NHS White Paper Equity and Excellence: Liberating the NHS

2. Workshop Aims Present key themes of NHS White Paper Identify key questions to facilitate discussion Provide opportunity to discuss key issues in relation to CAMHS Document points for inclusion in regional response to White Paper

3. White Paper: In a Nutshell Patients at centre of NHS 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

4. Liberating the NHS Key themes Liberate NHS from excessive bureaucratic and political control Power to be given to frontline clinicians and patients NHS values upheld Decentralisation and significant reduction in size of DH Responsibility for health improvement transferred to LAs Questions What will transferring power to frontline clinicians mean for CAMHS? What are the risks / opportunities for CAMHS of LAs having the lead role in public health? AIMS ~ To �liberate� the NHS from excessive bureaucratic and political control ~ To create a patient-focused NHS, achieving outcomes that are among the best in the world Government believes that current commissioning arrangements ~ Have been too remote from the patients they are intended to serve ~ Have been beset by political interference and micromanagement with a rhetoric of PCTs being free to reflect local health priorities but the reality of having to pursue targets and Ministerial demands. NHS values: available to all, free at the point of use, and based on need, not the ability to pay DH to have more strategic focus on improving public health, tackling health inequalities and reforming adult social careAIMS ~ To �liberate� the NHS from excessive bureaucratic and political control ~ To create a patient-focused NHS, achieving outcomes that are among the best in the world Government believes that current commissioning arrangements ~ Have been too remote from the patients they are intended to serve ~ Have been beset by political interference and micromanagement with a rhetoric of PCTs being free to reflect local health priorities but the reality of having to pursue targets and Ministerial demands. NHS values: available to all, free at the point of use, and based on need, not the ability to pay DH to have more strategic focus on improving public health, tackling health inequalities and reforming adult social care

5. Putting patients and the public first Key themes Patient focus, choice and shared decision-making: �no decision about me, without me.� More information for patients (as part of �information revolution�) Patients to rate services provided New national consumer champion, HealthWatch LINks to become local HealthWatch organisations Questions What does shared decision-making mean for CAMHS? What impact will choice have on local strategic planning? What information will CAMHS users need to help them make good choices? How do we ensure that these reforms don�t result in a two tier system of haves (informed / able to express needs) and have-nots? Choice of GP, choice of provider, choice of consultant-led team, choice of treatment for some MH servicesChoice of GP, choice of provider, choice of consultant-led team, choice of treatment for some MH services

6. Improving healthcare outcomes Key themes Government to set out key outcomes Focus on clinical outcomes (not processes) and patient-reported outcomes Role of NICE to be expanded to develop quality standards for social care Providers paid according to tariffs, performance and quality incentives includes CAMHS PbR Outcomes Framework to help patients, public and Parliament understand how NHS is doing to allow SoS to hold NHS Commissioning Board to account to help drive improvements in health outcomes BUT no development of current outcomes thinking focused on acute care little about mental health (nothing on CAMHS) accountability tool so partnership working excluded Commissioning contracts and financial incentives to take NICE standards into account Contractual penalties for providers delivering poor quality care Future payment structure to include CAMHS PbR Incentives to reduce avoidable readmissions Quality measures linked to payment � ie CQUIN expanded Commissioning contracts and financial incentives to take NICE standards into account Contractual penalties for providers delivering poor quality care Future payment structure to include CAMHS PbR Incentives to reduce avoidable readmissions Quality measures linked to payment � ie CQUIN expanded

7. NHS Outcomes Framework Acknowledges that NHS has found it more difficult to collect and understand the experience of child than adult patients (nationally co-ordinated surveys). Want to investigate the possibilities for measuring children's (and their parents' or carers') experiences of their care in a sensitive and appropriate way.Acknowledges that NHS has found it more difficult to collect and understand the experience of child than adult patients (nationally co-ordinated surveys). Want to investigate the possibilities for measuring children's (and their parents' or carers') experiences of their care in a sensitive and appropriate way.

8. Improving healthcare outcomes Each domain An overarching outcome indicator Specific improvement areas where evidence suggests better outcomes possible Supporting quality standards (NICE) Questions What would you want to see in the Outcomes Framework for CAMHS? What incentives would serve to drive quality improvement in CAMHS? What can CAMHS contribute to discussions around Patient Reported Outcome Measures (PROMs) and children�s experience of their care? How can the Outcomes Framework support partnership working? Overarching indicator � eg mortality amenable to healthcare Specific improvement areas � eg cancer stroke and heart disease Overarching indicator � eg mortality amenable to healthcare Specific improvement areas � eg cancer stroke and heart disease

9. Autonomy and accountability Key themes Commissioning: GP consortia NHS Commissioning Board Every NHS Trust to become a foundation trust Focus on competition and role for �any willing provider� Monitor: economic regulator for NHS Care Quality Commission: quality inspectorate across health and social care NHS Commissioning Board leadership on commissioning for quality improvement promoting public and patient involvement and choice ensuring development of GP consortia and holding them to account commissioning certain services allocating and accounting for NHS resources Government�s vision ~ Providers will be free from control by hierarchical management and instead subject to effective quality and economic regulation ~ Clinically led commissioning, payment by results and choice will drive improvements in quality beyond essential regulatory standards ~ Monitor will be an economic regulator responsible for regulating prices, promoting competition and supporting service continuity. Unclear quite how everything will fit together: Monitor, GP consortia, HealthWatch etc �80bn of taxpayers money will be transferred to GP consortia so that ~ redesign of patient pathways and local services will be clinically led ~ based on dialogue with hospital specialists and local people Commissioners free to buy services from any willing provider so providers will compete to provide services PCTs to support emerging consortia Government�s vision ~ Providers will be free from control by hierarchical management and instead subject to effective quality and economic regulation ~ Clinically led commissioning, payment by results and choice will drive improvements in quality beyond essential regulatory standards ~ Monitor will be an economic regulator responsible for regulating prices, promoting competition and supporting service continuity. Unclear quite how everything will fit together: Monitor, GP consortia, HealthWatch etc �80bn of taxpayers money will be transferred to GP consortia so that ~ redesign of patient pathways and local services will be clinically led ~ based on dialogue with hospital specialists and local people Commissioners free to buy services from any willing provider so providers will compete to provide services PCTs to support emerging consortia

10. Commissioning responsibilities GP consortia: elective hospital care and rehabilitative care urgent and emergency care most community health services mental health learning disability services NHS Commissioning Board primary medical services other family health services (eg dentistry, community pharmacy) national and regional specialised services maternity services prison health services Specialised Services National Definitions Set: ~ specialised mental health services (all ages) � Tier 4 CAMHS and forensic ~ specialised services for childrenSpecialised Services National Definitions Set: ~ specialised mental health services (all ages) � Tier 4 CAMHS and forensic ~ specialised services for children

11. Autonomy and accountability Key questions What are the commissioning risks for CAMHS? Tier 1 with LAs Tier 2 / 3 with GP consortia Tier 4 with regional commissioning Do GPs have sufficient knowledge and understanding of CAMHS to commission this well? Which elements of CAMHS could / should not be commissioned by GP consortia? How should GP consortia engage patients and the public in commissioning CAMHS?

12. Local Democratic Legitimacy Key themes: LAs to lead on local health improvement and prevention activity LAs to create Health & Wellbeing Boards join up commissioning of local NHS, social care and public health LAs to lead on JSNAs LAs to commission local HealthWatch Key questions: Should Health & Wellbeing Boards only focus on adults? How do the proposals fit with the current duty to co-operate through children�s trusts? What would further incentivise integrated working in CAMHS? Local HealthWatch to become the Citizens Advice Bureau for health and social care - ie wider responsibility for complaints advocacy and supporting individuals to exercise choice and control Functions of health and wellbeing boards Primary aim: to promote integration and partnership working across the NHS, social care, public health and other local services and improve democratic accountability To assess the needs of the local population and lead the statutory joint strategic needs assessment To promote integration and partnership across areas, including through promoting joined up commissioning plans across the NHS, social care and public health To support joint commissioning and pooled budget arrangements, where all parties agree this makes sense To undertake a scrutiny role in relation to major service redesign.Local HealthWatch to become the Citizens Advice Bureau for health and social care - ie wider responsibility for complaints advocacy and supporting individuals to exercise choice and control Functions of health and wellbeing boards Primary aim: to promote integration and partnership working across the NHS, social care, public health and other local services and improve democratic accountability To assess the needs of the local population and lead the statutory joint strategic needs assessment To promote integration and partnership across areas, including through promoting joined up commissioning plans across the NHS, social care and public health To support joint commissioning and pooled budget arrangements, where all parties agree this makes sense To undertake a scrutiny role in relation to major service redesign.

13. Cutting bureaucracy & improving efficiency Key themes Abolition of PCTs and SHAs Unnecessary quangos abolished Changes will lead to significant disruption and loss of jobs Efficiency savings of �20 billion, including significant (up to 45%) reductions in NHS management costs greater competition renewed focus on QIPP Government will not bail out commissioners who fail Questions How might greater competition between providers impact on CAMHS? How can CAMHS contribute to the QIPP agenda?

14. Timetable 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.