NH

S N

ext

Sta

ge R

evie

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.

NH

S N

ext

Sta

ge R

evie

w

NH

S N

ext

Sta

ge R

evie

w

NH

S N

ext

Sta

ge R

evie

w

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

w

What we will do

1

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

w

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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

NH

S N

ext

Sta

ge R

evie

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