All change: please mind the gap

The re-organisation of the NHS is well underway – indeed, there is frenetic activity going on to ensure that all the new structures and organisations are in place, so that they can take over from the current system by April next year. Sir David Nicholson, the NHS Chief Executive has described the challenge of this period of time as a “truly formidable leadership agenda” which is “not a time for the faint hearted”. If you work in a hospital, as most readers do, you may not be directly involved – and, as we know, you have your own challenging agenda to meet. However, since so much is changing, it would seem that, as a healthcare worker, or a potential user of the service, you should keep up to date with at least the main thrust of the changes, if not the detail. This article will set out the main reforms that are taking place.

NHS Operating Framework for 2012/2103

The detail of the requirements for enabling the transition to the new arrangements is set out in the Operating Framework. It sets out, as previous annual Operating Frameworks have, the agenda for planning, performance and financial arrangements and the basis on which the NHS will be held to account, for the year ahead. To improve services to patients there will be four key themes for all NHS organisations in 2012-2013: • Putting patients at the centre of decision making in preparing for an outcomes approach to service delivery, while improving dignity and service to patients and meeting essential standards of care. • Completion of the last year of transition to the new system, building the capacity of emerging clinical commissioning groups (CCGs) and supporting the establishment of Health and Wellbeing Boards so that they become key drivers of improvement across the NHS. • Increasing the pace on delivery of the quality, innovation, productivity and prevention (QIPP) challenge. • Maintaining a strong grip on service and financial performance, including ensuring that the NHS Constitution right to treatment within 18 weeks is met.1 The current means of accountability, at the strategic level, falls to a variety of different organisations and these will change for 2013/2014. The present NHS systems for overall accountability are the Strategic Health Authorities (SHAs) and the Primary Care Trusts (PCTs); together with the NHS Constitution which secures rights for patients and staff; contracts of care which form the means of doing business between the commissioners, (the PCTs), and the providers. The Care Quality Commission (CQC), which provides the regulatory mechanism for NHS Trusts by means of inspection and audit, ensures that Trusts meet the essential standards of care, safety and quality. In addition, Monitor ensures that NHS Foundation Trusts are meeting their terms of authorisation and the requirements of national reporting, as detailed in annual operating frameworks. Each year, the Operating Framework sets out a set of measures which are reported nationally; and this will continue, although – in future – in a different format more closely linked to outcomes. From 2013/14, the NHS Commissioning Board will be held to account by the Department of Health and NHS commissioners should anticipate the introduction of a more outcomes-based approach through the NHS Public Health and Social Care Outcomes Frameworks. Local publication and benchmarking will take place for all available quality measures, as well as the national measures set by the Operating Framework.