Anne Coutts

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The number of strategic health authorities in
England is to be cut from 28 to 10 (April 2006)
Health PCT mergers plan approved (May 2006)

• Anne Coutts
• Director of Workforce
• Organisational Development
• United Bristol Healthcare NHS Trust

The NHS is preparing for its biggest overhaul in
hospitals since the health service was set up
(September 2006)
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NHS Contacts per day
Since 1944 universal service for all, based on
clinical need, not ability to pay
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Department of Health NHS in England

• Strategic leadership to the NHS and social care
  organisations
• Resource allocation
• Determining standards eg. Operating Framework
• NHS Chief Executive

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Source Department of Health
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Strategic Health Authorities

• Manage NHS locally though PCTs in conjunction
  with regulators
• Manage public health
• Provide services across patches eg.
  specialist commissioning

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Primary Care Trusts

• 152
• Improve health of community
• Develop primary and community health services
• Commission services, either directly or though
  practice based commissioning
• Increasing diversity of suppliers of primary care
  services

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NHS Trusts

• 2005/06 262 Trusts
• Board usually Chair, 5 Non-Executive and 5
  Executives
• Intention that all trusts become Foundation
  Trusts by April 2008

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Foundation Trusts

• Independent public benefit organisations
• Remain part of NHS but local people can become
  members or governors
• Monitor is the independent regulator
• Increased freedom to retain operating surpluses
  and access capital
• ¼ of England's population now covered by FTs

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Other Models

• Care trusts greater integration of health and
  social care
• Childrens trusts
• Managed clinical networks primary, secondary
  and tertiary care

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New Providers

• Government policy to achieve greater plurality of
  providers
• By 2008 15 of operations and an increasing
  number of diagnostic tests
• But In the overall scale of the NHS, the
  independent sector is small beer
• ISTCs Treatment centres

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Primary Care

• 90 of treatment
• 300 million consultations each year
• Growing range of services in community

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Secondary Care

• Acute Hospitals
• Treatment Centres
• Ambulance Services
• Mental Health (primary and secondary)

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Money following the patients, rewarding the best
and most efficient providers, giving others the
incentive to improve (transactional reforms)
More diverse providers, with more freedom to
innovate and improve services (supply side
reforms)
More choice and a much stronger voice for
patients (demand side reforms)
Better care Better patient experience Better
value for money
A framework of system management, regulation
and decision making that guarantees safety and
quality, fairness, equity and value for
money (system management reforms)
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Priorities 200508

• Increased life expectancy
• Support people with long-term conditions
• Better access to services eg.18 week wait
• Patient involvement and choice
• MRSA

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Framework for Quality Assurance

• National Service Frameworks
• Healthcare Commission core and developmental
  standards
• National Institute for Health and Clinical
  Excellence (NICE)
• National Patient Safety Agency
• NHS Institute for Innovation and Improvement

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Finances

• NHS absorbs 15 of tax and NICs
• PCTs get a weighted capitation formula
  allocation
• Payment by results funding follows patient
• National tariff x Activity ? Income
• Capital limits set at different tiers of NHS
• PFI publicprivate partnership which makes
  private capital available for NHS projects

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