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Hampshire County CouncilHealth Review Committee Item 7 16 December 2003 Inquiries Received and Action Taken Report of the Chief Executive |
Contact: Denise Holden ext. 7338
e-mail: [email protected]
1. Summary and Purpose
1.1. The aim of this report is to provide Members with information about the issues brought to the attention of the Committee and the action taken as a result of this referral. The report sets out the inquiries received, the source of this inquiry, action taken and recommendations for further action. Where appropriate comments have been included and copies of briefings or other information attached.
1.2. The approach adopted provides the route through which Patient and Public Involvement Forums(due to be established by 1 December) and other partner organisations (Hampshire district councils, NHS bodies, voluntary and independent sector providers and organisations that are representative of social care service users and carers) can raise issues with the Committee.
1.3. Where inquiries raised with the Committee are already subject to monitoring or other performance management activities the action taken will be focused on the local resolution of inquiries through appropriate sign-posting to the agency best placed to respond.
1.4. Where an issue cannot be satisfactorily resolved between the parties concerned then options for further action can be considered by the Committee.
1.5. The recommendations included in this report support Aim 5 of the Corporate Strategy (Improving Services) through the overview and scrutiny of health services in the Hampshire County Council area.
2. Recommendations for Action
2.1. Chiropody Services: the Committee receives the report of the meeting on 9 December and the action agreed
2.2. Diagnostic and Treatment Centres: the Committee continues to follow the introduction of the new centres and the impact that they have on local services to ensure that these services are accountable to local people.
2.3. Patient and Public Involvement:
_ The Committee is provided with an updated from Help for Health and Help and Care regarding progress with recruitment to the Forums and schedules of meetings
_ The Commission for Patient and Public Involvement provides the information on patients forums previously requested from Scout Enterprises
2.4. Redevelopment of Queen Alexandra Hospital and services in south east Hampshire: This issue is included as a standing item on the Committees agenda. Links are established with Local Authority's affected by the changes proposed have been established with respect to:
_ Arrangements for the joint committee to consider maternity services
_ Hampshire County Council contribution to the planning of health services in Gosport and Fareham
_ Progress with Queen Alexandra redevelopment
2.5. Delayed Discharges: Regular reports will be provided to the Committee by the Director of Social Services on progress with placing patients
2.6. Consultation on Foundation Hospitals: The Committee
_ continues to be briefed on further developments to the proposed introduction of Foundation Hospitals
_ considers any joint working arrangements required should an NHS Trust move to formal consultation on this matter
Section 100 D - Local Government Act 1972 - background papers
The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.
NB the list excludes:
1. Published works
2. Documents which disclose exempt or confidential information as defined in the Act.
File Location
None
Hampshire County Council: Health Review Committee 16 December
Inquiries Received and Action Taken
Hampshire County Council Attachment A
Health Review Committee 16 December 2003
Diagnostic and Treatment Centres: Strategic Health Authority Response to the Health Review Committee
1 December 2003
Procurement of Independent Sector Diagnostic and Treatment Centres (ISTCs)
Thank you for your letter of 16th October 2003 regarding the ISTC procurement programme. I apologise for the delay in responding, because ISTCs are relatively new, I have had to seek responses to the questions you have raised from a variety of sources. Having sought comments from PCTs and policy sections from Department of Health, I would like to address each of the points you raised in turn.
· Planning Assumptions
The planning assumptions used to identify the activity required by the Havant IS-TC are those used to model activity for the Portsmouth Hospitals Trust Private Finance Initiative. These are based on projected growth assumptions, taking into account population growth, achievement of the NHS Plan access targets and an identified number of procedures judged to be clinically appropriate to be undertaken off-site. They were included in the PCT capacity plan and subsequently the SHA capacity plan. Across the country, these plans were used to inform the national ISTC programme.
· Benefits for Local People
The proposed Havant IS-TC would provide mostly diagnostic activity, plus minimal additional MRI capacity. It will not deliver elective capacity but will support achievement of the 2005 national elective access targets.
Nationally there is an expectation that IS-TC schemes will form an important component of Patient Choice. The contracts that PCTs enter into for ISTC capacity will be binding. This has been pre-determined nationally.
· Length of the Contract
Unlike the Opthalmology ISTCs the contract will be for 5 years which is the length of time required to provide the additional capacity to meet national targets.
· Funding
The cost to PCTs will not exceed the National Tariff currently being implemented as part of the national Payment by Results system. Where, for legitimate reasons, such as the costs of a different risk profile, the costs of providing the service in the IS-TC are higher than this tariff, the Department of Health will make available additional funding ("Dual Tariff") on a case by case basis. IS-TCs are expected to move towards National Tariff prices and therefore this additional funding may not be required over the full life of the contract.
· Linkage to LIFT
As part of the LIFT project, East Hampshire PCT is building Oak Park Community Hospital in Havant, which will provide accommodation for the IS-TC. LIFT will therefore provide the building within which IS-TC services will be provided. Ensuring robust linkage between LIFT and IS-TC will be a priority for the PCT.
· Staffing
As part of the procurement exercise, all IS-TC providers have to demonstrate the ability to provide staffing solutions that create "additionality" in terms of using new non-NHS staff. It is envisaged that many of the staff will be overseas teams who will be working for the providers on a contracted package basis, and providers will not be seeking local NHS personnel. ISTC providers are acutely aware of the underlying need to provide additional resources and are not intending to "poach" NHS staff.
However, in certain circumstances, NHS staff will be allowed to work in IS-TCs under a structured agreement, such as a secondment or local charging system. In these instances they will remain employees of the NHS.
With regard to training, in conjunction with secondments, IS-TCs offer excellent opportunities for staff to learn new and innovative ways of working and all of the independent sector providers are very willing to provide training opportunities for all levels of staff.
· Funding Issues
The strategic direction for the delivery of healthcare is that acute hospitals will provide more specialised care and that, wherever clinically appropriate, less specialist healthcare will be provided in alternative settings, closer to patients' homes. This is supported by the Hampshire and Isle of Wight Healthfit strategic service redesign programme.
Any issues with regard to case mix have been signalled as part of discussions on Payment by Results and National Tariffs.
· Aftercare
As stated above, the Havant ISTC would provide diagnostics and simple treatments only. Therefore, the issue of recuperative aftercare will not apply.
· Evaluation
All schemes in the national NHS-TC programme are subject to regular monthly monitoring in terms of performance. PCT Local Delivery Plans are expected to assess and integrate TC capacity with that commissioned from other providers.
· Health Scrutiny
At the earliest opportunity, the SHA will share with the PCTs the proposals set out in paragraph 4.4.1 of the `Overview and Scrutiny of Health - Guidance' - that NHS bodies have an opportunity to build clauses into tendering documentation that will encourage a closer working relationship between the independent sector and local authority overview and scrutiny committees.
· Complaints and PALS
Patients will enjoy the same rights as they do in other NHS hospital or healthcare facility. If a patient has a complaint it will be dealt with. In the first instance by the IS-TC and all complaints will be monitored by the local PCT to ensure a satisfactory outcome.
IS-TCs will be run by independent providers on behalf of local NHS commissioners, and as such will provide an integrated NHS service. Therefore local PCTs will want to treat these facilities in the same way as other NHS services and therefore would involve PALs in such a way as to meet local requirements.
· Clinical Governance and audit arrangements.
ISTCs will be subject to audit through CHAI and regulated through the National Care Standards Commission. This is being co-ordinated at National level.
GARETH CRUDDACE
CHIEF EXECUTIVE
Hampshire County Council Attachment B
Health Review Committee: 16 December 2003
Dates for Patient Forum Meetings
Background
As part of the Committee's wish to build understanding of the progress with establishing the new arrangements for patient and public involvement in health contact was made with each of the local network providers appointed to support the new Patient and Public Involvement Forums in Hampshire. Details of these organisations and the Forums they will be supporting were included in papers of the last meeting.
Statements made by the Department of Health and Commission for Patient and Public Involvement in Health indicated that the inaugural meetings of the Forums were expected to take place in late November, prior the abolition of CHCs on the 1 December.
Action taken
The three local network providers contracted to provide support to Patient and Public Involvement Forums in Hampshire were contacted on 24 October to ask for information about arrangements for Forum meetings. Two responses have been received (Help and Care, Help for Health). No response had been received from Scout Enterprises and this has been followed up.
To date the following meeting have been confirmed, subject to the confirmation of a minimum of 7 members. It is not yet clear who has been appointed or if the first meetings will have a quorum.
Help and Care Supported
Fareham and Gosport PCT - 19 December
New Forest PCT - 12 December
West Hants Trust - 9 December
East Hants PCT - 15 December
Help for Health Supported
Winchester and Eastleigh Health care Trust - 12 December
Hampshire Ambulance Trust -16 December
Eastleigh and Test Valley South PCT -16 December
Mid-Hampshire PCT - 19 December
Both local network providers have agreed to ensure that the Committee receives details of the membership, agenda papers and meetings of the Forums they are supporting.
Hampshire County Council Attachment C
Health Review Committee: 16 December 2003
National Patient Safety Agency- Up-date
The local face of patient safety
A patient safety manager in your area
To support staff across the service working to improve patient safety, the NPSA has established a network of patient safety managers, one for each Strategic Health Authority in England and NHS region in Wales.
Patient safety managers will:
·_Provide expertise, support and co-ordination to help develop and introduce
the National Reporting and Learning System (NRLS);
·_Support and advise NHS staff on patient safety issues, with an emphasis on
developing an open and fair culture and training in patient safety;
·_Support NHS risk managers in the identification, management, investigation
and reporting of patient safety incidents and risks;
·_Bring patient safety concerns and solution ideas to the attention of the NPSA
and help develop solutions;
·_Provide leadership and advice on patient safety to NHS organisations in their
area;
·_Work with NHS organisations participating in the NRLS to help them
maximise their local learning through specialist Root Cause Analysis (RCA)
training which will be provided to selected staff in each organisation. (A web based RCA toolkit will also be available on the NPSA's website from
December 2003.)
The patient safety manager for Hampshire and the Isle of Wight is
Julie Jones
07989 482465
Hampshire County Council Attachment D
Health Review Committee: 16 December 2003
Portsmouth Hospitals Response to the Health Review Committee
Thank you for your letter of 30 October, received on 4 November, when I was away. We will need to reply back in due course with the detailed information you request but here is a preliminary response. I have copied your letter and my reply to Sheila Clark, the Chief Executive of Portsmouth City Primary Care Trust, as the whole health community planning which you so rightly advocate depends on all the local PCTs working together.
I think it is unfortunate that the new development at Queen Alexandra Hospital is coming to a head just as the new scrutiny process is emerging. I can well understand that the new committees, having not actually participated in the earlier consultations, may feel a little short changed. Our public discussion process over the summer about the PFI was intended to address this issue. There was no formal requirement for this process but thought it very important to explain again why our plans have occurred, and to hear comments.
We have, as you know, acknowledged the issue about the Mary Rose Maternity Unit and a proper process involving the public is currently in place.
Whilst I totally support the spirit of your letter and am fully committed to inform the local people in planning of healthcare I have to make it clear that the general principles behind the PFI development and associated community development are set. Within a very short time, subject to final business case approval, a 33-year contract will be signed with the Hospital Company to deliver a new hospital at QA and provide the facility services. Whilst it will be possible to flex the balance of care provided between the acute hospital and community services the general shape has been agreed.
The model is of a comprehensive district general hospital focusing on services that need to be in such a hospital, with a network of supporting community facilities in each of the geographical areas that we serve. As you have heard me say publicly, the new hospital will not work unless there are those comprehensive local services.
Between now and Christmas the Trust will be finalising the final business case after discussion with the Primary Care Trust whose agreement is required before we can submit it for final Department of Health approval. Subject to that process being successful and contract negotiations go well it should be possible to sign the contract not long into the New Year.
We completely agree that it is not acceptable for services to develop in a fragmented way. It is probable that some of the network of supporting community health services will be developed quicker than was originally planned when the PFI first took shape. This requires very close work between the PCTs and this Trust, but ultimately this Trust will provide what the PCTs request us to provide and they have the ultimate responsibility of ensuring that the whole thing hangs together.
I will arrange for you to be provided with a list of services that will be provided in the new DGH and those services which will be provided in the community. I will also arrange for a brief description of the control processes to ensure that the PFI contract remains within agreed parameters. We will consider your suggestion about involving a member of the Overview and Scrutiny Committee in our PFI planning process.
We will also describe the mechanism by which we intend to ensure the quality of the non-clinical services to be run by The Hospital Company.
Thank you for your constructive letter. This Trust is very committed to involving the public in its own planning and development, and I know that my colleagues in PCTs share the same principle.
Hampshire County Council Attachment E
Health Review Committee: 16 December 2003
Briefing on Local Improvement Finance Initiative (LIFT)
The following report provides an up-date on progress with the LIFT imitative in south eat Hampshire. Further general information on the LIFT can be found at:
http://www.4ps.gov.uk/publications/LIFT%20Understanding%20Options%20Considering%20Opportunities.pdf
The NHS LIFT process has been introduced to stimulate investment in local primary and social care facilities, and to ensure delivery of the NHS plan targets for modernising primary care through capital development. (£1b investment in Primary Care/3,000 GP premises/500 new One-Stop Centres)
LIFT is a mechanism for grouping together a number of primary and social care developments to make them attractive for public private partnerships. A LIFT company is formed as the Public Private Partnership vehicle for delivering the schemes.
Equity stakes are shared between Partners as follows,
20% Local Partners, (PCT's District and County Councils, GP's etc)
60%, Private Partners
20% Partnerships for Health
Partnerships for Health (PfH) has been established to help deliver the LIFT process. PfH is 75% publicly owned. It has a mandate to manage the procurement process, e.g. legal and financial advice; to introduce standard templates across all schemes; and ensure schemes are commercially viable. PfH will have a 20% stake in each of the LIFT companies across the country, and will provide project management support. Each LIFT is led by a Project Director, and these are nationally networked through PfP to ensure shared learning and support.
PfH work closely with the NHS Private Finance Unit which holds an "enabling fund" that can be bid against to progress local schemes, for example it can be used for advanced land purchase.
NHS Estates are also involved with LIFT and provide project support to the production of a Strategic Service Delivery Plan which is the first stage of the LIFT process.
East Hampshire and Fareham and Gosport Primary Care Trust have recently been awarded LIFT status as one of 24 schemes approved in a third wave nationally this August. The Social Services Department has the opportunity to help shape the schemes and to progress the partnership and integration agenda through engagement and support of the LIFT process.
The achievement of LIFT status is the vehicle which will enable the PCT's to delivery the community services needed to support reconfiguration of services to a hub and spoke model following development of acute services at Queen Alexandra Hospital
East Hampshire schemes
Phase 1
· Oak Park Site in Havant proposals include-out of hours service, minor injury unit, child development centre, rehabilitation team base, re-provision of day assessment unit, GP beds.
· Cowplain Primary Care Centre.
Phase 1A
· Havant Primary Centre
· Dunsbury Way primary Care Centre
· Emsworth Primary Care Centre
Phase 2
Future schemes include development of Primary Care Centres to support West Waterlooville and Liss housing developments. The potential to include the community campus services for respite care of children with disabilities is being explored.
Fareham and Gosport schemes
Phase 1
· Rowner health Centre
Phase 2
· To be developed
· Likely to include development of a Community Hospital and other health centres including Fareham Health centre.
Local progress to date
A LIFT Project Board has being established, led by East Hants PCT. There is representation from both PCT's, Hampshire County Council, the Hampshire and Isle of Wight Strategic Health Authority, Fareham, Gosport, Havant and East Hants District Councils, GP's and potentially other professional groups
A LIFT project director - John Gummerson and LIFT project manager Roger Arney have been appointed and a LIFT project office established hosted by east Hampshire PCT at Raebarn House Waterlooville.
A LIFT Project Group is established including county council representation on the project board and project groups. Other individual project groups have been set up for each of the schemes. A challenging timetable has been established to ensure Phase 1 schemes commence construction by December 2003.
The first milestone achieved by December 2002 was a Strategic Service Development Plan signed off by all the partners.
During the Late Spring and Summer 2003 a team has been working on the tendering process following European rules. This team has a range of clinical and technical staff involved including all agencies. The sample projects used for the tendering process are a multi agency centre for staff working with children with disabilities and two primary care centres. Staff who will work in these buildings have been extensively consulted through user groups. The PCT has ensured that the financial aspects of LIFT developments are factored into the local health delivery Plans(LDP) and financial recovery plans
Throughout September and October 2003 proposals for the next Strategic Service Delivery Plan will be considered.
Nicky Pendleton
Partnership Manager
South East Hampshire
Hampshire County Council Attachment F
Health Review Committee: 16 December 2003
Delayed Transfers of Care
Hampshire County Council | ||
Policy and Resources Policy Review Committee |
Item: | |
4 December 2003 | ||
Delayed Transfers of Care and the release of the £3.5m contingent funds | ||
Report of the Director of Social Services | ||
Contact: Andrew Brooker ext: 7281
email: [email protected]
1. Introduction
1.1 Through the Social Services Department, Hampshire County Council has invested both time and money in focused activity to reduce delayed transfers of care.
1.2 This work has been reported throughout the County Council because it forms part of Hampshire County Council's PSA target and is part of the national policy framework related to the delivery of the NHS Plan which is monitored by the Department of Health. Most recently, the introduction of the Delayed Discharges (Community Care) Act and the reimbursement regime has required further analysis, preparatory work and reporting of the impact and potential risks to the County Council.
1.3 It is important to retain sight on the driving policy objective of this work. This is to ensure that an older person receives the right care at the right time in the right place. Hampshire County Council concurs with the view that it is not appropriate for patients to occupy acute beds when they no longer need acute treatment. However, it is clear that the number of patients remaining in hospital for reasons other than waiting for social care have not reduced " as much as social care waits".
2. The Context
2.1 Attached to this report in Appendix 1 is the report to the Cabinet meeting on 27th October 2003 for the release of the £3.5m contingent funds for delayed transfers of care. This formed part of the Budget Monitoring Report of the County Treasurer. The Cabinet approved, among other decisions, the business case as set out in the Appendix, subject to agreement by the Leader at his Executive decision meeting on staged release of this contingency in line with commitments and improved performance.
2.2 Appendix 1 details the current performance, costs and capacity issues that support the business case for the release of the funds. It also outlines some of the immediate implications of the introduction of the reimbursement system.
2.3 There are complexities in this work when trying to explain activity and associated costs. The particular method used nationally to monitor performance is a weekly-snapshot measurement of delays broken down into categories. The activity level and turnover of patients in the days surrounding measurement day is not reported. What we know is that for every one reduction in the snapshot count, the Department will have been involved in arranging and securing discharge care packages during the preceding week for maybe 7 - 10 other patients whose delayed transfer of care has been avoided. The associated costs of this level of turnover and activity are explored in paragraph (2.3) of Appendix 1.
2.4 It is important to also consider that emergency admissions are increasing and targets are set for a reduction in the RATE of growth in this area of activity. This, coupled with the prescribed NHS targets for elective surgery and waiting lists, and the increasing numbers of older people in the population, mean the only significant influence on the level of activity and turnover is the numbers of actual acute hospital beds in the system.
3. Risks
3.1 There are risks attached to the implementation of the Reimbursement legislation.
3.2 We are using the shadow implementation period from 1st October 2003 to 4th January 2004 to test systems and evaluate numbers of assessments needed and workforce deployment as well as potential levels of reimbursable delays.
3.3 The reimbursement system requires a full complement of staff at all time in acute hospital settings. As a critical business area and the need to balance our priorities, there may be knock on effects for our community-based activity.
3.4 Also with intense focus and operational emphasis being placed on clearing delays from acute hospital beds, a bottleneck further down the health system for example in community hospital beds may be created.
3.5 Such pressures and the increased acute activity are steering us towards focussing on `interim' care solutions. To secure such arrangements, often necessitating the purchase of residential or nursing home care, we may need to pay above inflationary price rises to secure the necessary capacity. The most common reason for delay is nursing home placement and there is a time-lag between now and when the additional Hampshire County Council nursing home beds will be operational.
3.6 Above all there is a risk to our core business of care within the community. This comes both from: (a) attention being given to implementing the reimbursement `system' and speedier responses needed within acute settings at the potential expense of putting the needs and well-being of older people at the centre of activity; and (b) across our whole range of activities the increasing use and focus of resources within acute activity that will reduce our ability to maintain levels of service for older people who have ongoing and long term community care needs.
4.0 Recommendation
4.1 To note the Social Services Department's work and resource needs related to Delayed Transfers of care.
Section 100 D - Local Government Act 1972 - Background Documents
The Following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.
NB the list excludes:
1. Published works
2. Documents which disclose exempt of confidential information as defined in the Act.
Appendix 1
Release of the £3.5m contingency for delayed transfers of care
Purpose of Report
This report outlines the business case for the release of the £3.5m contingency for delayed discharges for hospitals.
Current Performance
Social Services has invested heavily to reduce delayed transfers of care from acute hospital beds.
For the week ending 30 March 2003 the total number of delays reported for Hampshire was 225, however only 116 of these were `Social Care Waits'. For the week ending 7 September 2003 the figures were 160 and 51 respectively.
These much lower figures reflect the impact of the additional investment by the County Council and further improvements are anticipated by 1 January 2004.
However, because of throughput issues (i.e. reducing the Sitrep figures by one, may involve between one and five moves) the projected cost of halving the social care waits will have cost Hampshire (current spend plus commitment basis) £4,021,596 or approximately £60,000 for each reported reduction.
Following this theoretically indicated that to clear the Sitrep list at current rates would cost Hampshire in excess of £8m, assuming capacity in the private sector.
The most common reason for delay is nursing home placement. Although this is being addressed in the future by Hampshire's County Nursing Home Strategy, there is an interim time lag before this additional capacity will be operational. Therefore the next twelve to eighteen months will be very difficult in respect of capacity.
Securing available care is essential to continue to reduce delayed transfers. New capacity does not become available at short notice, so it is important to maintain purchasing activity, and ensure the baseline of delayed transfers is as low as possible. The current spending and activity level have been based on the assumption that the £3.5 million contingency is available on an ongoing basis this year.
Reimbursement
Councils with Social Service responsibilities will need to make reimbursement payments for eligible and appropriate cases following notification from 5 January 2004. The implementation of shadow systems have been put in place from 1 October 2003 to provide a 3 month lead-in period.
The release of the contingency funds for delayed transfers of care is needed to minimise the risks of being subject to financial penalties and contribute towards the local public service agreement target:
"To provide high quality pre-admission and rehabilitation care to older people to help them live as independently as possible, by reducing preventable hospitalisation and ensuring year on year reductions in delays in moving people over 75 on from hospital"
This will be achieved through:
· continued attention to improving delayed discharge performance through activity and service developments to ensure necessary capacity is available, with £3m spend on additional care packages/placements.
· establishment of the necessary business process arrangements, including improvement of staffing resources in acute hospital settings, to meet the requirements of the prescribed reimbursement regime with the remaining £0.5m.
The current expected cost associated with a delayed transfer following the introduction of the reimbursement legislation in January 2004, is £100 per person per day. The estimated full year cost therefore of the activity level of delays of the 65 as at 3 August 2003 would be over £2.2 million.
The delayed transfer grant allocation that is proposed to offset these costs is £1.2 million for Hampshire, the highest allocation nationally in 2003/04, to cover 1 October to 31 March. This grant is expected to rise to about £2 million in 2004/05.
Comparing current discharge processes with the `ideal' (reimbursement) discharge process is underway at present. A review of the operational demands of the proposed regime has shown that there will be a need for additional staff at hospital sites to augment existing hospital arrangements for carrying out service user assessments and to prevent hospital admissions or delayed hospital discharges. This will include Saturday working as this falls within the notification period covered in the Bill.
The workforce plan (2003/04) details the requirements and the associated costs of these posts of approximately £600,000 full year effect. This will be allocated to recruit up to 21 full time equivalent qualified social worker/care managers. The estimated costs in 2003/04 are approximately £400,000 with over half of the posts already filled at the time of writing.
Conclusion
To safeguard its principles in respect of service users, corporate priorities and also its current performance status, it is one of Social Services imperatives to continue to invest in reducing the number of delays.
Hampshire County Council Attachment G
Health Review Committee: 16 December 2003
Foundation Hospitals
The following report has been provided by Hampshire and the Isle of Wight Strategic health Authority.
1 Introduction
This paper provides an overview of NHS Foundation Trusts and their implications for the NHS in Hampshire and the Isle of Wight. The paper includes the following key sections:
· An overview of NHS Foundation Trusts (Section 2)
· An outline of current and future application waves (Section 3) and the application process (Section 4)
· A key focus on governance and accountability arrangements (Section 5)
· A list of current applicants (Appendix 1 and Appendix 2)
2 What are NHS Foundation Trusts?
2.1 NHS Foundation Trusts are fully part of the NHS
Subject to legislation, NHS Foundation Trusts will be set up as independent public benefit organisations and will be modelled on co-operative and mutual traditions. They will:
· Be controlled and run locally, not nationally. Local public accountability will replace central state control
· Have increased freedoms to retain any operating surpluses and access a wider range of options for capital funding to invest in delivery of new services
· Recruit and employ their own staff
· Have to deliver on national targets and standards like the rest of the NHS, but NHS foundation trusts will be free to decide how they achieve this
· Not be subject to directions from the Secretary of State for Health
· Not be subject to performance management by strategic health authorities and the Department of Health
2.2 NHS Foundation Trusts are based on cross-government public sector principles
· NHS Foundation Trusts enhance choice and diversity of provision
· NHS Foundation Trusts support devolution of responsibility
· NHS Foundation Trusts increase flexibility for front line workers
· NHS Foundation Trusts operate within high national standards and clear accountability
The Department of Health NHS Foundation Trust website (www.doh.gov.uk/nhsfoundationtrusts) describes NHS Foundation Trusts as follows:
· NHS Foundation Trusts will be firmly part of the NHS and subject to NHS standards, performance ratings and systems of inspection. They will treat NHS patients according to NHS quality standards and principles - free care based on need, not ability to pay.
· NHS Foundation Trusts will be established in law as independent Public Benefit Corporations. This will mean far greater local ownership and involvement of patients, the public and staff rather than control from the Department of Health. The principles behind NHS Foundation Trusts build on the sense of ownership many local people and staff feel for their hospital.
· NHS Foundation Trusts will be democratic. Local people and staff will directly elect representatives to serve on the Board of Governors. The Board of Governors will work with the Board of Directors - responsible for day-to-day running of the Trust - to ensure that the NHS Foundation Trust acts in a way that is consistent with its terms of authorisation. In this way, the Board of Governors will play a role in helping to set the overall direction of the organisation.
· NHS Foundation Trusts will prevent privatisation of the NHS. They will be required in law to use their assets - such as land and buildings - to promote their primary purpose of providing NHS services to NHS patients. A legal lock will protect these organisations from the sort of 'de-mutualisation' we have seen in the Building Society sector and prevent any threat of future privatisation.
· NHS Foundation Trusts will operate within a clear accountability framework. They will not be left to sink or swim, allowed to 'cherry pick' services or set loose to pursue organisational goals at the expense of the needs of their local health community.
· NHS Foundation Trusts will be there to treat NHS patients, not to make profits or to distribute them. Most of their income will come through agreements reached with local NHS Primary Care Trusts to provide locally relevant services for NHS patients at the national tariff rate. Private work will be strictly limited.
· NHS Foundation Trusts will be at the cutting edge of the Government's commitment to devolution and decentralisation in the public services. They will not be subject to direction from Whitehall. Local managers and staff working with local people - rather than remote Civil Servants - will have the freedom to innovate and develop services tailored to the particular needs of their local communities.
· NHS Foundation Trusts are not about elitism. All NHS Trusts will get help and support over a four to five year period so they too are in a position to apply for foundation status.
· NHS Foundation Trusts will work in partnership with other NHS organisations. They will remain part of the NHS. They will have a duty in law to co-operate with other local partners using their freedom in ways that fit with NHS principles and are consistent with the needs of other local NHS organisations. They will be overseen by a new Independent Regulator, accountable to Parliament, and inspected by the new Commission for Healthcare Audit and Inspection.
· NHS Foundation Trusts will be able to direct their services more closely to the communities they serve with freedom to develop new ways of working that reflect local needs and priorities. This will be done within the NHS framework of standards and inspection that safeguards the quality of NHS care. Direct elections of Governors by local people and staff will get local hospitals better focused on meeting the needs of the communities they serve.
3 Application Waves
3.1 Wave 1: Preparing for establishment on or after April 2004
The first wave of applications for NHS Foundation Trust status is currently underway and includes 25 Trusts.
Subject to legislation, the first wave of NHS foundation trusts will be established from April 2004 at the earliest.
There are no Trusts providing routine secondary healthcare to patients and communities in Hampshire and the Isle of Wight (although some applicants do provide specialist/tertiary services).
A list of Wave 1 applicants is set out in Appendix 1.
3.2 Wave 1a: Preparing for establishment on or after October 2004
Thirty two preliminary applications for NHS Foundation Trust status have been received by the Department of Health as part of Wave 1a.
Short listed applicants will be invited to prepare and fully consult on a second stage applications for return to the Department of Health by Spring 2004.
Wave 1a includes preliminary applications from the following organisations in Hampshire and the Isle of Wight:
· North Hampshire Hospitals NHS Trust
· Southampton University Hospitals NHS Trust
· Winchester and Eastleigh Healthcare NHS Trust
Wave 1a also includes a preliminary application from the following neighbouring organisation:
· The Royal Bournemouth and Christchurch NHS Trust
3.3 Future Waves
Attainment of 3-stars in the NHS Performance Ratings is the minimum
requirement to apply for foundation status. All NHS organisations are currently
finalising Improvement Plans which set out how they intend to improve their performance over the coming years. For NHS Acute Trusts these plans set out a route map by which Trusts plan to achieve NHS Foundation Trust status by 2008. As more organisations meet the criteria for NHS Foundation Trust status they will be eligible for future application waves.
4 Application Process
4.1 Preliminary Phase
Preliminary applications for foundation status are in the form of a report on the NHS Trust's current status. The Department of Health will assess these applications, supported by SHAs, to highlight areas that organisations will need to ensure are fully addressed in the next phases. During this phase organisations continue to operate as an NHS Trust under existing legislation.
Wave 1a applicants have submitted this preliminary application.
4.2 Preparatory Phase
During this phase applicants need to:
· Engage with partners, particularly during a 10-week period of consultation
· Demonstrate readiness to operate as an NHS Foundation Trust
· Provide their HR strategy, service development strategy and governance arrangements
· Undergo independent financial assessment
Wave 1a applicants will need to submit second stage applications, following local consultation, to the Department of Health by Spring 2004.
4.3 Establishment Phase
During this phase applicants need to:
· Set up shadow governance arrangements
· Negotiate terms of authorisation (their "licence") with the regulator
· Negotiate contracts with PCTs
Wave 1a applicants will be established from October 2004 at the earliest, subject to legislation.
5 Key Focus: Accountability and Governance
There are three key ways in which NHS Foundation Trusts will be accountable:
· Governance
NHS Foundation Trusts will be accountable to local communities and
front line NHS staff through their Board of Governors and Board of
Directors. Local people and staff will directly elect representatives to
serve on the Board of Governors. The Board of Governors will appoint
the chair and non-executive directors of the Board of Directors. It will work with the Board of Directors - responsible for day-to-day running of the Trust e.g. setting budgets, staff pay and other operational matters - to ensure that the NHS Foundation Trust acts in a way that is consistent with its terms of authorisation. The Governors, in appointing the chair and non-executive directors, will be in a strong position to influence the direction of the NHS Foundation Trust.
· Performance agreements
NHS Foundation Trusts will work closely with NHS Primary Care Trusts - the bodies responsible for buying NHS care for local communities. In future, NHS Primary Care Trusts will sign legally binding agreements with NHS Foundation Trusts to provide agreed levels of service which accurately reflect local needs and which reward results.
· Independent regulation
An Independent Regulator - accountable to Parliament - will be appointed to oversee NHS Foundation Trusts. The Independent Regulator will issue an authorisation - like a `licence' to operate - to each NHS Foundation Trust. This authorisation will set out the conditions under which each NHS Foundation Trust will operate (the terms of authorisation). The Independent Regulator will have powers to step in if there is evidence that an NHS Foundation Trust has significantly breached the terms of its authorisation, or has failed to comply with NHS Foundation Trust legislation.
5.1 Independent quality inspection
These accountability mechanisms will be underpinned by independent quality inspection. Like all other NHS organisations, NHS Foundation Trusts will be subject to independent inspection and monitoring by the new Commission for Healthcare Audit and Inspection, taking account of national quality standards for the NHS. NHS Foundation Trusts will also feature in the annual NHS performance (`star') rating system.
5.2 Regulation of NHS Foundation Trusts
The Independent Regulator for NHS Foundation Trusts will be appointed by the Secretary of State for Health, in line with national guidelines on public appointments. The Independent Regulator will be accountable to Parliament, not the Department of Health or the Secretary of State for Health.
The Secretary of State for Health's powers over the Independent Regulator will be limited to:
· Deciding on the Independent Regulator's length of appointment, pay and conditions; and
· Removing the Independent Regulator in the event of incapacity or misbehaviour.
The Independent Regulator will be responsible for appointing the staff of the Office of the Independent Regulator.
The Independent Regulator will be required to exercise his functions in a manner that is consistent with the way in which the Secretary of State performs his general duties.
An Independent Regulator will be appointed in autumn 2003 - in an advisory capacity at first - but subject to confirmation in post when the Bill currently before Parliament comes into force. The Independent Regulator will publish an annual report on how he has carried out his functions and present it to Parliament and the Secretary of State for Health. Individual NHS Foundation Trusts will also publish their own annual reports.
5.3 Authorisations of NHS Foundation Trusts
Each NHS Foundation Trust will operate under an authorisation issued by the Independent Regulator. The authorisation will set out the requirements, duties and standards that will apply to each NHS Foundation Trust and will be reviewed from time to time. Although the Independent Regulator will be able to add local conditions to individual agreements, all NHS Foundation Trust authorisations are likely to cover such things as:
· A requirement to provide quality healthcare, based on the national standards for healthcare against which the Commission for Healthcare Audit and Inspection will inspect;
· Protection of NHS clinical services and the circumstances in which major changes to services (for example, in response to a changing local population) need to be discussed locally and agreed by the Independent Regulator;
· Safeguards on any assets such as buildings, land or equipment needed to provide essential NHS services;
· Limits on the amount of private work an NHS Foundation Trust can carry out. NHS Foundation Trusts will be subject to strict limits on private patient work based on the amount of private work they currently do. If an NHS Foundation Trust wishes to treat more private patients, it will need to treat more NHS patients first. This will ensure that NHS Foundation Trusts continue to focus on NHS work;
· The amount of money an NHS Foundation Trust is allowed to borrow; and
· The financial and statistical information an NHS Foundation Trust is required to provide.
Each authorisation will be a public document and a copy will be held by the Registrar of Companies. If an NHS Foundation Trust wants to make substantial changes to the provision of essential `protected' NHS services it will need to consult the Local Authority Overview and Scrutiny Committee before applying to the Independent Regulator for a change to its terms of authorisation.
The Independent Regulator will oversee how NHS Foundation Trusts perform against their terms of authorisation and will have powers to take action if they do not comply in a significant way.
5.4 Board of Governors
Every NHS Foundation Trust will have a Board of Governors. Governors will work closely with the NHS Foundation Trust Board of Directors which will be responsible for day to day running of the Trust.
Governors, through their involvement in appointing the Chairman and non-executive directors will be in a strong position to influence the direction of the NHS Foundation Trust.
Each Board of Governors will comprise:
· People elected from the NHS Foundation Trust members - the `public constituency';
· People elected to represent the NHS Foundation Trust's staff members - the `staff constituency'; and
· People appointed to represent the interests of local partner organisations (NHS Primary Care Trusts, Local Authorities in the area, the local University if the Trust teaches doctors and dentists).
Each NHS Foundation Trust will have some flexibility over the exact composition of their Board of Governors but they must have a majority of members elected by the public constituency. They must also have:
· At least one governor representing local NHS Primary Care Trusts;
· At least one governor representing Local Authorities in the area;
· At least one governor representing staff;
· A chair; and
· At least one governor representing the local university (if the Trust teaches doctors and dentists).
A person cannot be a Governor of an NHS Foundation Trust if they are bankrupt or have served a prison sentence of three months or more during the last five years.
The Board of Governors will be responsible for:
· Representing the interests of NHS Foundation Trust members and partner organisations in the local health economy in the governance of the NHS Foundation Trust;
· Regularly feeding back information about the Trust, its vision and its performance to the `constituency' they represent;
· If necessary, chairing or attending relevant sub-committees;
· Appointing the non-executive directors, including the chair, of the Trust;
· Appointing the Trust's auditor;
· Working with the Board of Directors to produce plans for the future development of the Trust;
· Receiving, at a public meeting, copies of the Trust's annual accounts, auditor's reports and annual reports; and
· If concerns about the performance of the management board cannot be resolved at a local level, informing the Independent Regulator for NHS Foundation Trusts.
NHS Foundation Trust applicants will have a duty to consult with the local community, staff members and stakeholder organisations as part of their application on their governance arrangements. The views people give will influence the shape of each Trust's constitution as it is drawn up. The constitution will set out the way in which the governance arrangements will work.
It will include:
· Who (in terms of geographic area) can become a member in the public constituency;
· If appropriate, provision for patients and their carers from outside the area to be members in the public constituency;
· Eligibility for membership in the staff constituency;
· Processes for recruiting, retaining and communicating with members;
· Process for the
· election of the Board of Governors; and
· Process for the appointment of the Board of Directors.
6 Further information
Further information about national policy on NHS Foundation Trusts is available from the Department of Health's NHS Foundation Trust website at www.doh.gov.uk/nhsfoundationtrusts
Hampshire County Council Attachment H
Health Review Committee: 16 December 2003
An Introduction to the National Institute of Clinical Excellence (NICE)
NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers, to help them make decisions about treatment and healthcare. NICE was set up to tackle the post-code lottery where some drugs and treatments were available to some patients and not others depending on where people live. The NHS is now required to make drugs available throughout England where NICE advises that they are clinically and cost effective. NICE guidance and recommendations are prepared by independent groups that include healthcare professionals working in the NHS and people who are familiar with the issues affecting patients and carers. Currently NICE produces guidance in three areas of health: · the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals · the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales - clinical guidelines. · whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use - interventional procedures. NICE also funds four enquiries that undertake research into the way patients are treated, to identify ways of improving the quality of care. (These investigations are known as Confidential Enquiries.) Since its first published appraisal in March 2000, NICE has given advice in all of the key clinical areas, from new drugs for a variety of cancers including breast and ovarian cancer, smoking cessation to the artificial joints used in hip replacement surgery. An estimated 10 million people are benefiting every year from NICE guidance. Drawing on top experts in each field and consulting widely with patient groups, NICE has produced guidance for over 97 pharmaceuticals, 19 procedures, 5 diagnostics and 93 devices, in the 68 appraisals it has published to date. NICE also develops clinical guidelines, broader guidance on best care for all aspects of the treatment of specific conditions. Over the next few years these guidelines will cover many of the conditions responsible for the greatest burden of ill-health, disability and premature death in the UK. To date NICE has issued 5 guidelines - schizophrenia, chronic heart failure, head injury, pre-operative testing and infection control. Some frequently asked Questions Q: How are patients, carers, healthcare professionals and the NHS involved in producing NICE guidance? Organisations representing the patients and carers whose care is described in the NICE guidance under development, the bodies representing the healthcare professionals providing services to those patients, and a number of NHS organisations are invited to become involved in the development of each individual piece of NICE guidance. We also have a Partners Council with members drawn from the key organisations representing patients/carers, healthcare professions and NHS managers. The Partners Council advises NICE on key strategic issues and reviews its annual report. Q: How are members of the public involved with NICE? In addition, NICE has established a Citizens Council to bring the views of the public to NICE decision-making about guidance for treatments and care in the NHS. This Council of 30 members of the public is a mix of men and women of different backgrounds, ethnicity and age. They are not employees of the NHS, those who supply the NHS, or organisations that represent patients and carers. Q: Does NICE put costs before patients' needs? Q: Do doctors and other health professionals have to follow NICE's decision? Q: Do NHS organisations have to find funding to follow NICE guidance? Q: Are people being denied treatment while NICE makes its decisions? Q: How do NICE's recommendations reach healthcare professionals and patients? The media are kept informed about the guidance and is available through: · NHS Response Line - 0870 1555 455 · PRODIGY - the NHS's decision-support software for primary care prescribers (www.prodigy.nhs.uk/) · NHS Direct online (www.nhsdirect.nhs.uk/index.asp) · the National Electronic Library for Health (www.nelh.nhs.uk/) · patient/carer organisations · partnerships with other 'closed' websites · professional journals and other places where health professionals would seek information. Every 6 months, a compilation of all NICE guidance is published and circulated to healthcare professionals. Members of the public can get copies of completed NICE guidance from our website (www.nice.org.uk) or by phoning the NHS Response Line on 0870 1555 455. NICE also produces a monthly E-Newsletter, which gives details of forthcoming guidelines and technology appraisals. To subscribe to the E-Newsletter free of charge please visit the NICE website (www.nice.org.uk) to register. New Work Programme NICE will also develop clinical guidance on breast and prostate cancer and puerperal/perinatal mental health. Particular areas of interest for people in Hampshire may include: Fallers' clinics Diabetes in pregnancy Diagnosis and treatment of breast cancer
|
Hampshire County Council Attachment I
Health Review Committee: 16 December 2003
NHS Priorities 2003-2006
The following extracts are taken from the document setting out the planning and priorities framework for the NHS in the coming three years. More detailed information can be obtained from:
http://www.doh.gov.uk/planning2003-2006/index.htm#down
Planning framework 2003-2006
Planning in the past has been done annually and constrained by time pressures and the requirement for multiple plans. For the first time ever health services are now able to plan over a three-year period with, later this autumn, local health services receiving three-year budgets. Following the completion of the Local Government Finance Review, councils will have some confidence about the distribution of resources available over the next three years, including for social services. This will allow organisations to look in-depth at their services, plan change with confidence and implement improvements year on year. Against this background planning consists of the following six steps which need to be followed through in each organisation and community:
· identifying the national and local priorities and the key targets for delivery over the next three years
· agreeing the capacity needed to deliver them
· determining the specific responsibilities of each health and social care organisation
· creating robust plans which show systematically how improvements will be made and which are based on the involvement of staff and the public
· establishing sound local arrangements for monitoring progress and NHS performance management which link into national arrangements
· improving communications and accountability to the public locally so as to demonstrate progress and the value added year on year
The priorities
The priorities for this period are based on the Department of Health's Public Service Agreement which is shown at Appendix A.
The health and social care priorities are:
· improving access to all services through:
o better emergency care
o reduced waiting, increased booking for appointments and admission and more choice for patients
· focusing on improving services and outcomes in:
o cancer
o coronary heart disease
o mental health
o older people
o improving life chances for children
· improving the overall experience of patients
· reducing health inequalities
· contributing to the cross-government drive to reduce drug misuse
In each of these priority areas there are key targets for the next three years. These are shown in Appendix B. They are relevant to primary care as well as hospital services and will not be achieved without close co-operation between health and social services. Indeed many rely on achieving a better balance in local service provision with a greater emphasis on community-delivered services. Every health and social care community must plan to meet each of these targets in the next three years.
Within the new planning framework a lead agency will be responsible for ensuring that the process of developing plans is robust to take responsibility for the quality of the final product. For the priority areas the division in leadership between the NHS and social services is:
NHS lead |
Joint lead |
Social services lead |
Access to services for emergency and planned care |
Mental health |
Life chances for children |
Cancer |
Older people |
|
CHD |
|
|
Patient experience |
|
|
Health inequalities |
|
|
Drug misuse |
|
|
Where the NHS is in the lead, strategic health authorities will be responsible for ensuring the process and outcome of planning is robust, and similarly councils will take responsibility for the social care lead area. Where the lead is joint, PCTs and councils should locally agree the lead arrangements at the beginning of the planning process.
Improve access for both emergency care and planned care
Cancer
Coronary Heart disease
Mental Health
Older People
Life chances for children
Improving the patient experience
Reducing health inequalities
Drug misuse
Improvement, expansion and reform
The next three years' priorities and planning framework, 2003-2006 |
AIM: Transform the health and social care system so that it produces faster, fairer services that deliver better health and tackle health inequalities.
Objective I: improve service standards
1. Reduce the maximum wait for an outpatient appointment to 3 months and the maximum wait for inpatient treatment to 6 months by the end of 2005, and achieve progressive further cuts with the aim of reducing the maximum inpatient and day case waiting time to 3 months by 2008.
2. Reduce to four hours the maximum wait in A&E from arrival to admission, transfer or discharge, by the end of 2004; and reduce the proportion waiting over one hour.
3. Guarantee access to a primary care professional within 24 hours and to a primary care doctor within 48 hours from 2004.
4. Ensure that by the end of 2005 every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs.
5. Enhance accountability to patients and the public and secure sustained national improvements in patient experience as measured by independently validated surveys.
Objective II: improve health and social care outcomes for everyone
6. Reduce substantially the mortality rates from the major killer diseases by 2010: from heart disease by at least 40 % in people under 75; from cancer by at least 20% in people under 75.
7. Improve life outcomes of adults and children with mental health problems through year on year improvements in access to crisis and CAMHS services, and reduce the mortality rate from suicide and undetermined injury by at least 20% by 2010.
8. Improve the quality of life and independence of older people so that they can live at home wherever possible, by increasing by March 2006 the number of those supported intensively to live at home to 30 % of the total being supported by social services at home or in residential care.
9. Improve life chances for children, including by:
· improving the level of education, training and employment outcomes for care leavers aged 19, so that levels for this group are at least 75% of those achieved by all young people in the same area, and at least 15% of children in care attain five good GCSEs by 2004. (The Government will review this target in the light of a Social Exclusion Unit study on improving the educational attainment of children in care.);
· narrowing the gap between the proportions of children in care and their peers who are cautioned or convicted; and
reducing the under-18 conception rate by 50% by 2010.
10. Increase the participation of problem drug users in drug treatment programmes by 55% by 2004 and by 100% by 2008, and increase year on year the proportion of users successfully sustaining or completing treatment programmes.
11. By 2010 reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at birth.
Objective III: improve value for money
12. Value for money in the NHS and personal social services will improve by at least 2% per annum, with annual improvements of 1% in both cost efficiency and service effectiveness.
Improvement, expansion and reform
The next three years' priorities and planning framework, 2003-2006 |
IMPROVE ACCESS FOR BOTH EMERGENCY CARE AND PLANNED CARE
Objective
The overall objective is to provide fast, safe and high quality emergency care and fast convenient access and patient choice for planned care.
Throughout the country, there will be:
· Universally high quality primary care services which are accessible and responsive to patients' needs and preferences.
· Integrated networks of emergency care involving health and social services that link together primary care, social care, hospital care, ambulance services, voluntary services and NHS Direct all of whom will play their part.
· Increasing separation of elective and emergency capacity.
· Efficient systems for booking appointments and admissions that offer patient choice and fast access to planned care.
· Local systems to ensure that guarantees to patients are met including the NHS Plan cancelled operations guarantee. (From 1 April 2003 this will apply to patients cancelled at "the last minute" and not just those cancelled "on the day of surgery".)
Targets
For emergency care:
· Reduce to four hours the maximum wait in A&E from arrival to admission, transfer or discharge, by March 2004 for those Trusts who have completed the Emergency Services Collaborative and by the end of 2004 for all others. A target will be set relating to a reduction in the proportion of patients waiting over one hour, following consultation with the service over its precise definition.
· By December 2004 a single phone call to NHS Direct will be a one-stop gateway to out-of-hours healthcare, with callers passed on where, necessary, to the appropriate GP co-operative or deputising service.
For planned care:
· Ensure 100% of patients who wish to do so can see a primary health care professional within 1 working day and a GP within 2 working days by December 2004.
· Achieve a maximum wait of 4 months (17 weeks) for an outpatient appointment and reduce the number of over 13-week outpatient waiters by March 2004, as progress towards achieving a maximum wait of 3 months for an outpatient appointment by December 2005.
· Achieve a maximum wait of 9 months for all inpatient waiters and reduce the number of 6-month in-patient waiters by 40% by March 2004, as progress towards achieving a maximum 6 month wait for inpatients by December 2005 and a 3 month maximum wait by 2008, ensuring an overall reduction in the total list size and a reduction of at least 80% by March 2005 in the number of over 6-month in-patient waiters from the March 2003 baseline.
· Increase the level of choice in each year, offering routine choice of hospital provider at point of booking for all patients by December 2005 with 100% booking of day cases and two thirds of all first outpatient and inpatient elective admissions being pre-booked by March 2004.
National capacity assumptions
· Differential between growth in elective activity and GP referrals of 3% to ensure sufficient elective capacity to meet waiting time targets and offer choice.
· Day case rate increased to 75%
· Increased amount of activity taking place in primary and community settings to contribute to the national assumption of at least one million more outpatients appointments (around 10%) take place in the community rather than in hospital.
· Sufficient bed capacity (including critical care) to ensure that bed occupancy drops to a level consistent with admitting emergency cases without delay.
· Support and incentives for routine delivery of fast and convenient access to primary care services for all patients by increasing and targeted resources in those practices or other service providers with particular resource, management or other developmental needs.
· Increase the amount of elective activity undertaken in dedicated facilities (including DTCs) and non-NHS providers (including the private sector).
CANCER
Objective
The NHS Cancer Plan sets out a framework for services that will:
· Save more lives
· Ensure people with cancer get the right professional support and care as well as the best treatments
· Reduce inequalities
· Build for the future through investment in workforce and research for cancer
All patients should have access to prompt, high quality services for prevention, diagnosis, treatment and care for cancer as set out in the NHS Cancer Plan. Services should be developed through cancer networks (involving the Cancer Services Collaborative) and be provided in line with national cancer standards, taking full account of NICE appraisals and clinical outcomes service guidance. Providers should ensure full participation in national cancer comparative clinical audit, from 2003/04 for lung and breast cancer and from 2004 for colorectal and head and neck cancers.
Targets
· Maintain existing cancer waiting time standards and set local waiting time targets for 2003/04 and 2004/05 so that by the end of December 2005 there is a maximum of one month from diagnosis to treatment, and two months from urgent referral to treatment for all cancers.
· Reduce the rate of smoking, contributing to the national target of: reducing the rate in manual groups from 32% in 1998 to 26% by 2010; 800,000 smokers from all groups successfully quitting at the 4 week stage by 2006
· Extend breast screening to all women aged 65-70 by 2004
· Set local targets to achieve compliance with forthcoming national standards on supportive and palliative care (to be derived from NICE supportive and palliative care guidance)
· Agree, implement and monitor local plans to improve the outcomes of cancer treatment, as evidenced by increasing compliance with NICE Improving Outcomes guidance and the associated national cancer standards
National capacity assumptions
· Increased investment in cancer services, to contribute to additional funding nationally of £570 million for cancer services by 2003/04 (baseline 2000/01)
· Increased access to radiotherapy and diagnostic services (including radiology, pathology and endoscopy) to enable cancer waiting times targets to be met, as demonstrated through increased staffing, improved facilities and equipment.
· Increased investment in specialist palliative care in line with NICE Supportive and Palliative Care Guidance and NHS Cancer Plan commitment, contributing to an extra £50m nationally by 2003/04 (baseline 2000/01)
CORONARY HEART DISEASE
Objective
The National Service Framework for Coronary Heart Disease set the framework for action to:
· prevent disease, save more lives and improve quality of life;
· deliver services that are responsive to the needs and choices of patients;
· reduce inequalities, through action to reduce the risk of CHD
All patients should have access to prompt, high quality care across the patient pathway, as set out in the NSF. Service development should build on the experience of the Primary Care and Coronary Heart Disease Collaborative Programmes, and should take full account of the results of comparative clinical audits. In particular all appropriate units should participate in national CHD comparative audits for paediatric and adult cardiac surgery and for myocardial infarction; and prepare to contribute to the planned national audit on angioplasty.
Targets
· Improve access to services across the patient pathway and increase patient choice by achieving the two week wait standard for Rapid Access Chest Pain Clinics; setting local targets to make progress towards the NSF goal of a 3 month maximum wait for angiography; and delivering maximum waits of 3 months for revascularisation by March 2005, or sooner if possible.
· Deliver a ten percentage point increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help.
· In primary care, update practice-based-registers so that patients with CHD and diabetes continue to receive appropriate advice and treatment in line with NSF standards and by March 2006, ensure practice-based registers and systematic treatment regimes, including appropriate advice on diet, physical activity and smoking, also cover the majority of patients at high risk of CHD, particularly those with hypertension, diabetes and a BMI greater than 30.
· Improve the management of patients with heart failure in line with the NICE Clinical Guideline due in 2003, and set local targets for the consequent reduction in patients admitted to hospital with a diagnosis of heart failure
National capacity assumptions
· Increased access to diagnostic and surgical capacity to enable waiting times targets to be met.
· More defibrillators commissioned in public places, working with the New Opportunities Fund, to contribute to national target of 3,000 by 2004.
MENTAL HEALTH
Objective
The Mental Health NSF and Suicide Prevention Strategy set out a modernisation programme to:
· reduce the suicide rate and deaths by undetermined causes by 20% by 2010
· improve access to general community Mental Health services
Services should be delivered in line with the standards in the Mental Health NSF, the Mental Health Implementation Guide, national Mental Health strategies and compliance with NICE appraisals/guidance. Comparative clinical audit and information from the Mental Health Minimum Data Set (which should be implemented in all Trusts by 03/2003) should be used to develop services, and the National Institute for Mental Health England will support development work. Modernisation will be supported by a new Mental Health Legislative framework. NHS and social services joint responsibility will be delivered through Local Implementation Team partnership.
The Children's NSF and its emerging findings will set out the standards and milestones for improvement in child & adolescent mental health services (CAMHS), including year on year improvements in access.
Targets
· Reduce the duration of untreated psychosis to a service median of less than 3 months, (individual maximum less than 6 months) and provide support for the first three years for all young people who develop a first episode of psychosis by 2004.
· Offer 24-hour crisis resolution to all eligible patients by 2005.
· By Dec 2003, deliver assertive outreach to the 20,000 adult patients with severe mental illness and complex problems who regularly disengage from services.
· Increase breaks available for carers and strengthen carer support and networks to the benefit nationally of approximately 165,000 Carers of people on CPA by 2004.
· Improve mental health care in prisons so that all prisoners with severe mental illness have a Care Plan by April 2004 (approximately 5000 prisoners nationally) and ensure appropriate use of secure and forensic facilities by 2004, contributing to the national target of moving 400 patients from high secure hospitals by 2004.
· Ensure that by April 2004 protocols are in place across all health and social care systems for the care and management of older people with mental health problems.
National capacity assumptions
· Expanded service capacity in key services, to contribute to national requirements by 2004 of 335 crisis resolution teams; 50 additional assertive outreach teams; 50 early intervention teams; 140 new secure personality disorder places.
· Reduced pressure on acute inpatient units by reduction in bed occupancy rate
· All child and adolescent mental health services to provide comprehensive service including mental health promotion and early intervention by 2006
· Increase child and adolescent mental health services by at least 10 per cent each year across the service according to agreed local priorities (demonstrated by increased staffing, patient contacts and/or investment)
OLDER PEOPLE
Objective
The NSF for Older People sets out the framework for health and social care services that will deliver:
· Person centred care, respecting dignity and promoting choice
· The promotion of independent living and health and active life
· User satisfaction through timely access to high quality services that meet people's needs
· Partnership with carers
Services will be developed in line with the NSF standards and milestones. They will be provided in wider partnerships where appropriate, with the right professional support and care, to meet the full range of needs. The Information Strategy for Older People will be implemented and there will be systems in place to explore user and care experience. Councils will implement the policy of offering eligible individuals the choice of direct payments during assessment for community care services.
Targets
· Improve the quality of life and independence of older people so that they can live at home wherever possible, by increasing by March 2006 the number of those supported intensively to live at home to 30% of the total being supported by social services at home or in residential care.
· Each year there will be less than 1% growth in emergency hospital admissions and no growth in re-admissions.
· By December 2004: all assessments of older people will begin within 48 hours of first contact with social services and will be completed within four weeks, (with 70% within two weeks); following assessment, all social services will be provided within four weeks, (with 70% within two weeks); all community equipment for older people (aids and minor adaptations) will be provided by social services within seven working days.
· By 2006, a minimum of 80% of people with diabetes to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy as part of a systematic programme that meets national standards, rising to 100% coverage of those at risk of retinopathy by end 2007.
· By April 2004 all general hospitals caring for people with stroke to have a specialised stroke service, and all health and social care systems to have established an integrated falls service by 2005.
National capacity assumptions
· Intermediate care capacity expanded to meet the NHS Plan targets of an increase in the number of intermediate care beds by 5000 and the number of people benefiting from intermediate care by 220,000, in 2004 compared with 2000. By 2006 councils increase their intermediate care places to benefit an extra 70,000 people a year.
· Service capacity increased in other key services which support people at home so that in 2006: 30,000 more people a year receive care packages involving 5 hours or more a week of home care; 500,000 more pieces of community equipment are provided; there are 6,900 more extra care housing places. An increase of 6000 in the number of people in care homes supported by councils over the three years to 2006.
· An additional 130,000 carers a year receive services in 2006, using the increased investment in the existing carers special grant.
· As a result of investment in extra capacity and the introduction of reimbursement of the NHS by councils, delayed transfers of care reduce to a minimal level by 2006.
LIFE CHANCES FOR CHILDREN
Objective
Ensure the NHS and local government work together to improve life chances for children by:
· promoting the secure attachment of children to carers capable of providing safe and effective care for the duration of their childhood;
· enabling looked after children to gain maximum life chance benefit from educational opportunities, health care, social care and other services;
· addressing issues identified in the Kennedy Report including preparation for and implementation of the first module of the Children's NSF once this is published; and
· engaging fully with the ongoing development of cross-agency preventive work to support children and families, including local prevention strategies, and the continued development of Sure Start and Children's Centres.
Targets
· Improve the educational attainment of children and young people in care by increasing to 15 per cent by 2003-04 the proportion of children leaving care aged 16 and over with 5 GCSEs at grade A*-C, and maintain this level up to 2006. (N.B. The Government will review this target by the end of 2002 in the light of a Social Exclusion Unit study on improving the education attainment of children in care.)
· Improve the level of education, training and employment outcomes for care leavers aged 19, so that levels for this group are at least 75 per cent of those achieved by all young people in the same area by March 2004, and maintain this level up to 2006.
· Reduce by 2004, the proportion of children aged 10-17 and looked after continuously for at least a year who have received a final warning or conviction, by one third from September 2000 position. (Reduce the proportion from the 2000 national figure of 10.8 per cent to a local maximum of 7.2 per cent.) Maintain this reduction up to 2006.
· Maintain current levels of adoption placement stability (as measured by the proportion of placements for adoption ending with the making of an adoption order) so that quality is not compromised whilst increasing the use of adoption as follows:
· By 2004-05 increase by 40 per cent the number of looked after children who are adopted, and aim to exceed this by achieving, if possible, a 50 per cent increase by 2006, up from 2,700 in 1999-2000. All councils will bring their practice up to the current level of the best performers (band 4 or 5 on PSS PAF indicator C23).
· By 2004-05 increase to 95 per cent the proportion of looked after children placed for adoption within 12 months of the decision that adoption is in the child's best interests, up from 81 per cent in 2000-01, and maintain this level (95%) up to 2006, by locally applying the timescales in the National Adoption Standards, taking account of the individual child's needs.
National Capacity Assumptions
· All Local Authorities to have in place robust mechanisms for partnership working with relevant agencies to achieve targets.
· Improvement in the stability and quality of placements for looked after children including through recruitment/retention and support to foster carers over this period to support targets in line with the Choice Protects Review.
IMPROVING THE PATIENT EXPERIENCE
Objective
The NHS will be transformed through better engagement with patients, the public and staff. By regularly seeking out and acting on local feedback, the NHS will create patient responsive services that people perceive to be improving.
The 5 key dimensions for a good patient experience are:
· Improving access and waiting
· More information, more choice
· Building closer relationships
· Safe, high quality, co-ordinated care
· A clean, comfortable, friendly environment
Patients and the public will hold their local NHS to full and proper account for delivering improvements. They will expect updates on progress through formal patient and public involvement structures, and an annual guide to local health services.
Targets
· Improve the 5 key dimensions of the patient's experience as evidenced by increasingly positive local annual survey results, and other patient focused performance indicators, including those developed for the star ratings system. Agree, implement and jointly monitor local improvement plans as a result of surveys, with Patient Forums, as they come on stream during 2003.
· Strengthen accountability to local communities through improved engagement with them, as evidenced by annual Patient Forum reports to the Commission for Patient & Public Involvement in Health, and annual publication of a patient prospectus covering local health services.
· Set local targets to contribute to national target of reducing the value of NHS building backlog maintenance by 25% by 2004.
· Introduce bedside TV and telephone systems in every major hospital by December 2003.
· Eliminate Nightingale wards for older people by April 2004.
· Introduce ward housekeepers in hospitals by 2004 and appoint modern matrons to all remaining posts by April 2004.
National capacity assumptions
· Active Patient Advisory & Liaison Service
· Regular and systematic approach to obtaining, analysing and responding to local patient and public feedback about services
· Partnership working with Patient Forums
REDUCING HEALTH INEQUALITIES
Objective
To reduce inequalities in health outcomes across different groups and areas in the country. Initially the focus is on reducing the gap in infant mortality and life expectancy at birth, and on reducing teenage pregnancies.
NHS improvement, expansion and reform should narrow the health gap by:
· ensuring that the distribution of health benefit from service expansion and development consistently favours individuals and communities that have been traditionally under-served,
· ensuring that service planning is informed by an equity audit and supported by an annual public health report by the Director of Public Health
· tackling the wider determinants of health - agreeing a single set of local priorities with local authorities and other partners, contributing to regeneration and neighbourhood renewal programmes, and ensuring the NHS makes a full contribution to support the Sure Start programme
· building capacity for public health improvement and protection in PCTs
Targets
· Deliver a one percentage point reduction per year in the proportion of women continuing to smoke throughout pregnancy, focussing especially on smokers from disadvantaged groups as a contribution to the national target to reduce by at least 10% the gap in mortality between "routine and manual" groups and the population as a whole by 2010, starting with children under one year.
· Deliver an increase of 2 percentage points per year in breastfeeding initiation rate, focussing especially on women from disadvantaged groups.
· Achieve agreed local teenage conception reduction targets while reducing the gap in rates between the worst fifth of wards and the average by at least a quarter in line with national targets.
· Contribute to a national reduction in death rates from CHD of at least 25% in people under 75 by 2005 compared to 1995-1997, targeting the 20% of areas with the highest rates of CHD.
· Contribute to a national reduction in cancer death rates of at least 12% in people under 75 by 2005 compared to 1995-1997, targeting the 20% of areas with the highest rates of cancer.
· Achieve the target of 70% uptake in influenza immunisation in people aged 65 years and over, targeting populations in the 20% of areas with the lowest life expectancy.
National capacity assumptions
· Improved access to services for disadvantaged groups and areas, particularly
o Early antenatal service booking
o Antenatal and child health screening services
o Sexual health services, and breast/cervical screening.
o Strengthened primary care services through increased numbers of health professionals and improved facilities in under-served and deprived areas.
DRUG MISUSE
Objective
To contribute to delivery of the National Drugs Strategy by reducing the harmful effects of substance misuse.
This will be achieved through expansion and improvement of drug treatment services, and by contributing to the Strategy target to reduce the use of Class A drugs, and frequent use of any illicit drug by young people.
This will include:
· Agreement through the local DAT of arrangements for commissioning integrated drug treatment and prevention programmes jointly with other partners.
· Implementation of the NTA guidance on maximum waiting times for drug treatment, Models of Care, prescribing guidance and action plan on drug-related deaths.
Targets
· Increase the participation of problem drug users in drug treatment programmes by 55% by 2004 and by 100% by 2008 (against 1998 baseline), and increase year on year the proportion of users successfully sustaining or completing treatment programmes
· Reduce drug-related deaths by 20% by 2004 (against 1999 baseline).
National Capacity Assumptions
· An increase in access to general medical services for all problem drug users (irrespective of prescribing needs), and GP participation in training programmes on treatment of drug users.