Introduction - The national policy framework

1. National growth in resources - The current three year plan (to 2005) and the following one to 2008 will see England's expenditure on health (as a proportion of gross national product) increase from the bottom quartile to the top quartile in Europe.

2. Modernisation - national plans rely on combining innovative approaches to the delivery of care with the extra resources available to meet needs. Redesigning clinical care pathways with public involvement has the potential to improve the quality, convenience, efficiency and affordability of services.An increasing proportion of care will be provided by members of the primary health care team. More elective procedures will be undertaken in dedicated treatment centres.

Resources
The NHS Modernisation Agency

3. The Planning and Priorities Framework 2003-2006 identifies national priorities and targets, which NHS organisations need to build into their local plans. These targets are challenging, but simply achieving them will not be enough to guarantee success. Cultural change is an essential part of the transformation. Crucially the NHS at all levels needs to embrace diversity in provision and choice for patients. This can only be achieved through the increased involvement of the public, staff, service users and our partners. Developing these plans should itself involve all these different people and be part of that cultural change.

The health and social care priorities are:

· improving access to all services through:

· better emergency care

· reduced waiting, increased booking for appointments and admission and more choice for patients

· focusing on improving services and outcomes in:

· cancer

· coronary heart disease

· mental health

· older people

· improving life chances for children

· improving the overall experience of patients

· reducing health inequalities

· contributing to the cross-government drive to reduce drug misuse

In each of these priority areas there are key targets for the next three years

Resources

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4008430&chk=lXp8vH

4. Foundation Trusts

The first wave of Foundation Trusts will be established in April 2004. These Trusts will differ from existing NHS Trusts in the following ways. They will

• Have new freedom to decide locally how to meet their obligations
• Be accountable to local people, who will become members and governors
• Be authorised and monitored by an Independent Regulator for NHS Foundation Trusts
• Have legally binding contracts with their commissioners
• Have new financial freedoms to borrow capital
• Be encouraged to foster new partnership arrangements with other corporate sectors to enable innovative developments.

Foundation Trusts remain part of the NHS, and will continue to provide NHS services for local people free at the point of use, based on patient need, not ability to pay.

Resources

Resource Guide 6 Foundation Trusts

5. Patient Choice - Choice is central to the overall objectives of NHS reform, set out in the Planning and Priorities Framework, to deliver high-quality patient-focused services, through clear national standards reflected in National Service Frameworks and NICE guidance. The introduction of informed patient choice for acute care from April 2004 will stimulate the NHS to design services around patients' preferences and needs. This requires a sophisticated approach to commissioning that emphasises care of the individual.

Resources

More detail on Patient Choice is described in Resource Guide No. 6 - Delivering Patient Choice

PEC Paper 3 : Choice

Choice Consultation

PCTs roles around Choice and Engaging Communities, and patients

Dr Foster

6. Payment by Results (Financial Flows) - Patient Choice is underpinned by the introduction of Payment by Results (national price tariffs for care)

Resources

Resource Guide No. 1. Payment by Results

PEC Paper 1: Reforming NHS Financial Flows: Introducing Payment by Results.

7. Inspection

The Commission for Healthcare Audit and Inspection (CHAI) is a new body. It is being set up to help improve the quality of healthcare by providing an independent assessment of the standards of services provided to patients, whether it is provided by the NHS or privately. Building on the achievements of CHI and the other organisations whose functions CHAI will take over, CHAI, from April 2004 onwards, will start the process of building a new, integrated approach to assessing the quality of care provided to patients wherever they are treated.

Resources

Chairman Ian Kennedy's Vision

8. Information Technology - the NHS National Programme for IT aspires to improve care by giving clinical staff speedy access to medical information and decision support software; giving patients access to a plethora of clinical information and improving administration with for example electronic booking of outpatient appointments. The new systems are intended to be fully integrated, overcoming the historic barriers between primary care and hospital systems, and creating electronic links to the public and to companies that supply goods and services to the NHS.

Resources

NPfIT

http://www.doh.gov.uk/ipu/programme/index.htm

A variety of initiatives will increase the range and number of environments in which NHS patients receive their treatment - including for example independent sector provided and NHS owned treatment centres. These facilities will improve efficiency by concentrating on a limited range of clinical specialties. In addition they should be "hot-beds" of innovative clinical practice.

Resources

See Providers topics

10 Quality Standards

A wide range of national standards are being developed including:

· Guidance from the National Institute for Clinical Excellence about the introduction of new drugs and medical technologies,

· Clinical governance framework to ensure consistently high quality of care and the involvement of the public through the introduction of Patient Advisory and Liaison Services

· National Service Frameworks,

Resources

NICE

CHI

PALS

11. Public Involvement

Section 11 of the Health Act imposed a "duty to involve" on the NHS. Patients and the public should be involved and consulted on how health services are planned and developed. Their experiences of the NHS should be welcomed, taken seriously, and used to bring about change.

Engaging Communities

Analysis of Section 11

DH site

Commission for Patient and Public Involvement in Health

12. New GMS contract - The introduction of the new GMS contract provides PCTs with increased resources and the practical levers to deliver a greater proportion of activity in a primary care environment by primary care professionals. As a consequence only those procedures that need to be provided by the acute sector should be commissioned from the acute sector.

Resources
Primary Care Contracting area of NatPaCT site

NatPaCT will be developing further resources to support PCTs in Primary Care Contracting and making the linkages to commissioning of acute services.

13. Workforce - There is a range of national initiatives to increase the numbers of trained clinical staff to meet capacity needs and to extend the skills of existing staff to meet future needs: new GMS Contract, new Consultant Contract, and Liberating the Talents.

Advances in the professional training of clinical staff enable them to carry out more complex interventions than in the past, e.g. the wider role of the nurse. These changes produce opportunities to deliver more care and to higher standards.

Resources

New Ways of Working

Practitioners with Special Interests