NHS England Board meeting 29 September 2016

NHS England Board meeting 29 September 2016

Video will be available here:

Agenda

Item 1: Public Agenda
Item 2: Minutes of previous meeting held on 28 July 2016
Item 3: Chief Executive’s Report (verbal)
Item 4: NHS operational planning and contracting guidance 2017-19
Item 5: Primary and Acute Care Systems (PACS) and Enhanced Care in Care Homes (ECH)
Item 6: New care models in Tertiary Mental Health Services
Item 7: Improving the quality of customer insight through NHS Citizen
Item 8: Corporate and NHS Performance report
Item 9: NHS Finance Report
Item 10: Use of NHS England Seal
Item 11a: Commissioning Committee Report
Item 11b: Report from Investment Committee
Item 11c: Specialised Services Commissioning Committee
Item 11d: Audit and Risk Assurance Committee (no paper)

Highlights :

3: Chief Executive’s Report.

• The CE outlined the future safeguards regarding major service change he described when addressing the Public Accounts Committee Inquiry into the UnitingCare Inquiry

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.”
http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/unitingcare-partnership-contract-16-17/

4: NHS operational planning and contracting guidance 2017-19

• The NHS Operational Planning and Contracting Guidance for 2017-2019 was published on 22 September. The document sets out how planning and contracting processes are being changed to support Sustainability and Transformation Plans and the financial reset.
• Supported by Technical guidance around CQUINs, Quality Premium, operational and activity plans, Joint contract disputes resolution and draft 2017/18 NHS standard contract. (see https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/)
• Discussion emphasised the ambitious nature of the guidance and financial risk involved, in particular for STPs, and the importance of new system wide Control Totals (see Annex 5).

5: Primary and Acute Care Systems (PACS) and Enhanced Health in Care Homes (EHCH)

• New model frameworks for Primary and Acute Care Systems (PACS) and Enhanced Care in Care Homes (EHCH) now published.

Primary and Acute Care Systems (PACS)

Integrated primary and acute care systems (PACS) - Describing the care model and the business model

• A new, whole population-based model of care provision using better integration through radical care redesign. The PACS model is based on the GP registered list and brings together the delivery of primary care, community based care as well as hospital services .
• The PACS model redefines the responsibilities between commissioner and provider. Three new contracting models are emerging: the ‘virtual’ PACS, (providers are bound together by an alliance Agreement); the ‘partially integrated’ PACS (contract is let for the vast majority of health and care services with a single budget): and the ‘fully integrated’ PACS (a single contract for all local health and care services, operating under a whole population budget.)
• A joint assurance process is under development for publication in October 2016.
• Discussion emphasised
• the balance between joint working and local need for transparency and confidence around contracting. New guidance is being developed to support contracting the process.
• Importance of work with the third sector

Enhanced Health in Care Homes (EHCH)
The framework for enhanced health in care homes

• The new model is based on activity from six vanguards, using a set of evidence-based interventions which are designed to be delivered within and around a care home in a coordinated manner in order to make the biggest difference to its residents. The model seeks to overcome a series of challenges including care, financial, and organisational barriers, as well as development of new models of accountable care provision.
• The Framework describes the seven core elements of the EHCH model and how they can be commissioned to deliver joined-up services, and the fully mature EHCH model.

6: New care models in Tertiary Mental Health Services

• In order to reduce the number of Out of Area (OOA) placement by mental health patients a number of pilot sites have been selected where secondary mental health providers will trial managing care budgets for tertiary mental health services. Pilot sites include two CAMHs Tier 4 (in-patient) and four adult medium and low secure services.
• These new arrangements will be trialled in shadow form until 31 March 2017 and sites will produce a full business case by December 2016 setting out the new clinical pathways and models of care; projected reduction in occupied bed days; and plans for reinvestment in local community services. There will be no change to financial risk before April 2017.
• Benefits of the new models discussed included care closer to home savings through new community services, access to liaison services, cross government support leading to reduction in mental health crisis episodes, increased home care teams, and places of safety.
•  Extensive data on mental health services, which will be published for all CCGs, will be used to monitor outcomes.

7: Improving the quality of customer insight through NHS Citizen

• A summary of the proposed new approach for delivery of public and patient involvement across NHS England through a cross Arm’s Length Body approach.
•  The new approach will include
• NHS Citizen online: A repository for feedback from a variety of data and engagement structured around national NHS England priority areas;
• NHS Citizen outreach: Dedicated engagement and co-production with specific communities of interest, linking into national priority areas
• Citizen representatives on relevant governance groups across NHS England
• Involvement hub: A web-based involvement hub providing on-line resources and signposting training opportunities.
• An NHS Citizen campaign: An underpinning communications plan
• Practical support to STPs is also planned.

8: Corporate and NHS Performance report
The report considers

• NHS England’s performance against current corporate objectives (Learning disabilities, Primary care, Urgent and emergency care, Financial sustainability, Information technology).
• Issues relating to problems with Primary care support services managed by Capita, were highlighted.
• NHS performance against the NHS Constitution standards and other commitments (Urgent and emergency care, Referral to treatment (RTT) waiting times, Cancer waiting times, Diagnostic waits, IAPT, Dementia, Early Intervention in Psychosis, Transforming Care.)

9: NHS Finance Report

• Report to month 5.
• Discussion revolved around the high level of risk, in particular in year to date overspend in CCGs which correlates to shortfalls in commissioning efficiencies.

11a: Commissioning Committee Report 27 July 2016

• Extract:
• “The Committee heard about the future of pharmacy and prescribing, including the medicines optimisation process, aimed at delivering improved value and outcomes through better use of medicines, which is becoming embedded through RightCare.”

NHS England AGM will be at 4.30pm on 25 October 2016 at the RCOG, London.

Date of Next NHS England Board meeting: 18 November 2016