 2012/13
Local authorities assume responsibility for local health improvement (from PCT’s)
Health and Wellbeing Boards to be created within local government to coordinate commissioning of NHS South social care and health improvement

7. Future of Providers
All NHS Trusts to become Foundation Trusts by 2013 with abolition of NHS Trust model
New FT models with staff-only membership (social enterprise) for community and other FT’s
FT’s ‘will not be prioritised’
Increased freedoms for FT’s:
Abolition of cap of income from other sources
Greater ease to merge
Tailoring of governance arrangement

8. Regulation and Inspection
Monitor to regulate all NHS providers from April 2013
CQC and Monitor to deliver a joint licensing regime to cover essential safety and quality standards
CQC to use ‘targeted and risk based’ approach to assessment
Monitor to regulate pricing ‘where necessary’

9. Quality and Outcomes
New NHS Outcomes Framework- national goals relating to quality, safety and patient experience
GP consortia to have commissioning outcomes framework
NICE to develop quality standards- to inform contracts
NHSCB to be responsible for payment system structure- with economic regulations dealing with prices
PbR to be refined- best practice tariffs
CQINS extended locally
Cancer drug fund from April 2011

10. Getting it Right for Children and Young People

11. “ Many GPs have little or no experience of paediatrics as part of their professional training. Given that the majority of their patients are adults, caring for children and young people is low on most GP’s priorities. Accident and emergency (A&E) has become the default option. While A&E departments dedicated to children and young people provide good care, the experience of children entering adult A&E departments can be quite different.”
Source: Getting it Right for Children and Young People

12. The Relative Priority Given to Children and Young People
“ There is a real sense among professionals and organisations that service for children and young people in the NHS have a low priority. Children and young people receive a disproportionately lower priority than adults in the imperatives of management and delivery, in the relative funding allocated, and in the realisation that investment in the care of children and young people will reduce the cost of care later in life.”
Source: Getting it Right for Children and Young People

13. Changing the NHS
“ The starting point must be a network of arrangements. The obvious candidate is the general practice. The practice must be the single point of access, open at all times, at which the child or young person, with a parent or carer alone, is assessed and routed to the most appropriate professional (for example nurse, counsellor, doctor) for the most appropriate treatment, wherever it is best provided. The general practitioner will take on a more positive role: not so much the ‘gatekeeper’ of the past, more the ‘navigator’ of the future. The general practice must be at the hub of the network of services that the Local Partnership has determined are necessary. The general practice has a particularly important role, as the hub of a network of services, to ensure that the services are sustainable over time.”
Source: Getting it Right for Children and Young People

14. Finally, at the centre of any system for providing services are the professionals. The challenge for them is to re-engage with the system so as to change it for the better. It cannot change without them. The prize at stake is the chance to be the professionals they want to be. The greater prize is services for children and young people that they and the NHS can be rightly proud of.
Source: Getting it Right for Children and Young People

15. Achieving Equity and Excellence for Children

16. Key Messages
Support for the conclusions of the Professor Sir Ian Kennedy Report
Reinforce the changes in the “White Paper”.
Acknowledge the challenges concerning the quality of services and suggest that child health services have received “disproportionately low priority”
Committed to improving outcomes for children and young people

17. Challenges for Children’s Services
Increased demand for specialist care
Improvements in outcomes for long-term conditions
Developing highly specialised services
Improving service for vulnerable children
Increasing efficiency
Improving safety

18. Opportunities for Change
New commissioning arrangements?
Transforming models of care, working with GPs and community services?
Pharmacist independent prescribing?
Research and Development?
New business opportunities?