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PATRON HRH The Princess Royal

The Health and Social Care Act: In Brief

The Act aims to: • Devolve power to clinicians through Clinical Commissioning Groups. Primary Care Trusts and Strategic Health Authorities will be abolished • Devolve commissioning of public health services to local authorities • Introduce consumer champions for health service users through HealthWatch • Introduce Health and Wellbeing Boards to analyse the local needs of a community and to promote integration of health and social care services

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1ST APRIL 2013

What does this mean? • The 211 Clinical Commissioning Groups covering England begin to commission health services for patients • Monitor starts to license non-FT providers. Regulations to support the provider licensing regime come into force

• SHAs and PCTs are abolished and the NHS Commissioning Board takes on its full functions. All of England will be covered by

established CCGs, with the vast majority of these being fully authorised

• Health Education England takes over SHAs’ responsibilities for education and training. Local Education and Training Boards commence work and evolve

• The NHS Trust Development Authority takes over SHAs’ responsibilities for the foundation trust pipeline and for the overall governance of NHS trusts.

• Public Health England established and local authorities become responsible for commissioning public health services

• Local and national HealthWatch and Health and Wellbeing Boards are in place across the country

HEALTH AND SOCIAL CARE ACT IS IMPLEMENTED

SECRETARY OF STATE

REGULATION & SAFEGUARDING

PEOPLE & COMMUNITIES

KEY

Providing care

Commissioning care

Improving public health

Empowering people and local communities

Supporting the health and care system

Education and training

Safeguarding patients’ interests

DEPARTMENT OF HEALTH OTH

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MEN

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RTMEN

TS

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MEN

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NHS Commissioning

BoardGP surgeries

Health centres

Dentists

Ambulances

Care homes

Opticians

Home

Monitor

HumanTissue

Authority

NHSLitigationAuthority

Health Research AuthorityNational

Institute for Health Research

NIHR Clinical Research Networks

NHS Blood & Transplant

National Institutefor Health &

Care Excellence

Professional regulators

Health EducationEngland

Local Education & Training Boards

Care Quality

Commission

Human Fertilisation

& Embryology Authority

HealthwatchEngland

LocalHealthwatch

Medicines & Healthcare Products Regulatory Agency

NHS Business Services

Authority

NHS Trust Development

AuthorityHealth & Social

Care Information Centre

LOCAL HEALTH & CARE SERVIC

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HEALTH & WELLBEING BOARDS

NATIONAL ORGANISATIONS

LOCAL ORGANISATIONS

Public HealthEngland

ClinicalCommissioning

Groups

Communitygroups

Online/phone services

Hospitals

Pharmacies

Personalhelpers

LocalGovernment

The health & care systemfrom April 2013

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The role of the NHSCB: • The Act establishes the NHS Commissioning Board, which will report to the Secretary of State for meeting requirements

outlined in the mandate. This mandate will open to consultation and published by Parliament. • The NHSCB is responsible for authorising and allocating funding to Clinical Commissioning Groups (CCGs) • The Board will commission some specialised services such as cystic fibrosis services and specialised paediatric services (e.g.

children’s congenital heart services). This is alongside commissioning primary care, dentistry, community pharmacy, primary ophthalmic services, offender health services and military health services.

• There will be a sub-national structure of the commissioning board, which will reflect the arrangements made for PCT and SHA clusters.

• The NHSCB will be host to clinical networks and new clinical senates. Clinical networks will bring together experts on particular service areas and conditions whilst clinical senates will provide expert advice to the Board and CCGs with the expectation of bringing together clinical leaders across broad areas of the country to give clinical leadership and expert advice for commissioning.

What does this mean for paediatricians? • Members can use the RCPCH’s document Bringing Networks to Life which provides a guide to establishing and managing

successful networks for children’s health services across the UK. More guidance can be found at: http://www.rcpch.ac.uk/networks

Do you have concerns about clinical networks and senates in your area? Or do you have an example of best practice? Get in

touch.

The NHS Commissioning Board (NHSCB)

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• Clinical senates were announced during the ‘pause’ in the Bill in order to add more clinical involvement in commissioning decisions.

• 12 senates are to be established by April 2012 as non-condition specific, non-statutory advisory bodies, with a mandate to

advise on commissioning, promote innovation, engage with Strategic Clinical Networks and provide advice on clinical pathways in a locality.

• They are expected to input on local reconfiguration issues, however, the exact details of how this will work have yet to be

documented. • There will be two layers to the Senates: The Council, which will include chairs of local CCGs, members of local area teams,

network clinical directors, and The Assembly which will have a broader membership base.

More detail can be found in the NHS Commissioning Board document The Way Forward for Clinical Senates What does this mean for paediatricians? • We encourage members to join such Senates at both tiers so that commissioning decisions such as local reconfiguration

have a paediatric perspective

Clinical Senates

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Clinically led commissioning

• Clinical Commissioning Groups will manage local budgets and lead on the majority of commissioning of local NHS services to residents with the defined area of a CCG. • There are 211 CCGs covering England. Map of coverage. • The NHS Commissioning Board is responsible for ensuring that CCGs are providing a comprehensive service as the Act sets out particular duties for CCGs. These duties include reducing inequalities, integrated healthcare and promoting education and training. • The governing body of CCGs must include at least one registered nurse and one doctor who is a secondary care specialist. To avoid conflict of interest, the secondary care specialist cannot be employed by a local provider. • The area covered by a CCG will vary and depend on the GP practices that form it; however, in the majority of cases, CCG boundaries should not cross local authority boundaries. • All CCGs must go through an authorisation process, where you are assessed on readiness to take on responsibility for health care budgets for your community. Not all clinical commissioning groups will begin commissioning on 1st April with a ‘clean bill of health’ and will require some on going additional support • Authorisation is based on six domains, as outlined on the following slide.

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COMMISSIONING DEVELOPMENT PROGRAMMEWORK IN PROGRESS – STRICTLY NOT FOR FURTHER CIRCULATION

1

Authorisation remains based on six domains as widely discussed

1 A strong clinical and multi-professional focus which brings real added value

2 Meaningful engagement with patients, carers and their communities

3Clear and credible plans which continue to deliver the QIPP challenge within financial resources, in line with national requirements (including outcomes) and local joint health and wellbeing strategies

4

Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities, including financial control, as well as effectively commission all the services for which they are responsible

5Collaborative arrangements for commissioning with other clinical commissioning groups, local authorities and the NHS Commissioning Board as well as the appropriate external commissioning support

6 Great leaders who individually and collectively can make a real difference

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Performance management of CCGs • A Commissioning Outcomes Framework, which is under development, will measure the contribution of CCGs to NHS outcomes, as well as measuring how far the services contribute to the reduction of health inequalities. • The NHSCB’s annual review of CCGs will also look at CCG contribution to Joint Health and Wellbeing Strategies, engagement with the public as well as their financial performance. What are the duties of CCGs? • Have regard to the need to reduce health inequalities • Promote integration within the NHS and social care • Secure professional advice • Promote innovation • Promote the NHS Constitution • Have regard to enabling patients to make choices regarding their healthcare • Promote the involvement of patients, their carers and representatives What does this mean for paediatricians? • It is important that the needs of children and young people are represented and we encourage paediatricians to apply to be the secondary care specialist on CCGs in order to apply their expertise. More information on this to follow. • Further, paediatricians should liaise with primary care colleagues to find out who is providing advice on commissioning for children and young people

Are you interested in becoming the secondary care specialist on a CCG governing board? Get in touch.

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Choice and Competition • The Act establishes Monitor as the economic regulator for NHS services and all NHS providers will need to hold a licence with Monitor. • It will not be within Monitor’s remit to set licence conditions with the intention to promote competition; Monitor will be required to exercise its functions with the view to provide integrated services. • Monitor will be working with the NHS Commissioning Board to set out guidance on how choice and competition for certain services should be applied. •In February and March 2013 the RCPCH raised concerns about the Act’s Section 75 regulations relating to choice and competition.

Any Qualified Provider

• Choice of Any Qualified Provider (AQP) will be for those services covered by national or local tariff pricing. • There are eight areas for which AQP will be introduced from April 2012. The services which apply to children’s services are; wheelchair, continence and podiatry services, as well as primary care psychological therapies for people over 16 years.

What does this mean for paediatricians? • Paediatricians should make themselves aware of the guidance and regulations when available to familiarise themselves with how choice and competition ought to be applied for relevant services. • Are you concerned about choice and competition in your area? Get in touch.

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HealthWatch

What is HealthWatch? • The Act establishes Healthwatch which will become the new consumer champion for health and adult social care. •The national Healthwatch body will sit within the Care Quality Commission and support local branches of Healthwatch (replacing the previous Local Involvement Networks). These local organisations, which will be commissioned by the local authority, will be responsible for representing health service users and act as a point of contact for these users. • Local Healthwatch has a duty to; promote and support the involvement of people in their healthcare, enable people to monitor and review the standard of care, obtain the views of people about their experiences of local services. • Local Healthwatch will be accountable to the local authority’s Overview and Scrutiny Committee. What does this mean for paediatricians? • Paediatricians should check with local Healthwatch to ensure that it is representative of the views of children and young people locally •Paediatricians should signpost the local Healthwatch service to children and young people, and their parents

Do you feel that children and young people are being represented on your local Healthwatch? Let us know.

Further reading: HealthWatch Regulations explained National Children’s Bureau briefing on HealthWatch

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Health and Wellbeing Boards The role of Health and Wellbeing Boards: • The Health and Social Care Act introduces Health and Wellbeing Boards in each upper tier local authority. • These Boards will lead on Joint Strategic Needs Assessments (JSNA) on the health and wellbeing of their local community. This assessment should inform local commissioning plans and underpin the Joint Health and Wellbeing Strategy which will be produced by the Health and Wellbeing Board to set out how the needs outlined in the JSNA should be met by the local authorities, CCGs and NHSCB. • Health and Wellbeing Board members will include; the Director of Children’s Services a representative from each CCG, the Director of Adult Social Care Services, the Director of Public Health, local councillors and a member of the local HealthWatch. • The Health and Wellbeing Board will be accountable to the authority’s Overview and Scrutiny Committee. What does this mean for paediatricians? • Paediatricians should liaise with the local Director of Children’s Services (DCS), Director of Public Health and the Health and Wellbeing Boards to ensure that children and young people’s needs are properly addressed by the JSNA and Joint Health and Wellbeing Strategy. • The only specific voice for children on the board will be the DCS – however, due to financial constraints, the DCS role does not exist everywhere, having been merged with other roles such as Director for Adult Social Care.

Further resources: Health and Wellbeing Board regulations

Is there a DCS presence in your area? Let us know.

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Education and Training

Changes to Education and Training: • The Secretary of State has a duty to secure an effective planning and delivery system for education and training. The NHS Commissioning Board and CCGs also have duties to promote education and training and that healthcare providers cooperate with this discharge of duties. • Health Education England will be established in June 2012. This will be a Special Health Authority and will be the new national leadership organisation to ensure quality in education, training and research. • Health Education England will also authorise Local Education and Training Boards (LETBs) who, with membership from the healthcare and public health providers and independent chairs, will be established to commission local training for healthcare professionals. What does this mean for paediatricians? The Government has signalled that it will legislate further for education and training, so we expect several further developments on the issue in the coming months.

Are you concerned about the potential changes to education and training in your area? Get in

touch. Further reading: •RCPCH submission to the Health Select Committee Inquiry into Education and Training •Health Select Committee report on Education and Training •RCPCH response to report

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Public Health Changes to public health commissioning: •Public Health England will be the new national body within the Department of Health which will oversee the public health system and report to the Secretary of State. • Responsibility for public health is transferred to local authorities in the Act and authorities must employ a Director of Public Health. • Regarding the commissioning of the Healthy Child Programme, The NHS Commissioning Board will retain oversight of the services for children from pregnancy to five years of age until 2015. •From 2013, local government will assume responsibility for the component of the HCP for children aged 5 - 19 years. What does this mean for paediatricians? •The Government had previously signalled that there would be mandated elements of the Healthy Child Programme 5-19, but the recent ‘Public Health in Local Government’ factsheet notes that the Government does not now in fact intend to mandate any elements of the programme for 2013. This therefore runs the risk of inconsistent implementation of the Healthy Child Programme between local authorities across the country.

Further resources:

•See an RCPysch guide to the structure of PH England •Public Health England centres and regions

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PATRON HRH The Princess Royal

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