Just when you thought it was safe to come out from under your pile of Christmas presents, last week brought a real New Year treat in the form of the second phase of reports from the NHS Future Forum. The Forum has produced a set of four reports: on integration; public health; information; and education and training.
The reports contain a wide range of aspirations for progress in each of these key areas and a wealth of recommendations. Andrew Lansley's letter of response states: I am pleased to be able to accept all of the Forum's recommendations for the Government. Whether every organisation outside of government (such as CCGs) will be so enthusiastic for each and every recommendation made to them remains to be seen.
For an overview of the issues raised and the recommendations made the Forum has helpfully published a summary report. More detail is set out in the four main papers. I set out below some of the main themes and the key recommendations that affect commissioners.
Page 20 of the integration report looks at commissioning and pooling budgets. CCGs and local authorities have a major role to play in ensuring swift progress is made towards integrating around patients and making it easier for providers to play their part. Commissioners should ensure that patients and carers as well as the wider community are involved as partners throughout the commissioning process.
Page 23 states that all local commissioners must fully and properly explore the potential benefits of joint commissioning and pooled budgets for key populations requiring integrated approaches such as frail older people people with mental health problems people with learning disabilities children with complex needs and the socially excluded. Other recommendations include:
- The NHS Commissioning Board (NCB) should focus its commissioning guidance on supporting CCGs to commission for people not specific diseases
- Commissioners should ensure that every patient with long-term or complex needs has easy access to a named person or team to act as a coordinating point for all of their care
- All care records should be electronic and accessible at the point of care throughout the whole care journey
- The NCB should work with local commissioners to introduce measures of service interoperability in contracts to drive integration
- Monitor and the NCB should urgently support commissioners and providers to understand how competition choice and integration can work together to improve services for patients and communities
- CCGs should be allowed the freedom and flexibility to develop innovative local integrated solutions including variations to tariffs and contracts while new funding models are developed
- The NBC and the Local Government Association should make available a responsive facility providing advice and support to local commissioners on practical implementation issues of integration
The report includes the interesting concept of Mrs Crabtree - the point being that in whatever you do you should ask What does this actually mean for Mrs Crabtree? You might have your own Mrs Smith or Mr Jones to apply this question to.
- The government's information strategy must clearly set out the responsibilities of commissioners and providers in affirming the principle that information is an integral part of service to patients
- Commissioners must compel providers to ensure that information integrates around the needs of the individual. The NCB must lead by example in its direct commissioning of primary care and other services
- The RCGP BMA NCB and relevant patient organisations should be invited by the DH to develop a plan that delivers the roll-out of access to patient records by 2015 (this is the government's stated commitment to giving patients access to their online GP records by the end of the current Parliament)
- There should be a clear contractual requirement that all organisations delivering care in the NHS or in adult and child social care have systems that allow full electronic data sharing against set standards. There can be no opt-out. Commissioners must strive to ensure that this does not unfairly exclude smaller organisations that would otherwise be accepted as qualified providers
- Using data to drive quality is a fundamental governance responsibility for health and social care organisations. The NCB must ensure that commissioners and providers uphold this principle
This report emphasises that the NHS should be refocused towards prevention and promotion. Commissioners should ensure that providers redesign their business using contracts and incentives to improve health and wellbeing and to reduce inequalities. Commissioners should work with providers and public health commissioners to design interventions into NHS care pathways that achieve these outcomes. Support should be provided to enable CCGs to do this from the NCB and DH among others. Other recommendations include:
- Every healthcare professional should make every contact count as an opportunity to maintain and improve a patient's mental and physical health and wellbeing
- Health Education England (HEE) Public Health England and the NCB should build a coalition with professional bodies to agree a programme of action for making every contact count
- NHS organisations and their delivery partners should design and implement a strategy for improving staff mental and physical health and wellbeing
- All providers of NHS-funded care should build the prevention of poor health and the promotion of healthy living into their day to day business and be recognised for achieving excellence
- Commissioners and providers should use partnerships with other local services to improve the health and wellbeing of communities that the NHS locally finds difficult to reach
Education and Training
The authors of this report say they want to see increased consistency in quality in education and training and consequently in people's outcomes and experiences. They stress the need for a payment system which reflects good and excellent practice. Among the recommendations are these:
- Local Education and Training boards should be accountable to HEE
- CCGs must demonstrate a commitment to commissioning from service providers who are able to show evidence that high quality education and training is at the heart of their service. The NCB must assure itself that CCGs are delivering on that recommendation
- CCGs must work with LETBs to develop their community services to deliver the movement of care to the community including increasing the provision of community placements for trainee nurses midwives allied health professionals and other appropriate professionals
There is much to do in challenging timescales in a rapidly changing landscape.