Mcmanus 1 nov smuc chaplains lecture

Last updated: August 2013 © Nuffield Trust

The new NHS in England: A rough guide for Chaplains

Grateful thanks to the Nuffield Trust for allowing download ofand use of several Nuffield Trust slides in this presentation. http://www.nuffieldtrust.org.uk/

Jim McManusNovember 2013, St Mary’s University CollegeChaplaincy Degree Students

Objectives

• Structure and overview of NHS and Social Care System

• History• Relevance for Hospital Chaplains• Tips for further learning• Discussion

Last updated: August 2013 © Nuffield Trust

Part 1: NHS and Social Care System Overall Structures

Thanks to the Nuffield Trust for allowing download ofand use of the Nuffield Trust slides in this presentationhttp://www.nuffieldtrust.org.uk/

Jim McManus1st November 2013, St Mary’s University

Federalised structure of NHS in UK

• 1948 NHS created to be free at point of delivery• Since 1999, devolved government in Wales and

Scotland and later Northern Ireland have meant diverging health care systems

• England: purchaser provider split• Wales & Scotland: moving back towards integration –

market model rejected, services brought back ‘in house’

• All UK – varying approaches to voluntary and independent/private sectors

2008 to 2013• 2010 last year of above

inflation increases. 43% real terms increase in funding to 2010.productivity did not keep up

• 2010 onwards: coalition govt. Andrew Lansley’s new plans and principles

5

White Paper: In a Nutshell

• Patients at centre of NHS “No decision about me, without me”

• Greater focus on clinical outcomes• Shift in power toward health professionals

– £80bn transferred to GP consortia

• Bureaucracy reduced / autonomy increased– all NHS Trusts to become NHS Foundation Trusts

• “Increased choice and competition in the NHS”

NHS Outcomes Framework (copy in your packs)

Timetable – disruption, disagrement and change

• Health Bill: Autumn 2010• Public Health White Paper: late 2010• Further consultations: late 2010• Every GP a member of a 'shadow' consortium by 2011/12• NHS Commissioning Board and Health & Wellbeing Boards

established by April 2012• Monitor established as economic regulator by April 2012• Allocations for 2013/14 made directly to GP consortia in late 2012 (by

which time SHAs and PCTs will be formally abolished)• GP consortia take full financial responsibility and fully operational

from April 2013.

New Structure (Source: http

://www.nhshistory.net/a_guide_to_the_nhs.htm)

Director of Public Health in local authority

NHS Finance history

The NHS in transition: mapping the changes

• The Health and Social Care Act 2012 is changing the NHS’:

• Structure• Accountabilities• Funding arrangements• Working relationships

The following slides show the principal changes.

Regulation and Competition

• Care Quality Commission• Monitor• NICE• Professional bodies (NMC, GMC etc)• Cooperation & Competition Panel (Monitor)• Office of Fair Trading• Competition Commission• EU Competition Law – “right to provide”

12

The NHS in England before the reforms

NHS April 2013 onwards

New funding arrangements

Providers: regulation and accountability

Commissioners: performance management and guidance

How patients and members of the public can influence their health and social care services

Medical and professional education and training

Role of Clinical Commissioning Groups in Provider Development

Maintain an ongoing dialogue with aspirant FTs, supporting commitments set out in the Tripartite

Formal Agreements (TFAs)

Ensure support and sign-up to the activity levels agreed by both parties in the NHS Trust plans

Ensure NHS Trusts engage with and endorse provider strategies that support sustainable local healthcare, reflecting patient needs

Take actions to ensure appropriate providers and models of care are available to meet commissioning requirements

Support the development of Trust FT applications specifically with activity plans and overall health system strategies

Support Trusts in developing sustainable business models to achieve FT status

Provide support to NHS Trusts to ensure they are aware of the Equality Delivery System

NHS Trust

NHS Foundation Trust

CCGs must:

Provider and Commissioner Relationships

Provider

Commissioner

Consumer

Commissioners are focused on commissioning cycle to prove a balanced foundation for strategic change

A key challenge is designing and purchasing sustainable service specifications that provide quality and value for money

The provision and security of local hospital services are

vital for community confidence, user stability and

assurance

The provider will value and prioritise independence and autonomy acquired through FT statusThe format and content of an FT business plan is a crucial set of core requirements

Last updated: August 2013 © Nuffield Trust

Part 2: NHS Trust Structures and Systems

Jim McManusNovember 2013, St Mary’s University

How the money flows

NHS England also do specialist commissioning of hospitalsDsPH and Local Authorities too

NHS Trusts

• Providers• Commissioned by several commissioners usually• Community Trusts, Acute Trusts, Special Trusts• All have Board of Execs and Non Execs• Varying Clinical and Operational Structures within

this• Most have charitable funds• Many have private patients• NHS Foundation Trusts

NHS Foundation Trusts (from Monitor)

• What are NHS foundation trusts?• NHS foundation trusts are not-for-profit, public benefit

corporations. They are part of the NHS and provide over half of all NHS hospital, mental health and ambulance services.

• “NHS foundation trusts were created to devolve decision making from central government to local organisations and communities. They provide and develop healthcare according to core NHS principles - free care, based on need and not ability to pay.”

• Govt aspirations on NHS Foundation Trust coverage

NHS Foundation trusts 2

• What makes NHS foundation trusts different from NHS trusts?

• they are not directed by Government so have greater freedom to decide, with their governors and members, their own strategy and the way services are run;

• they can retain their surpluses and borrow to invest in new and improved services for patients and service users; and

NHS Foundation Trusts 3

• they are accountable to: – their local communities through their members and

governors;– their commissioners through contracts;– Parliament (each foundation trust must lay its

annual report and accounts before Parliament);– the Care Quality Commission (through the legal

requirement to register and meet the associated standards for the quality of care provided); and

– Monitor through the NHS provider licence.

NHS Foundation Trusts 4

• NHS foundation trusts can be more responsive to the needs and wishes of their local communities

• anyone who lives in the area, works for a foundation trust, or has been a patient or service user there, can become a member of the trust.

• These members elect the board of governors. • Members can stand for election as governors

NHS Foundation Trusts 5

• The council of governors works with the Board of Directors, Councils of governors are expected to focus on ensuring that NHS foundation trusts listen and respond to the needs and preferences of stakeholders, especially local communities.

• The Board of Directors - day-to-day running of the trust and both executive and non-executive directors.

• The council of governors does not have an operational role. Governors are responsible primarily for holding the non-executive directors individually and collectively to account for the performance of the board of directors and for representing the interests of the foundation trust members and of the public.

• Contact your local NHS foundation trust for more information on how to become a member, governor or non-executive director. A list of NHS foundation trusts, together with contact details, can be found on our NHS foundation trust directory.

• holding the non-executive directors individually and collectively to account for the performance of the board of directors;

• representing the interests of the foundation trust members and of the public;

• appointing, removing and deciding the terms of office of the chair and other non-executive directors;

• approving the appointment of the chief executive;

• receiving the annual report and accounts, and auditor’s report, at a general meeting; appointing and removing the auditor;

• approving increases to non-NHS income of more than 5% of total income;

• approving acquisitions, mergers, separations and dissolutions;

• approving changes to the trust’s constitution; and

• expressing a view on the board’s plans for the NHS foundation trust, in advance of the plan’s submission to Monitor.

NHS Foundation Trusts 6 – Governors’ roles include:

Issues for discussion

• How will you navigate this system?• What issues about identity and

professionalisation does this raise for you?• How does your dual locus as Church AND NHS

impact here and what does this say?• The NHS is a very large organisation, how do

you work within it with integrity and protect yourself from organizational politics?

• What do you need to know more about?

Further Resources

• [email protected]

• www.catholicsinhealthcare.wordpress.com • http://catholicsinhealthcare.wordpress.com • http://www.catholicmedicalassociation.org.uk/ • http://

www.cbcew.org.uk/CBCEW-Home/Subjects/Healthcare

Last updated: August 2013

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