Wellbeing East - NHS Reforms
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The Health and Social Care Act of 2012 provided legislation for the biggest reforms in health and social care since the inception of the NHS. It laid out changes locally and nationally and created new national organisations including NHS England, Public Health England and Healthwatch England.
It abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) and established new commissioning systems. Clinical Commissioning Groups, made up of doctors, nurses and other professionals are now responsible for buying most health services locally with some services commissioned centrally by NHS England.
Local councils have taken on a new role in promoting public health. Health and Wellbeing Boards, established under the new Act have brought together local organisations to work in partnership and local Healthwatch provide a powerful voice for patients and local communities.
The Department of Health has produced a new diagram illustrating the way the health and social care system in England will look from April 2013. This will help members in England understand how the new bodies and relationships are intended to fit together, and the functions of each of the organisations.
This briefing has useful information on the new healthcare structure
The Social Value Act
In January 2013, the Social Value Act came into force for all public authorities - from government departments to local councils, health commissioners, and probation trusts. The Act requires them to ’have regard to economic, social and environmental well-being in connection with public services contracts.’
The Department of Health published the ‘Caring for our future: reforming care and support’ White Paper in July 2012. It sets out the vision for a reformed care and support system. The Draft Care and Support Bill was also published in July and provides the legal framework for the main principles of the White Paper.
The Department of Health
The Department of Health (DH) lead, shape and fund health and care in England. DH is a ministerial department, supported by 26 agencies and public bodies
National Organisation: NHS [
] Commissioning Board England
The NHS Commissioning Board (NHS CB) was established on 1 October 2012. The NHS Commissioning Board is also known NHS England and is at the heart of the new health and care system. It is a Non-Departmental Public Body of the Department of Health, accountable to the Secretary of State for Health. Its aim is to ensure that the money spent on NHS services delivers the best possible care for patients.
NHS England will still have responsibility for commissioning primary care services such as GP and dental services, as well as some specialised hospital services.
Its other key function is to support and fund local Clinical Commissioning Groups (CCG’s) who will use their knowledge of local health needs to commission the best available services for their local communities
More information: www.commissioningboard.nhs.uk
Local Organisation: NHS England Regional Teams
NHS England Midlands and East is one of four regional teams that support the commissioning of services and directly commission primary care and specialised services at a local level across England. Geographically the Midlands and East regional team covers the East Midlands, North Midlands, Central Midlands and East
As part of its Organisational Change Programme 2014/15. NHS England has made changes to its internal structure, moving from 12 Area Teams to 4 integrated Regional teams which came into effect in April 2015.
The four regional teams will support the commissioning of services and directly commission primary care and specialised services across
Local Organisation: Clinical Commissioning Groups
Arguably the area of the NHS in England most affected by the reforms is the commissioning system. Clinical Commissioning Groups were established by the Health and Social Care Act 2012.
Primary care trusts and strategic health authorities were formally abolished on 1 April 2013, and replaced by NHS England (previously known as the NHS Commissioning Board) and 211 clinical commissioning groups (CCGs).They have taken over responsibility for commissioning the majority of NHS services in England.
They bring together groups of GPs and other key healthcare professionals to commission services and are responsible for around 80% of the healthcare budget in their area.They also have the power to grant funds to voluntary organisations.
Link to Regional Voices' briefing: Clinical Commissioning- A Guide for the Voluntary and Community Sector
The Department of Health (DH) defines commissioning as "the process of assessing the needs of a local population and putting in place services to meet those needs" (see equity and excellence on the DH Website).
Clinical Commissioning Groups (CCGs) in each local area are made up of doctors, nurses and other professionals including two independent members – one of whom must be a champion of patient and public involvement and the other who will have a lead role in overseeing key governance issues.
The CCG will commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed and ensuring that they are provided. They will use the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy when drawing up their commissioning plans.
England’s Clinical Commissioning Groups are independent statutory organisations, accountable to their Communities and boards.
Commissioning Support Units
Commissioning Support Units (CSUs) were established in April 2013 as part of the reorganisation of the National Health Service in England following the Health and Social Care Act 2012.
In February 2015 NHS England launched a new framework for commissioning support services. The framework has been developed with local clinical commissioners who asked for a simpler and less costly process for choosing the support they need.
CSU’s applied to deliver services under any of the following Lots within the Framework
The organisations that have been approved to join the new Commissioning Support Lead Provider Framework, include NHS Commissioning Support Units (CSUs) and their partners, as well as a number of independent sector consortia. Details of the suppliers can be found on the NHS England Suppliers List webpage
Commissioning Support Units are not geographically defined, this means that in some cases customers are local or regional clinical commissioners, and in others they include clinical commissioning groups in other parts of England.
Joint Strategic Needs Assessment (JSNA)
A Joint Strategic Needs Assessment (JSNA) is an assessments of the current and future health and social care needs of the local community. These are needs that could be met by the local authority, Clinical Commissioning Groups (CCGs) or the NHS England. JSNAs are produced by Health and Wellbeing Boards and are unique to each local area.
Joint Health and Wellbeing Strategy
Each Health and Wellbeing Board (HWBB) will be required to draw up a joint and high level Health and Wellbeing Strategy, informed by the Joint Strategic Needs Assessment. It will set the overall strategic direction for health and wellbeing.
Local government have significant new responsibilities for health and care covering three key aspects: improving public health, empowering people and local communities and commissioning care. Promoting the health and wellbeing of local communities will become a central part of local authorities’ work
Local authorities will lead Health and Wellbeing Boards and will also commission care and support services to work together to respond to people’s individual needs and choices. This means that councils and the NHS working more closely together to develop more integrated services.
Directors of public health in local authorities will use their knowledge of the local community to tackle public health challenges such as smoking, alcohol and drug misuse and obesity.
Empowering patients and local communities
As part of the reforms introduced under the Health and Social Care Act 2012, a new consumer champion, Healthwatch came into existence for health and social care patients, service users and carers. Healthwatch exists in two distinct forms – local Healthwatch, at local level, and Healthwatch England, at a national level.
April 2013, saw the launch of a local Healthwatch in each local authority area. Local Healthwatch organisations will involve people from all parts of the community, giving everyone a voice in local health and care services. They will be represented on health and wellbeing boards and will build on the experience and knowledge of existing Local Involvement Networks (LINks) which played a role in shaping services.
The aim of local Healthwatch is to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality.Concerns about health and social care services raised by local Healthwatch can be escalated to the Care Quality Commission.
Find your local Healthwatch.
Healthwatch England provides leadership, guidance and support to local Healthwatch organisations and advice to the Secretary of State, NHS Commissioning Board, Monitor and the English local authorities.
Local Level: Health and Wellbeing Boards
The Health and Social care Act 2012 establishes Health and Wellbeing Boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities.
Health and wellbeing boards [HWBB] have a duty, established in the Act, to encourage integrated working. This means supporting integrated working between health and social care commissioners and providers, and encouraging the use of, for example, pooled budgets, lead commissioning and integrated provision.
Health and Wellbeing Boards will have strategic influence over commissioning decisions across health, public health and social care and through undertaking the Joint Strategic Needs Assessment (JSNA), the board will drive local commissioning of health care, social care and public health and create a more effective and responsive local health and care system.
In addition, the boards have a statutory duty to involve local people in certain elements of their work, reflecting the Government’s plans for stronger democratic legitimacy and community involvement in health and social care.
Established and hosted by local authorities, each top tier and unitary authority will have its own Health and Wellbeing Board which will work together with health care services to respond to communities’ needs and priorities; bring together the NHS, public health, adult social care and children's services, including elected representatives and Local Healthwatch, to plan how best to meet the needs of their local population and tackle local inequalities in health. Board members will collaborate to understand their local community’s needs, agree priorities and encourage commissioners to work in a more joined up way.
Read more information on Health and wellbeing boards & JSNA and other ways to influence health and care commissioning in a local area:
Safeguarding Patients’ interests
Care Quality Commission (CQC
The Care Quality Commission (CQC) is the independent regulator for all health and social care services in England. CQC's purpose is to drive improvement in the quality of care through the unique function of measuring whether services meet national standards of quality and safety. CQC does this to protect and promote the health, safety and welfare of people who use health and social care services; and to encourage improvement, ensuring that services are focused on people's needs and that resources are used effectively and efficiently.
The CQC has a four region structure, which aligns with the structure of NHS England:
The CQC also has an important role to play in involving the public and people who receive care in their work. Their Website is www.cqc.org.uk
To watch a video explaining who the Care Quality Commission (CQC) are and what they do visit www.youtube.com/watch?v=oxCXNURV3DM.
Or meet the team by clicking here
Improving Public Health
Public Health England has been established as an executive agency of the Department of Health and has the aim of protecting and improving the nation’s health and wellbeing, and reducing health inequalities. It took up its full powers on 1 April 2013.
The Health and Social Care Act provides for a new approach to public health, which puts local authorities in charge of driving health improvement, pulling together work previously done by the NHS, social care, housing, environmental health, leisure and transport services.
PHE will provide national leadership for locally-led public health services and expert services to respond to health protection emergencies, working alongside local government, the NHS and other key partners.
Public Health England has published the Health Profiles for 2015
The Health Profiles give a snapshot overview of health for each local authority in England as well as information presented at ward level. You can see the Health Profiles for the East of England here.
Please click here for other health and social care resources One East Midlands has published in our library.
NHS England's Five Year Forward View was published on 23 October 2014 and sets out a vision for the future of the NHS.
It has been developed by the partner organisations that deliver and oversee health and care services including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority.
Chapter Two – What will the future look like? A new relationship with patients and communities looks to a future of a health system with a new relationship with patients and communities and sets out a series of commitments in relation to empowering patients, supporting carers, promoting volunteering, and engaging the voluntary sector and communities.
"Culture change in working with the voluntary sector is critical if the vision of the Forward View is to be realised...Empowering patients, engaging communities and working with the voluntary sector should be integral to all the work that comes out of the Forward View, including work on prevention and new models of care. The voluntary sector needs to be seen as part of the NHS, not an add-on"
NHS England has harnessed the resources of the voluntary and sector through the Peoples and Communities Board, chaired by Jeremy Taylor of National Voices.
Regional Voices will be supporting the People and Communities Board: delivery of the NHSE Five Year Forward View nationally and regionally though its partner organisations, including Wellbeing East.
The NHS Shared Planning Guidance asked every local health and care system in England to come together to create their own ambitious local plan for accelerating the implementation of the Five Year Forward View (5YFV). These blueprints, called Sustainability and Transformation Plans (STPs), will be placebased, multi-year plans built around the needs of local populations. STPs will help drive transformation in health and care outcomes between 2016 and 2021.
To deliver these plans NHS providers, Clinical Commissioning Groups (CCGs), Local Authorities, and other health and care services have come together to form 44 STP ‘footprints’. These are geographic areas in which people and organisations will work together to develop robust plans to transform the way that health and care is planned and delivered for their populations.
In forming their footprints, local areas will have taken the following factors into account:
- Geography (including patient flow, travels links and how people use services);
- Scale (the ability to generate solutions which will deliver sustainable, transformed health and care which is clinically and financially sound);
- Fit with footprints of existing change programmes and relationships;
- The financial sustainability of organisations in an area; and
- Leadership capacity and capability to support change.
The Sustainability and Transformation Plan footprints document provides information on the 44 STP footprints in England
Chapter three of the Five Year Forward View – What will the future look like? New models of care explains how in recent years, parts of the NHS have begun doing elements of this and the strategic plans developed by local areas show that in some places the future is already emerging.
As a catalyst to create new ways of delivering care that are better suited to modern health needs and more productive, NHS England are working with 31 Vanguard sites to develop and implement the new care models outlined in the Forward View.
Regional Voices, including Wellbeing East, was awarded funding from the Department of Health to support effective VCS engagement with health and wellbeing boards, both where there is a VCS representative and where there isn’t. Supporting influence on health and wellbeing boards project (DH,IESD funded project- 13/14-14/15)
Good practice was shared via events and online networking and developed through a peer learning programme and tracked through surveys. See further details at Supporting Influence for VCS reps on Health & Wellbeing Boards programme
Involvement is the name of NHS England’s “Field Force” Patient and Public Participation programme for the Midlands and East region, which is looking at new and pioneering approaches to engagement, aimed both at supporting professional and lay experts in the work they do.
In September 2013 NHS England published Transforming Participation in Health & care (www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf) in the guidance there was a key commitment to establish a regional field force to deliver more personalised approaches to healthcare and ensure effective engagement in local communities.
The NHS England ‘field force’ programme aims to deliver more personalised approaches to health care in the areas of ‘patients in control’ and ‘patient and public participation’. NHS England is working closely with a number of commissioning support units (CSU’s) and regional leads to ensure that the programme can pioneer new ways of working, share good practice and enrich commissioning support services via community connections, especially strong engagement with the voluntary and community sector.
One East Midlands under the umbrella Wellbeing East, are working with Midlands and Lancashire CSU to host the Involvement Patient and Public Participation Network for the East of England. This will be one of three networks (East of England, East Midlands and West Midlands) in the Involvement programme.
For further information click here.
Please click here for health and social care news One East Midlands has published on our website.
- In August 2014, One East Midlands and Public Health England published a project review of Better Data: making the third sector business case for health improvement. Prepared by Richard Hazledine, Project Manager, ConnectMore Solutions, and Sarah Hassell, Health Improvement Lead, Public Health England East Midlands, the review can be downloaded here.
Please click here for health and social care resources One East Midlands has published in our library.
Wellbeing East is the name of Regional Voices Health and Social Network in the East of England.
*From the 1st October 2015 Regional Voices' Health & Social Care Networks in the East and East Midlands (formerly managed by OEM) are being managed by selfhelp UK
Please email firstname.lastname@example.org if you would like to join our Wellbeing East network or if you have any news, events or resources you would like to share with network members.
or you can contact Jayne Quantrill contact, Health and Wellbeing Coordinator Wellbeing East directly at email@example.com mobile telephone number: 07508490731
Regional Voices champions the work of voluntary and community organisations to improve health, well-being and care, across England. Regional Voices is a partnership of nine regional networks. Together, we directly connect to over 25,000 voluntary and community organisations. Our coverage is broad, deep and well-established. Our vision is for a society where voluntary and community organisations are connected with decision-makers at all levels, able to influence policy and improve community health, care and well-being through better services.