Policy and Public Affairs update for Southern Network meeting 4 October 2012

Policy and Public Affairs update for Southern Network meeting

4 October 2012

Overview

1. The new quality, accountability and improvement architecture 1.1 Secretary of State’s mandate to the NHS Commissioning Board1.2 NHS Outcomes Framework1.3 Commissioning Outcomes Framework1.4 NICE quality standards

2. ‘It’s time for a better deal for neurology’ campaign2.1 Public Accounts Committee follow up hearing 2.2 Developing relationships with the NHS Commissioning Board2.3 Implications of the Government’s reshuffle

3. Strategic clinical network (SCN) for mental health, dementia and neurological conditions 3.1 Role of SCNs3.2 Operation3.3 Development timetable

1. The new quality, accountability and improvement architecture

1.1 Secretary of State’s mandate to the NHS Commissioning Board

PurposeThe mandate will set a series of objectives for the NHS Commissioning Board and describe theGovernment’s expectations of what it will achieve. It will act as a key means through which theSecretary of State for Health will hold the Board to account for its performance.

Consultation on the draft mandate and the Neurological Alliance’s responseThe Department of Health has just concluded its consultation on the draft mandate, to which

theNeurological Alliance responded at the end of September. Key issues drawn out in our response included the need for the madate to:

• reference neurology and other similarly large condition areas to ensure that the Commissioning Board has explicit responsibility to monitor and support commissioners in respect of these substantial patient populations

• highlighting the necessity of achieving early and accurate diagnosis, particularly in relation to complex, less common and rare conditions

• stress the importance of the relationship between the Board and patient representative and other third sector organisations

• position strategic clinical networks as key sources of advice and insight, with which commissioners have a duty to engage on an ongoing basis and will be assessed against


1.2 NHS Outcomes Framework

Purpose

The NHS outcomes framework sets out the outcomes and corresponding indicators that will be used

to hold the NHS Commissioning Board (NHS CB) to account for the outcomes it delivers through

commissioning health services from 2012/13. Indicators in the NHS Outcomes Framework are a basis

for indicators in the Commissioning Outcomes Framework.

Neurological Alliance’s work around the NHS Outcomes Framework

Given the virtual omission of neurology from the NHS Outcomes Framework, the Alliance worked with

the Neurology National Leadership Group and MHP Health Mandate to develop a report, Intelligent

Outcomes, identifying a range of key neurological outcomes for use in future versions of the NHS

Outcomes Framework.

Intelligent Outcomes also makes a series of practical policy solutions to enable enhanced monitoring

of neurological outcomes including:

• Commissioning of a national survey for people with neurological conditions to gather insights into patient care

• Appointment of a lead public health observatory for neurology• Development of neurology specific patient reported outcome measures (PROMs)


1.3 Commissioning Outcomes Framework (COF)

PurposeThe COF will measure the health outcomes and quality of care achieved by clinical commissioninggroups, allowing the NHS CB to hold clinical commissioning groups to account for their contributiontowards achieving the priorities for health improvement set in the NHS Outcomes Framework.

Developments on the COFNICE has made a final recommendation to the NHS Commissioning Board on the 42 indicators itsuggests should populate the 2012/13 COF; of these indicators, of the 10 neurology-relevantindicators, 8 relate to stroke.

The NHS Commissioning Board will make a final decision on the COF indicators in autumn 2012.

Given that indicators in the COF are sourced from the NHS Outcomes Framework and published NICEquality standards, of which there are only 2 for neurology to date, it is highly unlikely that the2012/13 COF will include further neurology indicators in addition to those relating to stroke, dementiaand epilepsy recommended by NICE.


1.4 NICE quality standards

Purpose

Quality standards are a concise set of statements designed to drive and measure priority quality

improvements within a particular area of care. Like indicators in the NHS Outcomes Framework,, they

are a basis for inclusion in the COF. A key function if to enable commissioners to be confident that the

services they are purchasing are high quality and cost effective and focussed on driving up quality.

Developments on quality standards

There are currently 15 confirmed neurological quality standards due to be published by 2015,

including one for rarer neurological conditions. Only 2 to date have been published, for stroke and

dementia.

Quality standards for epilepsy in children and in adults are due to be published by the end of 2012

and development of the headache and migraine quality standard is scheduled for next year.

Development timescales for the remaining neurology quality standards is not yet confirmed, although

those conditions with a NICE guideline will be developed prior to those without.

2. ‘It’s time for a better deal for neurology’ campaign update

2.1 Public Accounts Committee (PAC) follow up hearing

Following the Government’s response to the PAC’s report on neurological services in April 2012, theCommittee called Sir David Nicholson back in September to explain the contrast between his oralevidence to the Committee at the beginning of the year and the Government’s formal response to thePAC’s recommendations.

In preparation for the hearing, the Neurological Alliance:• briefed a number of key PAC members, including the Committee’s Chair• met with Dr Martin McShane, the new NHS Commissioning Board lead for long term conditions• developed a joint evidence submission for the PAC with the Association of British Neurologists

Outcomes of the hearingThe PAC has asked that Sir David Nicholson sends formal notes to the Committee on:1. what neurological data will be captured by the new neurology dataset and when the first

version will be published; 2. the new clinical leadership arrangement at national level;3. available data on readmissions to assess what proportion are reasonable and clinically required;4. the timetable for development of NICE quality standards.


2.2 Developing relationships with the NHS Commissioning Board

Relevant individuals appointed to the NHS Commissioning Board to date:

Professor Sir Bruce Keogh Medical DirectorJane Cummings Chief Nursing Officer

Dr Martin McShane Lead for long term conditionsProfessor Sir Mike Richards Lead for preventing premature deathProfessor Keith Willets Lead for acute episodes of care

The Commissioning Development and Patient and Public Involvement Directorates will also be a focus

for the Alliance as it develops an effective working relationship with the Board.

Forward role of the Department of Health Interactions with Departmental representatives in recent months suggest that the

Department is keento remain informed on issues that the Alliance is working on and, where relevant, to

partner with usto present a united case to the NHS Commissioning Board. However, the Department is

abundantlyclear that it no longer has responsibility for giving strategic direction to the NHS and that

matters forthe NHS Commissioning Board should not be addressed to Departmental officials.


2.3 Implications of the Government’s reshuffle

Jeremy Hunt MP - Secretary of State for Health (Con) Elected as MP for South West Surrey in May 2005; Shadow Minister for Disabled

People 2005-7; Shadow Culture Secretary 2007-10; Secretary of State for Culture, Olympics,

Media and Sport 2010-12

Norman Lamb MP - Minister of State (Lib Dem) Elected as MP for North Norfolk in May 2001; roles include Liberal Democrat

Shadow Health Secretary 2006-10; Assistant Government Whip, Chief Parliamentary and Political Adviser

and Parliamentary Private Secretary to the Deputy Prime Minister, Nick Clegg 2010-12

Other members of the ministerial team:

Dr Daniel Poulter MP (Con, Central Suffolk and North Ipswich) - Parliamentary Under Secretary of State

Anna Soubry MP (Con, Broxtowe) - Parliamentary Under Secretary of StateEarl Howe (Con) - Parliamentary Under Secretary of State

3. Strategic clinical network (SCN) for mental health, dementia and neurological conditions

3.1 Role of SCNs

SCNs are groups of multidisciplinary health professionals, patients and the public that theNHS Commissioning Board (NHS CB) is establishing in areas of major healthcare challengefor defined conditions or groups of patients. SCNs will focus on areas where large scalechange is needed across very complex pathways of care to achieve improvement in qualityand outcomes of care.

SCNs will: Provide clinical advice and support to clinical commissioning groups (CCGs) Help commissioners reduce unwarranted variation in services Assist commissioners in improving outcomes and ensuring best value for money Encourage innovation and support change projects Form close partnerships social care and the voluntary sector Engage patients and the public in all their work


3.2 Operation

The NHS Commissioning Board will fund SCNs and administer each via support teams across England.

The Board will set out what it expects each SCN to achieve in an individual improvement

programme.

Each SCN will sit under one of the five domains of the NHS Outcomes Framework and will be

overseen by the national clinical lead for that domain. A new improvement body will also provide

national support for SCNs, including sharing and disseminating good, innovative practice, training,

development, coaching and support and trouble shooting.

Under the SCN model England will be divided into 12 patches mapping onto CCG and local authority

boundaries. Each patch will contain a SCN support team led by a part-time clinical director and an

overall network director. The teams will perform a number of functions including:

helping networks to develop an annual programme of quality improvement based on local and national priorities

enabling quality assurance processes, including clinical audits supporting the assessment of network activity


3.3 Development timetable

QUESTIONS

Documents

Policy and Public Affairs update for Southern Network meeting 4 October 2012