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wThe fundamental values of the NHS:
• a universal, tax funded service, • with equal access for all, • free at the point of use,• provided according to clinical need not
ability to pay. • These are enduring values and will not
change.
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wPublic Sector Reform
• a transformational agenda across health, social care and other public services to shift from a welfare based to a citizen based model of service delivery
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wThe stages to our journeyWhere we have been and where we are going
Building capacity in the system
Introducing the reforms
High quality care for all
1
23
• NHS Plan saw greatest investment in the history of the NHS
• More doctors, more nurses, better facilities
• Patient choice and payment by results
• Foundation trusts• Stronger commissioning
• NHS Next Stage Review local clinical visions, national enabling report and NHS Constitution
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wOur health, our care, our say – a new direction for community services
• Ambition• Enabling health, independence and well being• Better access to GP• Better access to community services• Support for people with longer term needs• Care close to home• Ensuring reforms put people in control• Making sure change happens
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wKeeping it Personal
• Build on the best of traditional General Practice• Primary Health Care more than general practice• …but registered population and 80% of all NHS clinical
consultations• 90% of care solely undertaken in primary care• Support for self care• Long term conditions management• Care Closer to home• The practice can link the wider public’s health and bio-clinical
care• The practice as the local micro yet strategic health
organisation
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wHigh quality care for allNHS Next Stage Review Final Report
Quality at the heart of
the NHS
High quality care for
patients and the public
Freedom to focus on quality
High quality care for all
• Raising standards
• Stronger involvement of clinicians in decision making at every level of the NHS
• Fostering a pioneering NHS
• Empowering frontline staff to lead change that improves quality for patients
• Valuing the work of NHS staff
• Help to stay healthy
• Empowering patients
• Most effective treatments for all
• Keeping patients as safe as possible
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wThe journey of the NHS Next Stage ReviewJuly 2007 – June 2008
Reviewlaunched
Interimreport
Leading local
change
Clinical visions
launched
High quality
care for all
July October May May-June Today
• Prime Minister, Chancellor, Secretary of State request NHS review
• Following many visits around the country, the Interim Report is published
• New pledges on change in the NHS ensuring focus on quality
• The work of 2,000 frontline clinicians to improve quality for patients
• Report to enable local change to deliver high quality care for all
Largest local engagement in the history of the NHS underpins the whole process
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wWhat we heard from youOverview of findings of clinical pathway groups
• Support people to take responsibility for their own health, through reaching out to disadvantaged groups
Maternity & new born
Children’s
Acute care
Stayinghealthy
• Women want greater choice over place of birth and a more personal experience, with care provided by a named midwife
• Services needed to be more effectively designed around the needs of children and families, delivered in schools and children’s centres too
• Saving lives by creating specialised centres for major trauma, heart attack and stroke care, supported by skilled ambulance services
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wWhat we heard from youOverview of findings of clinical pathway groups
• More care should be provided closer to people’s homes, with greater use of technology and outpatient care not always meaning a trip to hospital
Mentalhealth
Long-termconditions
End of life
Plannedcare
• Extending services in the community, benefits to general wellbeing and to physical health arising from stronger mental health promotion
• Need for true partnerships between people with long-term conditions and the professionals and volunteers caring for them
• Necessity for greater dignity and respect and desire to have round the clock access to palliative services
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wAll advanced health systems face significant challengesChanges in healthcare and society
Ever higher
expectations
Advances in
treatments
Demand driven by
ageing
Changing NHS and
Social Care workplaces
Health in an information
ageChanging nature of disease
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wHigh quality care for patients and the publicOverview of proposals
• It is the quality of care that matters most to patients, public and staff
• Today, NHS is high quality many aspects
• Next stage is to go to being high quality in all aspects
Context
Help people to stay healthy. Effective partnerships, more health promotion, better access to prevention services
What we will do
1
2
3
4
Empower patients. More choice and control to patients to promote quality
Provide the most effective treatments. Fair access to the best treatments for all
Keep patients as safe as possible. Patients in environments that are safe and clean, avoiding harm
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What we will do
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2
3
4
Helping people to stay healthyHigh quality care for patients and the public
• Challenges of 21st century are ‘lifestyle diseases’
• NHS has a responsibility to promote good health as well as tackling illness
• Real focus on primary care to improve health
Context
A new Coalition for Better Health. With Government, private and third sector organisations
‘Reduce Your Risk’ campaign. Raise awareness of biggest killer – vascular diseases and how to reduce risk
Support family doctors to help individuals and their families stay healthy. Changes to QOF and PBC to promote prevention
Support for people to stay healthy at work. We will pilot integrated Fit for Work services
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wEmpowering patientsMore choice and control over their health and care
• Patients want more control rather than being passive recipients of services
• Patients want services that are personal to their needs
• Giving more control for health services should encourage more responsibility for health
Context
Extend choice of GP. Fairer rewards for practices taking on new patients, electronic registration
New right to choice. Draft NHS Constitution contains new right to choose treatment and providers with quality information
Personalised care plans for people with long-term conditions. Service organised around people
Pilot personal health budgets. Learn from social care to give greater control to individuals & families
Guaranteeing access to NICE approved drugs. NICE appraisals will be speeded up
What we will do
1
2
3
4
5
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1Bring clarity to quality
• Expanding NICE so it selects the best available, or fills the gaps, and runs a new NHS Evidence service
2Measurequality
• Quality Metrics across service line (Patient experience and patient related outcomes)
• Clinical dashboards for teams
3Publish quality performance
• All providers of NHS services will publish ‘Quality Accounts’ from April 2010
• Comparative information on NHS choice
4Recognise and reward quality improvement
• New Commissioning for Quality and Innovation scheme
• Multi-year tariff projections, tariff for mental health
Quality: Define, measure, publish, reward…High quality care throughout the NHS
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wImprove, regulate, and innovateHigh quality care throughout the NHS
5Raisestandards
• Stronger clinical engagement in commissioning• Medical Director and Clinical Advisory Group at
every SHA• Quality Observatory in every region • National Quality Board
6Safeguard quality
• Strong role for regulation by the Care Quality Commission
• Regulation extended to primary care for first time
7Stay ahead
• Best Practice Tariffs programme from 2010/11• SHAs to promote innovation, new fund, & prizes• Health Innovation & Education Clusters• Academic Health Science Centres
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wFreedom to focus on quality New accountability and empowering staff
Empowering staff
• If clinicians need to be empowered to improve the quality of care for patients
• This means they should set the direction for the services they deliver, make decisions on resources and on people
• Practice-based commissioning will be strengthened to empower primary care clinicians
Unlocking talents
• Healthcare is delivered by a team
• Everyone needs to pull in the same direction
• Clinicians should be practitioners, partners and leaders in the NHS
• This will enable us to unlock talents of all NHS staff
• This is the new professionalism
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wFreedom to focus on quality Unlocking talents and greater freedom to the frontline
Greater freedom to the frontline
• Commitment for all NHS organisations to become foundation trusts
• More freedoms for community services
• Right to request new professional-led model such as social enterprise will retain pension rights
• More autonomy for high performing PCTs
New accountability
• With greater freedom must come new and enhanced accountability
• Achieved through openness on quality performance
• New accountability is for whole patient pathway
• Applies to care in all settings
• Commissioners accountable for health outcomes of populations
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wLeadership for qualityMaking change happen
Expectations how people will have to change
Vision where we are
going
Methodthe way that improvement will happen
Embed in training. Leadership will be included in undergraduate curricula for nurses and doctors
New standards. Accredited health leadership standards for both clinicians and managers
NHS Leadership Council. Support all leadership, with strong focus on top 250 in the NHS
Support Boards. New development programme for trust boards to be commissioned
NHS Leadership Model
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wFirst NHS Constitution Secured today for future generations
Why a constitution What it says
• Secure the NHS for the next generation
• Empower all patients and the public
• Value and empower NHS staff
• Create a shared understanding of purpose, values and principles
• Strengthen accountability through national standards for patients and local freedom to deliver
• Key principles stated
• Rights for patients articulated
• Pledges to staff and patients
• Decision-making explained
• Every organisation will have legal duty to take account of the Constitution
• Requirement for Secretary of State for Health to renew every 10 years
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wCase for change
Personal continuity of care & strong ties to local communities
Professional ethos and high levels of patient trust
Progress in bringing together health and local government
Improvements in quality of care, e.g. for people with LTCs
• Services that do not fit together and are confusing to navigate
• Unwarranted variation in quality of care & access to services
• Changes in public expectations, technology, demographics, and
nature of disease
• People want more involvement in their health and care
Strengths Challenges
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wPrimary and community care strategy: key themes
• Not a national blueprint• Setting a clear vision …
• … and creating the right environment for leading local change
Shaping services around individuals
Promoting healthy lives
Continuously improvingquality of care
Clinical leadership
World class commissioning
Patient power and choice
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wLeading local change
Reinvigorating PBC
• Repositioning PBC: clinical leadership & health outcomes• Incentives for more multi-professional engagement• Entitlement to management and financial support• Holding PCTs to account through assurance framework• Different levels of engagement
entry-level PBC (dependent on quality of primary care) increasing freedoms for high-performing, multi-
professional and accountable PBC groups
Piloting new models of integrated care
• Clinical collaboration across primary, community and secondary care
• Integration between health and social care• ‘Integrated care organisations’ managing capitated budgets• Testing safeguards for choice and competition• Specifying service quality and financial management
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wLeading local change
Supporting integration of health and social care
World Class Commissioning for primary care
• Joint strategic needs assessment & LAAs• More integrated working between SHAs and GOs• Ministerially-led group to identify how to support
organisations that want to go further
• World class commissioning guide for primary care• understanding needs of local communities• clinical leadership and clinical engagement• incentives for integrated care and upstream prevention• information for patients and the publci• applying system rules• stimulating innovation and choice (market making)
• Support and development• predictive modelling and risk stratification• public engagement and social marketing• dataset development (including equality monitoring)• contract management• estates strategies
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wThe Primary Care ‘Home’
• Population based primary care is where the needs of the individual and of the community can be met
• Care closer to the patient’s home• Where bio-clinical focus and addressing the social
determinants of health can be the responsibility of one provider organisation
• The ‘home’ for extended skills and services