Integrated Support and Assurance Process (ISAP) for new care model procurement

Integrated Support and Assurance Process (ISAP)
NHS England and NHS Improvement, 17 August 2017

• It has been recognised that the contractual arrangements through which some new care models will be implemented may mean:
• The contract structure, form, content or the calculation of the financial value of the contract envelope are ‘novel’;
• The bidder’s organisational forms may be complex, as providers form legal entities and arrangements that allow for greater collaboration between partners; and
• A single procurement for a new care model can significantly affect incumbent NHS providers. 
• These documents describe the integrated NHS England and NHS Improvement process for supporting commissioners and providers looking to procure and bid for complex contracts. 
• Part A: Introduction to the ISAP for commissioners and providers looking to procure, or bid for, a complex contract;
• Part B: The questions that will be asked and the submissions from commissioners expected at each stage of the ISAP; and
• Part C: Guidance for NHS trusts and foundation trusts looking to bid for a complex contract. This may also help independent providers bidding for such contracts.

NHS England Board meeting 15 December 2016

NHS England Board meeting 15 December 2016

• Papers available here.
• Video will be available here

Agenda

• Minutes of meeting 29 September 2016
• Item 2: Chairman’s Report – Verbal report
• Item 3: Chief Executive’s Report – Verbal report
• Item 4: Taking the cancer strategy forward: programme update
• Item 5: Update on the 17/18-18/19 operational planning and contracting round
• Item 6: Sustainability and Transformation Plans
• Item 7: NHS England Corporate and NHS Performance Report
• Item 8: NHS Finance Report
• Item 9 ia: Commissioning Committee on 28 September 2016
• Item 9 ib: Commissioning Committee on 13 October 2016.
• Item 9 ic: Commissioning Committee on 17 November 2016.
• Item 9 ii: Investment Committee 
• Item 9 ii: Specialised Services Commissioning Committee

Highlights :

Integrated Support and Assurance Process (ISAP)

Integrated Support and Assurance Process
NHS Improvement, NHS England 4 November 2016

• A consistent, streamlined process for supporting and assuring the successful delivery of complex contracts.
• This guidance provides an initial introduction to, and overview of the process ISAP and includes:
• lessons learnt from past complex contracts
• key risk management questions for providers, commissioners, NHS Improvement and NHS England
• the stages of the ISAP
• when to apply the ISAP
• how to feedback on the ISAP
• next steps for those working on complex contracts
• NHS Improvement will be publishing the full guidance later this year which will include more information on the submissions and evidence expected from commissioners and providers at each stage of the procurement process.

Guidance resulting from UnitingCare Partnership contract failure

UnitingCare Partnership contract inquiry
Public Accounts Committee 14 September 2016

• Giving evidence to the inquiry following the NAO report into the collapse of the UnitingCare contract Simon Stevens discussed the safeguards which are being put in place going forward.
• Q172 
• “Simon Stevens: From October, we will publish a checklist that will have to be gone through for any CCG wanting to embark on these kinds of service changes, and NHS England and NHS Improvement will create a joint assurance process that, for any part of the country that is going through a big thing of this nature, will answer four questions. 
• First, can we be convinced that the clinical model—the service model they are talking about—will actually produce net benefits to the health service across the whole economy? 
• Second, is the provider—whoever they are— actually capable of managing the contract and the risk that is involved? 
• Thirdly, have people thought through the consequences for other providers? That is not to say there is a veto on change, but nevertheless in the real world there may be consequences for other providers, so what are you going to do about that? 
• Fourthly, as we talked about earlier, does there need to be any change in the regulation that NHS improvement has for that provider or providers and the Care Quality Commission as well? 
• Those four tests would have to be applied to any of these kinds of arrangements in future.” 

New CCG improvement and Assessment Framework 2016/17

CCG improvement and assessment 2016/17
NHS England 31 March 2016

• A new CCG Improvement and Assessment Framework 2016/17 replaces both the existing CCG assurance framework and CCG performance dashboard. 
• From June, an initial assessment of CCG performance will be available online that will cover six crucial areas including cancer, dementia, diabetes, mental health, learning disabilities and maternity care. This will be followed by an annual assessment in June 2017.
• The Technical Annex (published 23 May 2016)  of provides details of the construction and purpose of each of the 60 indicators across 29 areas  in the Framework. 
• Also published is the OperatingManual Part One which describes the first part of a phased approach to operationalising CCG improvement and assessment for 2016/17
• To track updates see  CCG improvement and assessment 2016/17

Good Practice Guide: Service Reconfiguration

Planning, assuring and delivering service change for patients: A good practice guide for commissioners on the NHS England assurance process for major service changes and reconfiguration
NHS England 1 November 2015 (updates previous edition Dec 2013)

• Guidance for those considering, and involved in, service reconfiguration to navigate a clear path from inception to implementation. It will support commissioners to consider how to take forward their proposals, including effective public involvement, enabling them to reach robust decisions on change in the best interests of their patients.
• Also sets out how new proposals for service change or reconfiguration are tested through independent review and assurance by NHS England.

Latest version always available here:

Shared principles for redesigning local health and care landscape

Shared principles for redesigning the local health and care landscape
LGA, ADASS, SOLACE, CfPS, ADPH, 14 October 2015

• This document lays out five key principles to provide all local system leaders with shared principles which will ensure that service redesign meets a number of fundamental requirements and provide assurance that proposals are focused on improving services and health and wellbeing outcomes. 
• It also emphasises the need to co-create and co-design new services in partnership with local service users and the community
• The principles are:
• Do the proposals promote a person centred approach?
• To what extent are they rooted in local accountability?
• Are they evidence-based? 
• Do they support a community budgeting, place-based approach?
• Will they make a difference?

CCG assurance framework for 2015/16

CCG assurance framework for 2015/16
NHS England 26 March 2015

• The new CCG assurance framework includes a strengthened focus on a CCG’s performance in delivering improvements for patients, as well as assessment of its capability to deliver core and additional delegated responsibilities.
• The framework will be underpinned by additional documents which will be published later in due course following further detailed engagement with stakeholders. These will include:
• a more detailed operational guidance for CCGs;
• a CCG scorecard; and
• technical guidance on the metrics used in the scorecard.

Government's Care bill, fact sheets and glossary

Care Bill announced
DH, 10 May 2013 updated 23 December 2013, 10 January 2014

• The Government’s Care Bill to reform the law relating to care and support for adults, relating to support for carer and provision about safeguarding adults from abuse or neglect has been published.
• The legislation will
• Help people get compassionate care in hospital, in a care home or in the community, by introducing Ofsted-style ratings for hospitals and care homes, making quality as important as finance and strengthening training for staff.
• Join up care by enshrining in law that everyone should have a personal care plan, access to a personal budget and that carers, for the first time, will have a right to get support themselves if they are found to have eligible needs. There will also be a national minimum eligibility threshold across the country.
• Reform the funding of care so no one will have to sell their home in their lifetime, or lose everything they’ve worked for, to pay for the costs of living in a care home. And a cap on care costs and financial support for more people will protect people from catastrophic costs and provide important peace of mind.
• The includes responses to the  Government’s Caring for our future White Paper (2012), the Francis report. It will also strengthen training and education and research regulation.
• The DH has published a number of Care Bill Fact Sheets to accompany the Bill and a Care Bill Glossary

CCG assurance framework and sources of evidence

Clinical commissioning and direct commissioning assurance
NHS England, 28 November 2013

• The CCG Assurance Framework sets out how NHS England will meet its statutory responsibility to conduct a performance assessment of each CCG. 
• Alongside the framework, an operational guide sets out how assurance should be delivered in 2013/14, with key sources of evidence which will inform the assessment and a 2013/14 delivery dashboard
• Annual assurance engagement process report 2013

GP assurance website

Primary Care Web Tool - an assurance management website www.primarycare.nhs.uk 

• This site provides a web portal for Primary Care data accessible to GP practice staff , CCGs area and regional teams of NHS England.
• The web interface provides pre-analysed data to facilitate relationships between area teams and practices. Unique practice profiles are also available.
• This portal will also be used to collect the annual electronic practice declaration. Primary medical services assurance management policy and guidance is available in the resources section once registered.
• Registration is required to access the website

Primary medical services assurance framework

Primary medical services assurance framework: Standard operating policies and procedures for primary care
NHS England,  June 2013
Available on the primary care assurance website (registration required)

• This document forms part of a suite of policies and procedures to support commissioning of primary care. They have been produced by Primary Care Commissioning (PCC) for use by NHS England’s area teams (ATs).
• This policy outlines the approach to be taken by NHS England when managing primary medical care contracts to ensure compliance with quality standards and details the core principles that underpin the operating model for AT staff in their interaction with contractors post 31st March 2013.
• "Management responsibilities sit firmly with the ATs, but recognising CCGs have a statutory duty to assist and support the NHS England in securing continuous improvement in the quality of primary medical services. This means that the future operating model needs to be different to that adopted by any one PCT currently i.e. the transfer of contractual responsibility does not mean a corresponding transfer of current processes and procedures."p8
• See the letter (20 June 2013) from Dr David Geddes, Head of Primary Care Commissioning describing the framework

CCG assurance framework and balanced scorecard

CCG Assurance Framework 2013/14 (outline proposal and interim arrangements)
NHS England, 7 May 2013

• This document describes NHS England’s outline proposal and interim arrangements for the CCG assurance framework.
• The core elements of assurance  are delivery, capability and and support
• Annexes include:
• Proposed balanced scorecard domain assessment 
• Proposed support, intervention and escalation framework under the balanced scorecard
• Proposed domains for assurance of organisational health and capability

How do we know we are providing a high quality service? Guidance for NHS provider trust boards

Quality governance: How does a board know that its organisation is working effectively to improve patient care?
Monitor, April 2013

• Guidance for boards of NHS provider organisations to enable them to perform their role in improving health services for patients.
• Based on the three dimensions of quality identified by Lord Darzi: clinical effectiveness, patient safety and patient experience and helps trusts to measure themselves against Monitor's Quality Governance Framework
• This guidance also covers some practical steps that boards can undertake, and concludes with a list of questions boards may want to ask themselves to assess how well they are doing.