Engaging with the NHS Commissioning Board and the impact of the changes in the wider LHE Simon Weldon, NHS Commissioning

1. Engaging with the NHS Commissioning Board and the impact of the changes in the wider LHESimon Weldon, NHS Commissioning Board London Regional Team London Regional Team 23 October 2012

2. Role of the NHS Commissioning Board • Directly commissioning £25 billion worth of services including primary care, some public health services such as immunisation and screening, and specialised health services. • Allocating £60 billion to Clinical Commissioning Groups and supporting them in the effective use of that money to buy local services. • Planning for civil emergencies and making sure the NHS is resilient. • Developing relationships and agreements with delivery partners at national level, and at local level on health and wellbeing boards. • Leading the development of strategy and vision for the NHS, and promoting the research, innovation and change which will make the NHS world class in all it does. • Setting policies and standards for the NHS, in particular in respect of information, leadership, competition. • Developing incentives, tools and guidance to help clinical commissioners achieve their goals.

3. Operations directorate • The Operations directorate will be led by Ian Dalton, Chief Operating Officer and Deputy Chief Executive. • It will work to achieve shared goals of improving outcomes and delivery of the mandate, using a single, transparent, rules-based operating model. • The key functions of the national Operations directorate are: • To conduct direct commissioning and provide oversight of delivery of primary care commissioning; specialised commissioning; military health; public health; offender health • To provide assurance and assessment of Clinical Commissioning Groups • To be responsible for emergency preparedness.

4. 10 design principles Operate as a part of the NHS Commissioning Board. Fit with the footprint of organisations with which relationships are key to the London region’s success. Focus on delivering the national commissioning priorities at a regional and local level. Delivery of a national, clinically-led strategy and the creation of a clinically and financially-viable provider landscape will require significant service transformation and reconfiguration. Reduce complexity by acting as a link between the public, patients and services at a local level, and the NHS Commissioning Board and system at a national level.

5. 10 design principles Play a coordinating and oversight role across the NHS in London, ensuring roles and accountabilities are aligned to delivery. Enable ‘assumed autonomy’, but hold Clinical Commissioning Groups and providers to account and ensure performance remains high. Have internal clear accountabilities, minimise internal complexity and avoid conflicts of interest. Localise activity where relationships or local knowledge are key and centralise activities where economies of scale or skill are achievable. Remain flexible to the changing needs of the local system and population, and of the national priorities.

6. Regional Structure: Regional Director Business Office Director of HR and OD Director of Patients and Information Medical Director Director of Nursing Finance Director Director of Operations and Delivery Commissioning Director Transformation Director

7. What are the immediate challenges? • Authorisation of CCGs • The planning and contracting round • Managing in year delivery • Setting aspirations • Forming new relationships • Implementing strategic change

8. Authorisation of CCGs • The process that establishes CCGs as statutory organisations – governed in the Act • Well underway in London and will be complete by early January • Establishes the terms under which a CCG will be authorised • Principles of assumed liberty and local planning with partners

9. The planning and contracting round • For acute, mental health and community, the planning round will be led by CCGs • Commissioning Board a significant commissioner of services; specialised, public health • Planning guidance and allocations will be issued in December

10. Managing in-year delivery • The need to maintain in year delivery both of standards and the money is paramount • The process of managed transition to the new system organisations has begun • This creates the platform for the CCGs, the NCB and the NTDA to carry out their functions • The process of transition completes at the end of March 2013 • The first operational challenge the new organisations face will be the management of winter

11. Setting aspirations • The process of creating the new systems and authorising CCGs is rigorous • But authorisation in itself is a moment in time • The challenges CCGs will face include not only being great commissioners of their providers but also describing and setting the aspirations to meet local health needs with partners • These aspirations should be drawn from the NHS outcomes framework • The new system offers opportunities to consider new approaches – for example, how to promote wellness.

12. Forming new relationships • The changes create a number of new organisations • The challenge will be to articulate and define how these organisations will work together to deliver benefit • The CCG should lead the commissioning of local health care for a population • The NCB will hold the system accountability for delivery of the NHS Constitution • The NTDA will be responsible for the oversight of non-FTs journey towards FT status and for in-year performance management

13. Implementing strategic change • The new system inherits a significant agenda around strategic change • This will fall into two, linked areas: reconfigurations and clinical service redesign • There are significant challenges associated with the current programme of reconfiguration both in terms of securing decisions and also implementation • In addition, we must also continue to build on the legacy of the current system with continued work on cancer, urgent care, integrated care and hospital standards.

14. In conclusion • Authorisation of CCGs • The planning and contracting round • Managing in year delivery • Setting aspirations • Forming new relationships • Implementing strategic change • These are undoubtedly massive challenges • But we also have significant opportunities – all of us – to shape and design what the new system delivers

15. Any questions?