July 2009: Review of the first year of the Review is now published: High Quality Care for All: Our Journey So Far
It concludes there has been progress: 50 new GP-led Health Centres, the introduction of Personal Care Plan for 9.3 million patients with long term conditions and the growth in keyhole surgery. The focus on quality has moved up the agenda for staff and organisations, supported by the promotion of innovation through the introduction of tools and funds such as NHS Evidence, the Innovation Fund and the Challenge Prizes.
The DH summary: "The report also outlines plans to drive up the quality agenda even further and free up clinicians time to do this. Proposals include:
- Refining of targets based on evidence - We will remove the obsolete 13 week outpatient and 26 week inpatient performance targets, as well as reviewing data collections across the board in order to reduce the burden on front line staff;
- Clinician budget ownership - Allowing clinical teams to manage their budgets will promote entrepreneurship and innovative delivery of services built around the needs of the patient.
- Peer review accreditation system - we will create a new voluntary peer review system in which clinicians will judge the standard of their peers in order to drive up quality and achieve a 'gold standard' of care. The system will be developed through close collaboration and consultation with the relevant partners and stakeholders."
June 2008
The once-in-a-generation Review of the NHS by Lord Darzi: Next Stage Review of the NHS has now been published on 30 June 2008: High Quality Care for All. Click here. The key elements of the vision are:
• Fair – equally available to all, taking full account of personal circumstances and diversity
• Personalised – tailored to the needs and wants of each individual, especially the most vulnerable and those in greatest need, providing access to services at the time and place of their choice
• Effective – focused on delivering outcomes for patients that are among the best in the world
• Safe – as safe as it possibly can be, giving patients and the public the confidence they need in the care they receive. The IMPRESS summary is here.
One of the strategies supporting it is the primary care strategy published on 3 July as part of the once-in-a-generation Review of the NHS by Lord Darzi has a number of points of relevance for IMPRESS (those in bold):
"People shaping care"
GP patient survey
Multi-disciplinary teams
Greater choice of GP
Fairer funding
NHS Choices to include primary and community care
Own personalised care plan for long term conditions by 2010
Patient Prospecus for people with long term conditions
Pilot of individual budgets for people with long term conditions
"Promoting healthy lives"
Greater pooling of resources with local government, third sector
Suite of indicators to measure and incentivise improvements in health and wellbeing
New Child Health Promotion Programme
Pilot access to musculoskeletal, psychological and other services to support return to work
Vascular Risk Assessment programme (40-74 years)
Improved access to services to quit smoking, control alcohol use and improve diet or exercise
Primary and community care to have central role in tackling health inequalities
Improve QOF to incentivise maintenance of good health
"Continuously improving quality"
Professional development for clinical leaders
Pilot tools to compare clinical quality, productivity and patient experience in community health services.
New tariffs for community care
Staff right to request set up of social enterprises. Guaranteed NHS pension.
With NICE, create independent, transparent process to develop and review QOF indicators, focusing on health outcomes + quality
Support collection, analysis and publication of data on quality
Promote accreditation schemes eg with RCGP
New Care Quality Commission, will register all GP and dental services and help tackle persistently poor performance
"Leading local change"
Support PCTs and clinicians to make local decisions on integrated primary and community care services
PbC groups entitled to improved information, management and financial support - PCTs accountable
PCTs will give more power and responsibility to high-performing, multi-professional PbC groups
With PCTs, pilot formation of integrated care organisations (will look for bidders)
Provide support and and development programmes to ensure primary and community care is better commissioned
Minister-led group to identify how best to support organisations that wish to go further with health and social care integration
There are several other supporting strategies:
The Draft NHS Constitution – The proposed new constitution was published on the 30th June and is out for consultation led by the SHAs. It marks 60 years of the NHS, and is about safeguarding its core principles and values for the next generation, whilst setting a clear direction for the future. It reaffirms rights to NHS services, free of charge and with equal access for all, and it enshrines patient rights to choice and to NICE-approved drugs recommended by clinicians.
The Health Informatics Review - This report describes how informatics is supporting the delivery of better, safer care of patients, improving the NHS through better research, planning and management, and empowering patients to make more informed choices about health and care.
A High Quality Workforce
In addition, clinicians and commissioners should be mindful of a number of key policy documents:
- Department of Health policy on managing long term conditions and care closer to home
Our health our care our say: a new direction for community services http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4127552
Long term conditions compendium of information 'Adding life to years and years to life'
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082069
- The Operating Framework for the NHS in England for 2008/09 that lists key priorities and includes the 2008/09 tariff as part of Payment by Results
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081094
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081096
- The opportunities that the General Medical Services contract and the Quality and Outcomes Framework afford
http://www.dh.gov.uk/en/Healthcare/Primarycare/Primarycarecontracting/GMS/index.htm
- The review of the NHS in London http://www.london.nhs.uk/londonnhs-news.aspx?id_Content=7311 and nationally http://www.ournhs.nhs.uk/ led by Lord Sir Ara Darzi
The Jargon Buster gives further support in understanding terminology and giving further links. The IMPRESS links section also clusters links.
There is a new guide (Sept 2008) on principles and rules for c-operation and competition. Click here.
Carers at the heart of 21st century families and communities: a caring system on your side, a life of your own
A new national carer's strategy was launched in July 2008 as a cross-departmental policy. It sets out the Government's short-term agenda and long-term vision for the future care and support of carers. Click here.
The carers' strategy is underpinned by £255 million to implement some immediate steps alongside with medium and long-term plans.
New commitments in the carers’ strategy include: £150 million towards planned short breaks for carers; £38 million towards supporting carers to enter or re-enter the job market and £6 million towards improving support for young carers. Other schemes include the piloting of annual health checks for carers to help them stay well and training for GPs to recognise and support carers. A more integrated and personalised support service for carers will be offered through easily accessible information, targeted training for key professionals to support carers, and pilots to examine how the NHS can better support carers.
Social Services Departments are actively considering the implications, but it will affect health care commissioning too.