Ian Dalton on NHS planning in 2013/14

Everyone Counts describes a new process of NHS planning. For the new NHS which comes
into existence on the 1st April 2013. Planning in the NHS is about how we, and clinical commissioners
work together to deliver improved outcomes for the patients of England and ensure that
they benefit from the rights outlines in the NHS Constitution. But a new NHS, one that
is built on assumed liberty, with clinilca commissioning groups having the main responsibility
for looking after their local populations on behalf of the NHS requires a different
approach to planning than we’ve had in the past. What Everyone Counts does is set that
out. The new approach to planning has been worked following discussions with people who
will be delivering it in future. What I’ve heard is a big interest in ensuring within
the NHS planning system we carve out a real focus on the needs of local communities as
well as reflecting the national ask that comes from being part of the National Health Service.
To meet that very legitimate challenge that I’ve heard from clinical commissioning groups
in particular we’ve now broken the planning process down into three lenses. Three different
kinds of plans that taken together will give the offer to patients about what the NHS will
do for them next year. The first lens responds to that message from
clinical commissioning groups that they want the space to work to focus on the needs of
their local communities. We want the NHS across the country to improve against the NHS outcomes
framework because we know those are the things which make a difference for patients. But
we know the needs of local communities are different and that’s what we’ve heard
from clinical commissioning groups. So we’re asking every part of the country to look at
its local needs working as part of local Health and Wellbeing Boards and come up with a plan
that makes an improvement in outcomes for that population. This is a different kind
of planning ask to the usual planning ask. We recognise that, that need to be let by
clinical commissioning groups working with local authorities and colleagues in Health
and Wellbeing Boards our offer from the NHS Commissioning Board is that we as a fellow
commissioner will be in those conversations as a member of local Health and Wellbeing
Boards contributing to the discussions on the needs of local communities. But what we
wont be doing predetermining the outcome, or performance managing the outcome of that,
this is about local collective analysis of what’s needed the local ideas of clinicians
who are in touch with local population’s needs coming up with a plan that works for
those local areas and holding themselves to account in the local area for making those
improvements. That’s a new approach to planning, one that’s really important and we’re
determined to give that the space and the resources and from our point of view the information
support to help it happen. But it’s not one we manage in a top down way. At the same
time, there are two other very important lenses that come together to give us confidence that
we’re doing right by patients. The second lens looks at the clinical commissioning
group as an organisation and builds on the work that each clinical commissioning group
has done to prepare its plans for next year that they have worked up as part of their
authorisation and development process. So it is about asking a clinical commissioning
group what its plans are to improve outcomes and to ensure that its patients benefit from
the rights in the NHS Constitution. The third lens to planning turns the focus
onto us as a commissioner, the NHS Commissioning Board. We commissioning across England around
26 billion pounds worth of care for patients, we commission the care provided by general
practitioners and other primary care practitioners right through to the very specialist care
that is provided to often very small groups a patients suffering from very rare conditions.
And our offer is that we make a commitment to over time becoming an exemplar commissioner
in our own right and so the third lens is about our challenge to ourselves to be as
good as we can be in using that resource to the benefits of patients. Taken together,
those three lenses, the very local lens looking at local needs the focus on the clinical commissioning
group as an organisation and how it uses its budget to help achieve benefits for its patients
and the challenge to ourselves about becoming as good a commissioner as we can be to use
our resource wisely taken together that reflects a very new approach to planning but one that
I think has real benefits for patients, and that is what Everyone Counts is all about.
Within Everyone Counts there are some tools that we believe will help do their job in
planning for the future. So I’d like to highlight just a couple of those very quickly.
The first is an opportunity to reward excellence, patches and organisations that go beyond the
minimum on behalf of their patients and I’d just very briefly like to highlight two examples
of that. We have a commitment in the document to a quality premium for clinical commissioning
groups this will be, I think, again reflecting the balance of national and local in the new
system not merely a list of things we’d want to see from the national commissioning
end but a synthesis of a national ask around improvement in a small number of areas in
the NHS Outcomes Framework with a group of self-set improvement objectives based on local
need and that are agreed with the Commissioning Board but come from clinical commissioning
groups themselves. Across that basket of, you know, some things in the national outcomes
framework and some local relevant improvements organisations which make improvements in 2013-14
for their patients across that will be rewarded with a small quality premium in 2014-15 to
further invest in improving services for patients. One the provider side we’re once again putting
2.5% of resource into a programme, there will be a national ask as part of that as there
has been in previous years. This year we’re looking to see improvement in four key areas,
which I think are worth briefly highlighting. The first is an improvement in care for people
with dementia, the second is the effective rollout of the Friends and Family Test ensuring
we ask patients what they thought of services and whether they’d recommend them, the third
is the use of the NHS safety thermometer to ensure that our services for patients are
even safer, and the fourth is an improvement in screening for patients for venous thromboembolism.
So there will be four measures there which we will look to see improvement in next year
and will reward through CQUIN. To get CQUIN of course, providers will also need to have
met the high impact changes in the improving health and wealth strategy that we set out
last year. So, in conclusion, Everyone Counts is a new
approach to planning, one that is built on the structure of the new system and that recognises
the important role of local, autonomous clinical commissioning groups, in driving change for
patients. I very much hope that everybody reading the guidance will see the clear intent
of the Commissioning Board to make the new system work and will find the tools that we’ve
outlined there and the support which we as a Commissioning Board are giving into local
planning as a helpful part of preparing for the important work we have to do next year.