East of England

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East of England East Midlands London North
East North West South East Coast South
Central South West West Midlands Yorkshire the
Humber
High quality care for all NHS Next Stage Review
Final Report
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What is the Next Stage Review about?

• The review will help support local patients,
  staff and the public in making the changes they
  need and want in their local NHS
• It was carried out by Leading clinician and
  Health Minister Lord Darzi
• His final report was published on Monday 30th
  June
• Supported by additional documents
• NHS Constitution
• Workforce Planning, Education Training
• Primary Community Care Strategy and
• Informatics Review

identify the way forward for a 21st Century NHS
which is clinically-driven, patient-centred and
responsive to local communities

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Why are we doing it?
Challenges

• The NHS
• Well placed to respond as tax-based system, based
  on need not ability to pay
• The NHS has the resources it needs
• High quality care is more efficient and
  prevention is a better investment

• Ever higher expectations
• Advancements in treatments
• Demand driven by demographics
• Health in an information age
• Changing nature of disease
• Changing health workplace

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Where we have been and where we are going
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High quality care for all

• NHS Next Stage Review local clinical visions,
  national enabling report and NHS Constitution

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Introducing the reform levers

• Patient choice and payment by results
• Foundation trusts
• Stronger commissioning

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Building capacity in the system

• NHS Plan saw greatest investment in the history
  of the NHS
• More doctors, more nurses, better facilities

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How has the Review engaged people?
Context

• What has this meant in practice
• More than 2,000 clinicians, social care staff and
  others involved across the country
• Eight clinical pathway groups in each SHA, a
  total of 74 nationwide
• 60,000 people participated locally and nationally
  
• This is how the NHS should do change

• Core of the Review has been the people engaged in
  it based on clinically-led process
• Each NHS region (SHA) held 2 deliberative events
  (nationwide process) and involved people in many
  more ways
• Every SHA used this as a basis for their vision
  published May and June

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What did the SHA Visions say?

• Staying healthy people want more support and
  advice to stay healthy
• Maternity and new-born. Women want greater choice
  and a more personal experience, with care
  provided by a named midwife
• Childrens. Services needed to be more
  effectively designed around the needs of children
  and families.
• Acute care. Saving lives by creating specialised
  centres for major trauma, heart attack and stroke
  care
• Planned care. More care could and should be
  provided closer to peoples homes.
• Mental health. Challenge to extend services in
  the community, notably for psychological
  therapies
• Long-term conditions. Personalised partnerships
  between people with long-term conditions and the
  professionals and volunteers caring for them
• End-of-life. Necessity for greater dignity and
  respect at the end of life

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Next Stage Review Overview

• Raising standards. Its about safety, experience
  and outcomes. Quality matters to patients, is
  good value for taxpayers and energises staff. Our
  framework is to set standards, measure against
  them, publish the information, act on it,
  regulate against it, reward it and improve on it
• Clinical voice at every level. Putting clinical
  decision-making at the heart of the NHS.
• A pioneering NHS. Taking advantage of the
  continuous improvement in technology.

• Care that is high quality and personal (4
  principles). What matters most is quality of
  outcome and experience
• Giving patients more rights and control over
  their own health empowering patients
• Help to stay healthy. NHS focusing on improving
  health as well as treating sickness

Quality at the heart of the NHS

• Empowering front line staff to lead change that
  improves the quality of care
• Valuing the work of staff through a greater
  investment in training and education
• Locally-led, clinically-driven. Change for the
  right reasons in the right way.

A bold vision for the 21st Century secured by our
first NHS Constitution
An NHS that empowers patients and staff
Working in partnership with staff
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An NHS that empowers patients and staff
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Helping people to stay healthy

• A new emphasis on prevention
• every PCT will commission wellbeing and
  prevention services focused on six key goals
• tackling obesity, reducing alcohol harm, treating
  drug addiction, reducing smoking rates, improving
  sexual health and improving mental health.
• A new Coalition for Better Health, to improve
  health outcomes
• With Government, private and third sector
  organisations
• Reduce Your Risk campaign.
• Raise awareness of biggest killer vascular
  diseases and how to reduce risk
• Support for people to stay healthy at work.
• We will pilot integrated Fit for Work services to
  help people who want to work but are struggling
  with ill health
• Support family doctors to help individuals and
  their families stay healthy.
• Changes to Quality Outcomes Framework and PBC to
  promote prevention

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Giving patients more rights and control over
their own health

• Extend choice of GP.
• Fairer rewards for practices taking on new
  patients, electronic registration
• New right to choice.
• Draft NHS Constitution contains new right to
  choose treatment and providers with quality
  information
• Personalised care plans for people with long-term
  conditions.
• Service organised around people
• Pilot personal health budgets.
• Learn from social care to give greater control to
  individuals and families
• Guaranteeing access to NICE approved drugs.
• All patients will have the best treatments and
  NICE processes will be speeded up

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Quality at the heart of the NHS
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Quality at the heart of the NHS

• Getting the basics right first time, every time
• Improvements in safety, enforced by the new Care
  Quality Commission to tackle, for example,
  healthcare acquired infection
• Independent clinical standards and priority
  setting
• NICE expanded to set and approve independent
  quality standards
• A new National Quality Board will give
  transparent advice to Ministers regarding top
  clinical priorities
• Quality of care measured from the frontline up
• Every organisation will be required by law to
  publish Quality Accounts just as they publish
  financial accounts
• All staff will have access to NHS Evidence
  service
• Web based portal on what high quality care looks
  like, and how to deliver it

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Quality at the heart of the NHS

• Making funding for hospitals that treat NHS
  patients reflect the quality of care that
  patients receive
• For the first time patients own assessment on
  the success of their treatment and the quality of
  their experiences will have a direct impact on
  the way hospitals are funded
• For senior doctors, the operation of the current
  Clinical Excellence Awards Scheme will be
  strengthened, to reinforce quality improvements
• In primary care all GP practices and dental
  practices registered with Care Quality
  Commission.
• NICE to develop and review quality indicators for
  the QOF
• Support for practice accreditation schemes e.g.
  from the Royal College of General Practitioners.
• Developing new best practice tariffs focused on
  areas for improvement
• These will pay for best practice not average
  cost, meaning NHS organisations will need to
  improve or lose out

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Clinical voice at every level

• Medical Directors and Clinical Advisory Boards
  feature at every level of the NHS
• local (in PCTs), regional (SHAs) and national (in
  the DH itself).
• Health service plans will be based on eight
  pathways of care
• Primary Care Trusts will publish plans later this
  year that will put into practice the local
  clinical visions that are based on eight pathways
  of care
• There is clear local support for quality
  improvement.
• A new Quality Observatory will be established
  in every NHS region to inform and support local
  quality improvement efforts

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A pioneering NHS

• SHAs will have a new legal duty to promote
  innovation, with new funds and prizes to support
  and reward innovation
• Innovation will be supported and local action
  encouraged to improve care, by making funds and
  prizes available to the local NHS
• Strengthened horizon scanning process for new
  medicines in development and for new medical
  technologies.
• Simplification of the pathway by which they pass
  from development into wider use.
• Creating new partnerships between the NHS,
  universities and industry
• These clusters will enable pioneering new
  treatments to be developed and then delivered
  directly to patients.

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Working in partnership with staff
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More freedom at the front line

• Unlocking talents
• Acknowledging clinicians wider roles in the NHS
  providing opportunity for all to be
  practitioners, partners and leaders
• Continuing to set NHS organisations free from
  central direction. Includes helping NHS staff
  establish their own not for profit social
  enterprises and retain their pension if they
  transfer
• Enhanced accountability
• Enabling shared endeavour across
  multidisciplinary teams through new locally
  tailored service line quality metrics
• Expecting staff to look out to the patients and
  communities they serve with outcomes openly
  available
• Fostering leadership
• Expecting that local leaders will enable
  meaningful conversations around shared vision,
  management methods and expectations of each other
• Establishing a National Leadership Council
  chaired by the NHS CE to set standards, quality
  assure and commission
• Embedding leadership and management training into
  undergraduate and postgraduate curricula and
  appraisal systems
• Introducing 3 levels of nationally accredited
  leadership training

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Valuing and empowering staff

• Valuing staff
• The constitution sets out the NHS-wide values
  that have been developed bottom-up with patients,
  the public and staff to inform behaviour across
  organisations. These sit alongside local values
  within organisations
• Four new pledges for staff. The NHS Constitution
  makes pledges on work, wellbeing, learning and
  development, involvement and partnership. Staff
  rights and responsibilities are set out for the
  first time
• Excellence in education and training
• Ambitions for clinical career pathways are
  described to enable progression and flexibility
  with a link to models of care
• Continued investment in education and training
  with a three-fold increase in funding for nurse
  and midwife preceptorships and a doubling of
  apprenticeships to 10,000 across the service
• Transparency of funding flows
• Reforming the funding of education and training
  to make it fairer and more transparent, with
  funding following the trainee
• Strengthening the arrangements to promote
  consistent and equitable opportunities for
  continuous professional development

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Making workforce systems work

• Improving workforce planning and education
  commissioning
• Basing workforce planning on patient pathways and
  models of care with greater local accountability
• Education commissioning will match the service
  model and be designed around commissioners and
  providers with the use of a tariff to drive
  quality
• Advisory bodies and centre
• Supporting the creation of professional advisory
  boards, including Medical Education England. A
  Centre of Excellence will be established to
  improve forecasting and assure analytical rigour
• Increased transparency of reporting
• Requiring the annual publication of Trust
  investment on continuous professional development
  with benchmarking introduced over time
• Introducing staff satisfaction as an indicator in
  the annual evaluation of NHS trusts and NHS
  foundation trusts
• From today, we will set no new national targets.
  Instead the outcomes achieved by every NHS
  organisation will be openly available. In this
  way, clinicians, and the organisations they work
  in, will be held to account by their patients,
  their peers and the public.

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The Constitution will secure the founding NHS
values for us and for future generations,
ensuring care that is high quality, fair and
personal for all.
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NHS Constitution - implementing the vision

• Secure the NHS for the next generation
• the Constitution is intended to safeguard the
  common principles, values and commitments on
  which the NHS is founded
• Empower patients by clearly setting out, for the
  first time, patients existing legal rights.
• Strengthen NHS accountability
• by setting out the rights of patients and staff,
  and explaining the mechanisms through which they
  can hold the NHS to account.
• Four new pledges to staff. The NHS Constitution
  makes pledges on
• work and wellbeing,
• learning and development,
• Involvement,
• and partnership.

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NHS Constitution - implementing the vision

• At the heart of the proposed Constitution are the
  NHS commitments to patients, public and staff in
  the form of
• rights to which people are legally entitled
• pledges which the NHS will strive to deliver
• All NHS organisations will have statutory duty to
  take into account the NHS Constitution in their
  decision making
• There will be a consultation process which
  everyone will be welcome to participate in,
  running until the end of October.
• It can be accessed at www.ournhs.nhs.uk

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NHS Constitution what you need to know

• For the first time the values of the NHS - what
  binds all parts of the NHS system - have been set
  down
• developed from the bottom up, with full input of
  staff, public and patients, as well as NHS
  leaders and stakeholders.
• These highlight the common ground across the NHS,
  and will guide how different parts of the NHS
  interact with each other
• Local values, aligned to the national set, are
  essential to make sure they become embedded in
  day-to-day life they dont replace local
  values, but complement them

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NHS Constitution what you need to know

• These values will provide common ground for
  debate when difficult decisions need to be made
  within and between organisations.
• The constitution provides more stability for the
  NHS, leaving it to focus on patient care based
  on 3-10 year reviews
• The right to NICE approved drugs, vaccines and
  screening - Ending the post code lottery
• Everyone will be looked after no discrimination
  e.g. on the basis of lifestyle

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NHS Constitution - Values

• We will set out the core values that underpin the
  NHS and have been developed from the bottom up.
• 1. Respect and Dignity - Treating people,
  whether patients or staff, as individuals not
  symptoms or resources.
  
• 2. Commitment to quality of care - Earning
  others trust by insisting on quality and getting
  the basics right.
• 3. Compassion - Finding the time to listen and
  understand.
• 4. Improving Lives - Striving to improve health
  and wellbeing in England through excellence and
  professionalism.
• 5. Working together for patients - Putting
  patients first in everything we do, by reaching
  out to staff, patients, carers, families and
  communities, and professionals outside the NHS.
• 6. Everyone Counts - Using our resources for the
  benefit of the whole community.