20 December 2010 NHS Outcomes Framework was published. This framework follows from the consultation Transparency in outcomes framework for the NHS.
1 framework defining how the NHS will be accountable for outcomes
5 domains articulating the responsibilities of the NHS
10 overarching indicators covering the broad aims of each domain
31 improvement areas looking in more detail at key areas within each domain
51 indicators in total measuring overarching and improvement area outcomes
The indicators relevant to IMPRESS
Domain 1 Preventing people from dying prematurely
Overarching indicator
1a Mortality from causes considered amenable to healthcare
Improvement areas
1.2 Under 75 mortality rate from respiratory disease* *Shared responsibility with Public Health England - including children (excluding pneumonia and influenza)
1.4 v One and vi five year survival from lung cancer
Domain 2 Enhancing quality of life for people with long-term conditions
Overarching indicator
2 Health related quality of life for people with long term conditions (EQ5D)
Improvement areas
Ensuring people feel supported to manage their condition
2.1 Proportion of people feeling supported tomanage their condition (also included in Adult Social Care Outcomes Framework) (GP survey)
Improving functional ability in people with longterm conditions
2.2 Employment of people with long term conditions (Labour Force Survey)
Reducing time spent in hospital by people with long term conditions
2.3.i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) New indicator
2.3.ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s
Enhancing quality of life for carers
2.4 Health related quality of life for carers (EQ5D) GP survey
Guided by NICE COPD Quality Standard
Domain 3 Helping people to recover from episodes of ill health or following injury
Overarching indicators
3a Emergency admissions for acute conditions that should not usually require hospital admission
3b Emergency readmissions within 28 days of discharge from hospital
Improvement areas
Preventing lower respiratory tract infections (LRTIs) in children from becoming serious
3.2 Emergency admissions for children with LRTIs (indicator of effectiveness of NHS in managing LRTIs)
Helping older people to recover their independence after illness or injury
3.6 The proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into rehabilitation services
There will be scoping work for bronchiolitis to have a NICE quality standard
Domain 4 Ensuring that people have a positive experience of care
Overarching indicators
4a Patient experience of primary care (GP Patient Survey)
4b Patient experience of hospital care (Inpatient Survey plus new surveys Outpatients and A&E Surveys)
Improving the experience of care for people at the end of their lives
4.6 An indicator needs to be developed based on the survey of bereaved carers (new survey tool being developed for use in 2012/13
Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm
Overarching indicators
5a Patient safety incident reporting
5b Severity of harm
5c Number of similar incidents
Improvement areas
Reducing the incidence of avoidable harm
5.4 Incidence of medication errors causing serious harm
Summary
20 December 2010 Liberating the NHS: Developing the Healthcare Workforce sets out proposals for a new workforce, education and training structure driven by patient need and led by local healthcare providers.
Responses can be completed online by 31 March 2011.
15 December 2010 DH published Liberating the NHS: Legislative Framework and Next Steps, which sets out the policy for NHS England reform in detail including a timetable.
There were nearly 6,000 responses to the White Paper, ‘Equity and excellence: Liberating the NHS’. Many of those published by policy organisations expressed concern about the fast speed of the reforms at a time when financial control was critical. However, the timetable appears unchanged.
The government has drawn attention to two changes:
• commissioning of maternity services will now sit with GP consortia
• councils’ formal scrutiny powers will be extended to cover all NHS-funded services, and local authorities will have greater freedom in how these are exercised.
An NHS Bill will be introduced in 2011.
15 December 2010 Operating Framework 2011/12 - see IMPRESS page for full information about implications for respiratory services.
30 November 2010 DH England published public health white paper: Healthy lives, healthy people: our strategy for public health in England. The document promises to put significant control of public health, including ring-fenced funding, in the hands of local authorities. Much of the DH focus will move to public health and “a dedicated new public health service – Public Health England", will be accountable to the Secretary of State for Heath. Its role will be to "fund those services that contribute to health and wellbeing primarily by prevention rather than treatment aimed at cure ... for funding and ensuring the provision of services such as health protection, emergency preparedness, … and some elements of the GP contract (including the Quality and Outcomes Framework (QOF)) such as those relating to immunisation, contraception, and dental public health."
Public Health England will have three principal ways to fund services:
Granting the public health ring-fenced budget to local government;
Asking the NHS Commissioning Board to commission services, such as screening services, and the relevant elements of the GP contract; and
Commissioning or providing services directly, for example national purchasing of vaccines, national communication campaigns, or health protection functions currently conducted by the Health Protection Agency (HPA).
Responses:
NHS Alliance: "The development of public health performance 'league tables' for GPs appears to be on the way. This should be an interesting challenge.....Another interesting challenge will be to understand whether, how and from where 15% will be removed from the existing QOF to fund a public health QOF."
Royal College of Physicians: "The white paper gives a clear overview of how this government plans to improve public health, and is to be welcomed for attempting to bring to the field a much needed strategic focus and coherence. However, the RCP is disappointed by the lack of detail, especially around how to deal with the threats posed by alcohol misuse, obesity and smoking. We wait keenly to see if the promised subsequent strategies will fill in the gaps."
Faculty of Public Health response "FPH supports public health’s return to local authorities and the authorities’ new responsibility for health. The director of public health will play a central role as an authoritative, independent and influential leader in shaping local services and delivering a new vision for public health. FPH also welcomes the approach to outcomes and evidence, and the focus on health inequalities, which still blight so many communities around the country, as well as the Government’s willingness to explore a mixture of innovative measures to help people lead healthier lives."
ASH response: "ASH welcomes the Health Secretary’s commitment to reducing health inequalities by improving the health of the poorest people in society fastest. Research shows that the best way of doing this is to help those who are most disadvantaged to stop smoking since smoking accounts for half the difference in life expectancy between rich and poor."
King's Fund response" "positive move.....But this must not result in public health being separated from the work of the NHS – GPs and other health professionals have a vital contribution to make so we welcome the emphasis in the White Paper on strengthening the role of GPs in improving the health of their local populations.....Ministers are right to focus on how people can be nudged to adopt healthier lifestyles. But, as the ban on smoking in public places has shown, strong state intervention is also needed to change people’s behaviour and meet the challenges posed by smoking, alcohol misuse and obesity. It remains to be seen whether the government will strike the right balance on this. The question is not whether regulation or nudging is more effective – a combination of both is required to deliver the behaviour changes needed.....not clear whether it is ambitious enough to address the significant and growing gap in life expectancy between rich and poor."
NHS Confederation response: "The relationship between GP consortia and local authorities is really crucial.....We need to work out the details about what incentives there will be to encourage each part of the system to work together and also how to ensure clear accountability. For example, it may be sensible to mandate that GPs sit on local council health and well-being boards or keep some public health expertise inside the NHS."
29 November 2010 Summaries from NHS Alliance conference 18-19 November 2010 - by IMPRESS Project Manager on GP commissioning, integrated care, personal health budgets, role of NICE. Click here. Original presentations - go here.
Adult social care
13 January 2011 DH England announces new investment to support its vision for adult social care, and to support its reablement policy.
(Scanned and last time not visible: "work together..".)
DH England 15 November 2010 published the Government’s plans for adult social care
services - A Vision for Adult Social Care: Capable Communities and Active Citizens. Alongside the Social Care Vision, the Department of Health has also launched a consultation on Transparency in outcomes: a framework for adult social care - a new strategic approach to quality and outcomes in adult social care.
The vision sets the context for the future development of social care services and is highly relevant for health care providers and commissioners in terms of its strategic direction. It is the first step towards the White Paper on care and support at the end of 2011. This will set out plans for "care and support", also known as continuing care and the requirements for new legislation.
Plans for service reform were outlined in the social care consortium’s Partnership Agreement, Think Personal, Act Local 3 launched at the National Children’s and Adult Services conference on 4 November 2010. It describes the next steps for councils to personalise services and provide more comprehensiveinformation for people who need advice on care and support services. In addition to this, the consortium has also produced a number of best practice guides. The themes are:
- Prevention
- Personalisation
- Plurality
- Partnership
- Protection
- Productivity, quality and innovation
- People
The separate best practice guides are
Practical approaches to improving the lives of disabled and older people by building stronger communities
Practical approaches to market and provider development
Practical approaches to co-production
Practical approaches to safeguarding and personalisation
Personal Budgets - Checking the Results
Enabling risk, ensuring safety - self-directed support and personal budgets
18 October 2010 Liberating the NHS: An Information Revolution and Liberating the NHS: Greater choice and control. Consultation closes 14 January 2011. These take further the idea of "nothing about me without me" and providing people with better information about health and social care services to improve outcomes, involving people in decisions about their own health and care and giving patients real choice and control.
Equity and Excellence - Liberating the NHS
13 October consultation responses to Liberating the NHS and also to the Outcomes Framework.
GP commissioning: including FAQs click here.
Responses from other organisations can be found here:
BTS including the response
Royal College of Physicians
Royal College of General Practitioners
British Medical Association
Royal College of Nursing
NHS Confederation
Kings Fund
15 July 2010 - Equity and Excellence: Liberating the NHS. The new white paper on the NHS in England was released on 12 July. Until details are available about the outcomes framework, the 150 quality standards, or other details that specifically affect the provision of respiratory care, IMPRESS will not add commentary to what is already available from other policy analysts. However, the briefing papers are all available here:
- The white paper
- summary slides
- letter from David Nicholson, CEO of the NHS in England describing transition arrangements, and a tighter central control of quality and finance whilst the decentralised model takes shape
- slides about the transition timelines
There are some references to respiratory care:
OECD comparision of avoidable asthma admissions. See here and also EUROCARE-4. on cancer, although lung cancer statistics are not currently available.
21 May 2010
The New Secretary of State for Health, Andrew Lansley, announced that from now on all service reconfigurations must
• focus on improving patient outcomes;
• consider patient choice;
• have support from GP commissioners; and
• be based on sound clinical evidence.
He has therefore put a hold on NHS London plans pending demonstration of GP support.
December 2009
Operating Framework for 2010/11. See separate IMPRESS page.
December 2009: NHS 2010-2015: from good to great. Preventative, people-centred, productive.
This presents the medium term vision for the NHS in England. Here are some of the implications for respiratory care:
1. Prevention: continue to build on smoking cessation successes and NHS Constitution messages about people taking responsibility for their lifestyle. Heralds new tobacco control strategy due out shortly and role of partnership with local authorities.
2. People-centred, productive: sets an expectation for “transformed services” for COPD, diabetes and dementia. Particular mention of high comparative (OECD countries) admission rates for asthma. Consultation on strategy for COPD and asthma highlighted “this could include the following:”
1. Reviewing registers
2. Active case management
3. Education and support
4. Structured hospital admission and early discharge
3. Reminder of the long term conditions strategy, including personal health budgets and personalised care planning. Note that two SHAs have web resources on this:
South West
And East of England
There is also an NHS Evidence example of good practice.
4. Review of tariff system to incentivise right pathways of care – limiting payment for activity in excess of planned levels (might have cash limits). In addition to the levers such as CQINS, and non-payment for Never Events. Over time this might mean new locally negotiated incentives to reduce bed days through early discharge schemes and hospital at home, rather than admission avoidance pressures (where these are not felt to be appropriate).
5. Strong focus on encouraging NHS providers to work together – see page 58. Including, para 4.45 looking seriously at vertical integration – argues this is not the right time to spend effort on creating new structures and new organisations. Vertical integration is likely to mean mergers between hospital trusts and community services. Although the social enterprise model is supported only 20 have been supported by end Dec 2009 under Right to Request. This seems to reemphasise the new commitment to use preferred NHS providers, and so has not found favour with the third or private sector although the commitment to the third sector in supporting people with long term conditions is still there (there is likely to be renewed debate about whether choice is affordable).
6. Greater support and performance management of PCT commissioners – both required to go more local, but also for underperforming PCT s to be taken over by high-performing.
7. Pay restraint: page 46 and page 47: “explore the pros and cons of offering frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint.” This is not offered to management or commissioning.
High Quality Care For All – the Next Stage Review by Lord Darzi June 2008 Click here and see IMPRESS summary here.
Clinical commissioning: our vision for practice-based commissioning. Click here. This is the latest report on practice-based commissioning
Implementing care closer to home: convenient quality care for patients (DH, May 2007) Click here.
Commissioning Framework for Health & Well-being (DH, March 2007) Click here.
Our Health, Our Care, Our Say’ a new direction for community services (DH, January 2006) Click here
Healthy lives, brighter futures – The strategy for children and young people’s health - Feb 2009 Children's Strategy - opportunities for children with asthma and other respiratory diseases
Respiratory – a consultation Strategy for Services for Chronic Obstructive Pulmonary Disease (COPD) in England was launched on 23 February 2010. It also has a chapter on asthma. Consultation closes 6 April 2010. Both BTS and PCRS-UK will be responding. A second consultation document, Impact Assessment is worth downloading. It contains estimates of the costs and benefits of the strategy.
End of life
High quality care for all adults at the end of life (DH 2008) Click here
Smoking: A smokefree future: a comprehensive tobacco control strategy for England
Carers: Carers at the heart of 21st century families and communities. This requires that PCTs should work with local authority partners and publish joint plans on how their combined funding will support breaks for carers in a personalised way.
The Operating Framework 2011/12 requires PCTs to agree policies, plans and budgets with local authorities to implement Recognised, valued and supported: next steps for the Carers Strategy. It gives four priorities:
- supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages;
- enabling those with caring responsibilities to fulfil their educational and employment potential;
- personalised support both for carers and those they support, enabling them to have a family and community life; and
- supporting carers to remain mentally and physically well.
It offers these actions:
- providing £400m additional funding over the next four years for breaks, and further resources for GP training, to increase GPs’ awareness and understanding of carers’ needs for support. The Department for Education has already announced that additional funding recycled from the Child Trust Fund will be used to support short breaks services. The legislative process to place a duty on councils to commission a short breaks service should be completed in the New Year;
- the Department for Education will make a new early intervention grant available to local government from April 2011-12, bringing together a range of funding streams for early intervention services for young people and families, including young carers;
- the Department for Business, Innovation and Skills will issue a consultation document next year to consult with business on how best to take forward the Coalition commitment to extend to all employees the right to request flexible working;
- The Department of Health and the Department for Business, Innovation and Skills will examine how small local enterprises can be encouraged to provide good quality, reliable and consistent replacement care either to give carers a break from caring responsibilities or to enable them to work alongside caring responsibilities; and
- the Department of Health and the Department for Business, Innovation and Skills will work with industry and statutory and voluntary sector stakeholders to identify the barriers and enablers to market growth in assisted living technologies, and to support further uptake and boost innovation.
Scotland
Wales
Northern Ireland