Department of Health Provider Services Options for the

Department of Health Provider Services Options for the Future 1

Why are we talking about this? • Commissioning a patient-led NHS (DH Aug 2005) • ‘Our health, our care, our say (White paper DH Jan 2006) Department of Health • PCT’s would become commissioning organisations • Greater joint commissioning • Provider services to be managed at arms length • Shift resources from acute to community • This fits with ‘contestability’ • Integrated health and social care teams 2

SHA have set out the criteria for assessing PCT provider options Improves Responsiveness Enables Responsiveness Acceptability Promotes Innovation Department of Health Promotes Choice Supports Clinicians Promotes Value for Money Patient Focus Improves Clinical Quality Promotes Public Health Robust Governenace Promotes Capacity Supports colloboration Source: Lindsay Mac. Intyre letter to PCT Chief Executives, 8 May 2007 3

PCTs should explore a range of options that promote innovative and responsive services Focus on Professional Roles or Client Groups? Department of Health Provide services over larger or smaller geographical areas? Integrate with acute care? Provider Options Integrate with Practice Based Commissioners? Joint Provision with Social Care? 4

Options • Community Foundation Trust • Social Enterprises Department of Health • Children’s Trust • Care Trust • Integrated Community & Acute Trust • Private Sector 5

SWOT OPTION ADVANTAGE DISADVANTAGE Department of Health Community Foundation § Operational and financial Trust freedoms § Ability to retain NHS employment § May be considered a monopoly § Regulation by Monitor restricts freedoms Social Enterprise § Freedoms outside of the NHS (not for profit company) § Seamless services § Currently under developed in health/social care § Move away from NHS ethos Children’s Trust § Shared goals § Builds on integrated services § NHS staff may be unwilling to transfer to CSF § Friction from a two system approach Care Trust § Seamless integrated services § Builds on current strengths § Constitutionally complex § Ambiguities over extent of responsibilities 6

SWOT / Options contd……… OPTION ADVANTAGE DISADVANTAGE Department of Health Integration with the Acute Trust § Builds upon clinical relationships § Facilitates care pathways between community and acute services § Community services might be marginalised § May focus on medical led care and not be acceptable for the health and social care agenda Externalise our services (for profit company) § Provides incentives for staff § Against the ethos of our services and staff Retain in-house provider role with a ‘glass wall’ § Provides continuity and stability § Sustains membership of the NHS community § Legal implications around the PCT being liable for its provider function 7

Community Foundation Trust Department of Health • NHS Foundation Trusts remain firmly part of the NHS and exist to provide and develop healthcare services for NHS patients in a way that is consistent with NHS standards and principles • NHS Foundation Trusts have greater freedoms and flexibilities than NHS Trusts in the way they manage their affairs 8

Social Enterprise Department of Health • A business like organisation with a primarily social objective • The organisation aims too make a profit but unlike a private business all surpluses are reinvested into the business to the benefit of its community • In essence a social enterprise uses business solutions to achieve public good 9

Children’s Trust Department of Health • This may be a NHS Trust providing services across a defined area – providing universal and specialist services • More feasibly this would be a partnership arrangement with the local authority provider (Children’s Schools and Families arm of Hertfordshire County Council 10

Care Trust Department of Health • May provide a wide range of services for all age groups but more likely to focus on an adult focused client group • Working as a partnership organisation with Adult Care Services arm of Hertfordshire County Council. Could include alternative providers as partners 11

Integrated Acute and Community Trust Department of Health • This maybe a partnership arrangement with two or more organisations working in collaboration to provide services to a given community • Consideration could be given to full integration of organisations with a single board • Remains an NHS organisation may consider Foundation Trust status as an option 12

Private Sector Department of Health • Private enterprise not linked to NHS able to make a profit to reinvest into the organisation or for shareholders to take a benefit 13

Proposals, which will be subject to subsequent consultation, should be submitted to the SHA by 16 th September 1. PCT Outline Proposals 2. SHA Filter 3. Robust Proposals 4. Detailed Development Provider Model PCT 16 th Sept SHA approval Go live Department of Health Consultation A B C Service Fit Greater Patient Choice Mechanisms to ensures contestability and value for money Investing Outside of Hospitals Meets future challenges 14

Process • PCT outline proposals by 16 th September 2007 Department of Health • SHA Filter proposals • Robust proposals by PCT • Detailed development Source: Options for primary care trust providers, HSMC November 2006 15

Staff and Stakeholder engagement • Team briefings to share message and encourage engagement • Stakeholder meetings and briefings Department of Health • Newsletter/website • Open event for staff and stakeholders – early September 16