The New NHS & Local Health Economies

Michael SobanjaUK Vision Strategy Networking Day

29 April 2014

Historical Principles of the NHS

• A common risk pool

• A Nationalised Industry

The NHS is no longer a single organisation

• Northern Ireland

– Pooled Budgets across Health and Social Care

– No Provider competition

• England– Quasi market– Complex funding systems– Market entry and exit– Patient choice and competition– Means tested social care

• Wales• No quasi market in

health care• No Prescription

charges

• Scotland• No quasi market in health

care• No Prescription charges• State funded personal

care

The NHS In England

The Health and Social Care Act 2012

What does the Act really do?Establishes an independent NHS Board to allocate

resources and provide commissioning guidanceIncreases GPs’ powers to commission services on

behalf of their patientsTransfers Public Health to Local Authorities and

Public Health EnglandAll Hospitals to become Foundation TrustsInstalls robust regulation (Monitor and CQC)Frees Market entry and market exit – AQP and

Failure Regime

The architecture...

1 NCBA4 Regions27 Local Area Teams19 Commissioning Support Services10 Specialised Commissioning LATs211 Clinical Commissioning Groups12 Clinical Senates4 Strategic Clinical Networks130+ Health & Wellbeing Boards

Policy Makers

Commissioners

Providers

Regulators

• DH• NHS England• NICE

• Clinical Commissioning Groups• Local Area Teams• Local Authorities

• GPs• Hospitals• Optometrists• Dentists• Community pharmacists

• Care Quality Commission• Monitor

NHSE Mandate

Treasury110bn

DH

Public Sector

AgreementSpecialist

commissioning

Primary CareContracting

LAPH

HWB5-6%

Hospitals

Prescribing

CCG55%

Follow the money Trail – Now...

An example of a Local Health Economy from April 2013

Purpose

• Improve Health and wellbeing of the population within available resources...

Personal Health Budgets

Multiple and sometimes conflicting priorities...

Future Scenarios

• Consolidation of Health Bodies– CCGs– LATs– CSUs

• Recreation of HAs/PCTs• Overt Centralisation – NHS England takes

commissioning • Local Authorities assume responsibility for health

budgets• Healthwatch as mutuals take funding decisions