Health

NHS Operating Framework 2012/13

The Operating Framework for the NHS sets out the business and planning arrangements for the NHS. It describes the national priorities, system levers and enablers needed for NHS organisations to maintain and improve the quality of services provided, while delivering transformational change and maintaining financial stability.

Subject to the passing of the Health and Social Care Bill, this is the final Operating Framework for the current system of PCTs and Strategic Health Authorities. So it also sets out the steps that need to be taken to carry the NHS through transition over the next year, maintaining standards and financial grip, in the move to the new system envisaged in Liberating the NHS.

There are four key themes:

putting patients at the centre of decision making in the shift to an outcomes approach to service delivery, whilst 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.
increasing the pace on delivery of the quality, innovation, productivity and prevention (QIPP) challenge; the QIPP challenge is to respond to the need to achieve £20bn worth of efficiency savings to be reinvested in services, including transformational service change. An Innovation Review will be published in December 2011. (The SHIP (Southampton, Hampshire, IOW and Portsmouth) cluster has a QIPP target of £576m over four years.)
maintaining a strong grip on service and financial performance, including ensuring that the NHS Constitution right to treatment within 18 weeks is met.

As more decision making is taken locally, it is important for the NHS to do more to integrate service delivery, not only across primary and secondary care, but also with social care organisations. In addition the Framework states that each sector needs to look at where it can work better with partners, including voluntary organisations, so that services are organised around individuals and not institutions.

The Framework is set out in four inter-related sections, giving the basis on which success will be judged:

Quality: the national priorities to be delivered in 2012/13 to improve services for patients and to support the NHS Constitution and meet a more outcomes-based approach. Certain areas have been identified as needing particular attention during 2012/13; dementia and the care of older people; carers; military and veterans’ health; health visitors and family nurse partnerships.
Reform: what needs to be done during 2012/13 to deliver a different system for delivery from April 2013, improving patient choice and local accountability. This includes getting CCGs up to speed to take on their new commissioning roles, clinical networks and senates to be established (one of their key roles will be to contribute to clinical service redesign), Health & Wellbeing Boards, the transfer of many public health functions to local authorities, and progress on NHS Trusts becoming NHS Foundation Trusts.
Finance and business rules
Planning and accountability

Other activities that feed into the reform agenda include: the introduction of Any Qualified Provider (AQP), with PCT clusters offering patients choice of AQP in at least three services during 2012/13; preparing for the wider roll-out of personal health budgets; the NHS Information Revolution which takes in giving patients better access to their records, providing information on outcomes in order to support patient choice, and appropriate sharing of information to support integrated care.

an outcomes approach

From 2013/14, the Secretary of State will hold the new NHS Commissioning Board to account using the NHS Outcomes Framework, which will be used in turn to hold CCGs to account.

During the period of the Framework organisations should be preparing for this approach, and outcomes measures/proxies have been identified for 2012/13 and are set out in the document for the five domains within the Outcomes Framework.

Domain 1 – Preventing people from dying prematurely

Domain 2 – Enhancing quality of life for people with long term conditions

Domain 3 – Helping people to recover from episodes of ill health or following injury

Domain 4 – Ensuring that people have a positive experience of care

Domain 5 – Treating and caring for people in a safe environment and protecting them from avoidable harm

More information about the NHS Outcomes Framework is available on the Dept of Health website.

NHS Standard Contracts

2012/13 will see implementation of the first phase of the review of the contracts. The 2012/13 NHS Standard Contract will be a single agreement for use with providers of NHS funded secondary and community services. This is said to reflect that delivery of care now happens in a range of settings, and is supposed to be more user-friendly and easier to follow. It is to be published with accompanying guidance. Generally, contracts will be limited to 12 months for 2012/13.

The NHS Operating Framework 2012/13 is available on the Dept of Health website.

Liberating the NHS: Legislative framework and next steps

Published in December 2010, this document reaffirms the government's commitment to its proposed reforms set out earlier this year in its consultative White Paper. It gives the government's response to the feedback, highlighting amendments made in the light of comments, and the plans for taking the reforms forward. CAH has produced a briefing, giving a broad overview of: the modifications that have been made to the original proposals: how GP consortia might shape up: the new health and wellbeing boards; and a new 'duty of quality improvement'.

The CAH briefing paper is on the CAH website.

Liberating the NHS is on the Dept of Health.

Personal health budgets

It was announced in June 2010 that 8 PCTs would start to road test direct payments for personal health budgets. This will allow Primary Care Trusts to give the money for someone’s care directly to them, allowing individuals to decide how, where and from whom they receive their healthcare, in partnership with the local NHS. These pilots will run until June 2012.

Previously, personal health budgets could only be held by a Primary Care Trust or third party.

Using direct payments is part of a wider programme of piloting personal health budgets. You can find out more about the programme on the Dept of Health website.