Work the System: The Simple Mechanics of Making More & Working Less -- 3rd Edition

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Work the System: The Simple Mechanics of Making More & Working Less -- 3rd Edition

Work the System: The Simple Mechanics of Making More & Working Less -- 3rd Edition

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NHS and local government’s national leaders set out a vision of more collaboration in the NHS Five Year Forward View Despite the success of NHS England and NHS Improvement’s joint working programme, there are limits to how far they can fully collaborate under the current legislation. For example, both organisations have separately been assigned some distinctive and non-shareable functions in legislation – they are currently required to have separate Boards, Chairs, CEOs and non-executive directors and still consist of 3 separate employers. Despite the efforts of both organisations to find practical arrangements and ‘work-arounds’, these restrictions and governance arrangements prevent the organisations from fully operating as one single organisation. Stakeholders have said that existing legislation is overly detailed and prescriptive in some areas. We intend to reform the existing legislation to support the workforce by creating the flexibility NHS organisations need – to remove the barriers that prevent them from working together and to enable them to arrange services and provide joined up care in the interests of service users. We will put pragmatism at the heart of the system. Enabling the NHS and local authorities to arrange healthcare services to meet current and future challenges by ensuring that public and taxpayer value – and joined up care – are first and foremost. This will require changes to both competition law as it was applied to the NHS in the Health and Social Care Act 2012 and the system of procurement applied to the NHS by that legislation. These changes will enable the NHS and local authorities to avoid needless bureaucracy in arranging healthcare services while retaining core duties to ensure quality and value. This will be supported by further pragmatic reforms to the tariff and to remove the statutory requirement for Local Education and Training Boards. Improving accountability and enhancing public confidence To support closer working between actors in the health and care system, greater clarity is needed to enable joint appointments across different organisations. At the heart of the changes being taken forward by the NHS and its partners, and at the heart of our legislative proposals, is the goal of joined up care for everyone in England. Instead of working independently every part of the NHS, public health and social care system should continue to seek out ways to connect, communicate and collaborate so that the health and care needs of people are met. Healthy, fulfilled, independent and longer lives for the people of England will require health and care services, local government, NHS bodies, and others to work ever more closely together. Different professions, organisations, services and sectors will work with common purpose and in partnership. This will be especially important when we seek to focus on the people and communities that are most in need of support.

remove the CMA function to review mergers involving NHS foundation trusts. The CMA’s jurisdiction in relation to transactions involving non-NHS bodies (for example, between an NHS Trust/ FT and private enterprise) and other health matters (such as drug pricing) would be unchanged give NHS England the ability to joint commission its direct commissioning functions with more than one ICS Board, allowing services to be arranged for their combined populations Further detail on our proposals for integrated care systems is set out at annex B, encompassing both the legislative and the non-legislative arrangements we intend to put in place. This is one of the most important elements of the legislative proposals, and we have sought to understand the hopes and concerns of a range of stakeholders in framing them. We have been particularly mindful of the importance of places within systems and of the enormous potential for joint working and innovation between local government and health partners that many of the vanguard ICSs have already demonstrated, while also recognising the distinct accountabilities of NHS bodies and local government. Reducing bureaucracy Turning effective innovations and bureaucracy busting into meaningful improvements for everyone, learning from innovations during COVID-19We will also work closely with the NHS to reduce the health inequalities currently experienced in the area of choice, by helping to increase clarity and awareness of patient choice rights within systems and of the range of choices available. Reducing bureaucracy proposals The powers within the bill are intended to enable us to develop a new provider selection regime which will provide a framework for NHS bodies and local authorities to follow when deciding who should provide healthcare services. The provider selection regime will be informed by NHS England’s public consultation , and aims to enable collaboration and collective decision-making, recognising that competition is not the only way of driving service improvement, reduce bureaucracy on commissioners and providers alike, and eliminate the need for competitive tendering where it adds limited or no value. Commissioners will be under duties to act in the best interests of patients, taxpayers, and the local population when making decisions about arranging healthcare services. To further support integration, we propose to implement NHS England’s recommendation for a shared duty that requires NHS organisations that plan services across a system ( ICSs) and nationally (NHS England), and NHS providers of care (NHS Trusts and FTs) to have regard to the ‘triple aim’ of better health and wellbeing for everyone, better quality of health services for all individuals, and sustainable use of NHS resources.

The collaborative working between Health Education England ( HEE), NHS England and NHS Improvement and the Department on the development of the NHS People Plan has shown the need for a flexible and future-proofed regional workforce operating model. As NHS Improvement currently consists of the NHS Trust Development Authority (NHS TDA) and Monitor, we are proposing to formally transfer their functions to NHS England and abolish Monitor and the NHS TDA. Over the last 2 years, we have seen NHS England and NHS Improvement come together to work effectively as a single organisation. We have seen clear benefits from them working in practice as one organisation providing national leadership: speaking with one voice, setting clearer and more consistent expectations for providers, commissioners and local health systems; removing unnecessary duplication; using collective resources more efficiently and effectively to support local health systems and ultimately making better use of public money.These legislative measures are intended to support improvements already under way in the NHS. They should be seen in the context of those broader reforms. And they are by no means the full extent of this government’s ambition for the nation’s health. We will also bring forward changes in social care, public health and mental health. We also remain committed to the sustainable improvement of adult social care and will bring forward proposals this year. The targeted public health interventions we have outlined here in relation to obesity and fluoridation, sit alongside our proposals for the future design of the public health system, including the creation of the National Institute for Health Protection ( NIHP). We are also bringing forward legislation to bring the Mental Health Act up to date, as set out in our white paper last month. Finally, we plan to bring forward measures that contribute to improved quality and safety in the NHS, including placing the Health Services Safety Investigations Body on a statutory footing; establishing a statutory medical examiners system; and allowing the Medicines and Healthcare products Regulatory Agency to set up national medicines registries. We are also putting in place legislation to enable the implementation of comprehensive reciprocal healthcare agreements with countries around the world. Next steps Each year the government publishes the NHS mandate, a document which sets out the objectives which NHS England should seek to achieve. The NHS mandate is intended to set strategic direction for the NHS by setting out the top priorities that the government expects NHS England to focus on delivering. These objectives are carried through to NHS England’s planning guidance. We are therefore proposing to create provisions relating to the formation and governance of these joint committees and the decisions that could be appropriately delegated to them; and separately, allowing NHS providers to form their own joint committees. Both types of joint committees could include representation from other bodies such as primary care networks, GP practices, community health providers, local authorities or the voluntary sector. Collaborative commissioning We want to legislate for every part of England to be covered by an integrated care system ( ICS). This builds on the work the system has been doing since the publication of the NHS Long Term Plan, and is in line with NHS England’s recommendation in their recent document, formally recognising the need to bring together NHS organisations, local government and wider partners at a system level to deliver more joined up approaches to improving health and care outcomes, coterminous with local authorities.

The original set of national NHS bodies has already altered in form and purpose, and in the proposed legislation, we intend to continue the work already undertaken to formally bring together NHS England and NHS Improvement into a single legal organisation. where NHS England specifies a service in the National Tariff, then the national price set for that service may be either a fixed amount or a price described as a formulaSet out in more detail below, we also intend to legislate to improve accountability in the social care sector. An enhanced assurance framework will provide a greater level of oversight of the delivery of social care by local authorities. At the same time improved data collection will improve insight into the functioning of the sector. We will take forward NHS England’s proposals on the National Tariff, by amending the legislation to enable the National Tariff to support the right financial framework for integration whilst maintaining the financial rigour and benchmarking that tariff offers. This includes: enable NHS England to delegate or transfer the commissioning of certain specialised services to ICSs singly or jointly, or for NHS England to jointly commission these services with ICSs if these functions are considered suitable for delegation or joint commissioning subject to certain safeguards. Specialised commissioning policy and service specifications will continue to be led at a national level ensuring patients have equal access to services across the country

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