Age UK London & Inclusion London 7 th February 2013 Michael Bell, Director of MBARC,

1. Liberating the NHS?Overview of the new NHS and the opportunities for older deaf and disabled Londoners to have their say Age UK London & Inclusion London 7th February 2013 Michael Bell, Director of MBARC, Associate Director of NHS London & Chairman Croydon Health Services NHS Trust

2. Presentation Outline • Financial Challenge • Overview of the new NHS Architecture • A New Commissioning Landscape: • NHS Commissioning Board • Clinical Commissioning Groups • Commissioning Support Services • Primary and specialised commissioning • Public Health • A Changing Provider Landscape and Any Qualified Provider • Opportunities for older deaf and disabled Londoners to have their say

3. How did we get here… and where are we going? Whoever wishes to foresee the future must consult the past. Machiavelli History consists of a series of accumulated imaginative inventions. Voltaire

4. ... Not quite what we expected... • Health Care before 1945 • Original NHS Budget • Growing Needs • Medical Advances & Changing Expectations • “Matron Knows Best” Culture • Vested interests....

5. Facing the Big Squeeze:The £20bn “Nicholson” Challenge

6. A Return to Growth? • Average Increase in NHS expenditure 1949-2010 – 4% above inflation p.a. • 2011-2015 increase in expenditure 0.1% • The tightest spending round in 50 years • Demographic pressures leading to increased demands on NHS services • A return to 4% annual growth rate unlikely – it would require a further seven year freeze on all other public expenditure or a substantial rise in taxes or debt NHS & Social Care Funding: The Outlook to 2021/22 (Institute of Fiscal Studies)

8. The health and social care landscape will look very different from April 2013 Funding Accountability Other Parliament Version 0.4 DH Public Health England National NHS Commissioning Board NHS Trust Development Authority Monitor (economic regulator) CQC Health Education England NHS CB London Sector NHS TDA London Sector London Health Education Sector Joint licensing between Monitor and CQC Health & Wellbeing Boards (HWBs) Clinical Senates NHS CB Patch Teams Work together to ensure commissioner support for aspirant FTs contract Providers Commissioning Support Services Local Authorities (incl. Public Health) Clinical Commissioning Groups (CCGs) NHS Trusts FTs ‘Footprint’ / Local contract contract contract Accountability for results Local HealthWatch Patients and Public

9. NHS CB Sectors – North, Midlands and East, South and London 27 local offices of NHS CB • Summary of functions • Co-ordination and oversight of local offices • Management of delivery of specialised commissioning • Support and co-ordination of clinical senates and networks • Performance oversight, including intervention and failure regime • Involvement in large scale reconfigurations • Co-ordination and oversight of emergency preparedness • Stakeholder engagement, particularly with sub national presence of bodies such as CQC and Monitor • Information functions on behalf of PEII • Summary of functions • Managing the Board’s day-to-day relations with CCGs, including providing development support, and monitoring performance and outcomes • Direct commissioning, covering offender health; military health, specialised commissioning; and primary care, including management of family health service functions • Professional and clinical leadership • Partner and stakeholder engagement, including representation on Health and Wellbeing Boards

10. Now London has 32 ‘emerging CCGs Enfield Barnet Harrow Waltham Forest Haringey Redbridge Hillingdon City & Hackney emerging CCG Brent Camden Havering Islington Barking & Dagenham Ealing Tower Hamlets Westminster Newham Hammersmith & Fulham City of London Local Authority West London Commissioning Great West Commissioning Consortium South- wark Greenwich Lambeth Lewisham Richmond Wandsworth Bexley All are coterminous with their local authority except for: Merton City & Hackney CCG covers the boroughs of Hackney and the City of London Kingston Bromley Sutton Croydon West London Commissioning covers the whole of K&C and 12 practices in Westminster 9

11. Three CSSs are taking shape in London, developing cost effective services that meet the needs of their CCG customers North & East London: The emerging CSS covers a population of just over 3 million. This organisation builds on the commissioning support arrangements already in place in East London and the City PCT cluster. The CSS has had discussions with all CCGs to understand their priorities and commissioning support needs. There is broad support and as a result the CSS is planning on offering a ‘one stop’ commissioning support service. Further work and engagement will take place to validate the intentions of CCGs. North West London: The emerging CSS covers a population of 1.9 million. Their prospectus submission was accompanied by a signed letter from all 8 CCG leads, expressing their support for the proposed commissioning support service. Work is underway to refine the view of CCGs intentions, in particular what they are planning to provide in-house. South London: The emerging CSS covers a population of just over 3 million. It has been working with CCGs to understand more fully their intentions around commissioning support, where a wide range of plans are developing. Whilst some CCGs are supportive of a one stop service offering, others are considering hosting some services in-house or purchase them from other providers. 10

12. A word on Public Health The Architecture • NHS CB - screening, immunisation vaccination • Public Health England - Health protection scientific advice, information and intelligence regional leadership • DPHs in LAs • health improvement and protection, population health advice to CCGs and CSSs • Commissioning of HIV Prevention work most contraceptive services and all STI/HIV testing services (GUM) • Health & Wellbeing Boards • local direction and priorities and Joint Strategic Needs Assessments • London Health Improvement Board

13. Any Qualified Provider: A Changing Provider Landscape Acute Sector • Mandatory move to FT status • Financial viability challenge and the PFI legacy • Mergers, Acquisitions & Disposals – a role for the Independent Sector? • Further specialist designation? Mental Health, Community & Primary Care • Transforming Community Services (TCS) agenda • Opportunities for Independent Providers • Duty to secure continuous improvement in primary care

14. Assurance, Governance & Regulation • The NHS Commissioning Board • Sub-National committees of the Board • Specialist committees of the Board • Provider Development (FT Pipeline) – NHS Trust Development Authority • Fitness to Trade – Monitor • Fitness of Purpose (Clinical Quality) – CQC • Workforce Development – Health Education England • Public Health England

15. Beyond LansleyTrends & Predictions • Francis Inquiry • Continued pressure to invest in community based services and disinvest in hospitals (but will need to be led by clinicians) • A greater role for Academic Health Science Centres/Networks • Continued drive towards AQP – with more divrse range of NHS providers (including private sector, social enterprises and third sector) • More specialisation by hospitals and larger multi-purpose trusts • Unpredictable expressions of localism and expanding role for local authorities (including further integration of health & social care) • Increased emphasis on self management and early intervention … and the Labour Party’s commitments to date: • An end to AQP (as presently constituted…) • Consolidation of CCGs • “No Top Down Reorganization of the NHS”

16. Opportunities for older deaf and disabled Londoners • NHS Constitution • Local Authorities: • Public Health • Healthwatch and “Nothing about me without me” • “Integrated Care Pathways” • Health & Wellbeing Boards • Joint Strategic Needs Assessments • Relationships with CCGs • Outcomes from Francis Inquiry • Any Qualified Provider – How can new providers “add value”

17. Questions? www.mbarc.co.uk