Structure of the NHS

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Scrutiny Commission 3 Scrutiny of Health 30
September 2002
Jane LewingtonChief ExecutiveNorth East
Lincolnshire PCT
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Structure of the NHS
USERS CARERS
PRIMARY CARE Primary Care Trusts (303) GPs Pharm
acists Dentists Opticians
SECONDARY CARE NHS Trusts Acute and
specialised hospital services Mental Health
trusts Ambulance trusts
NHS DIRECT
Planning
Planning
PERFORMANCE MANAGEMENT Strategic Health
Authorities (28)
Special Health Authorities
GOVERNMENT Department of Health
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Primary Care Trusts
ROLES RESPONSIBILITIES
Improving the health of the local population
and tackling health inequalities
Planning and securing health services for the
local population
Develop primary care and community services
Integrating health and social care services
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Background
North East Lincolnshire PCT
Established April 2000
Co-terminous with unitary authority
35 general practices ( 82 GPs )
7 Primary Health Care Teams ( PHCTs )
Budget - 144 million
Main providers Northern Lincolnshire
Goole Hospitals Hull East Yorkshire
Hospitals
Met all service and financial targets in first
two years of operation
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Local Structure of the NHS
PRIMARY CARE North East Lincolnshire PCT North
Lincolnshire PCT
SECONDARY CARE Northern Lincolnshire Goole
Hospitals Acute secondary care
provider Doncaster South Humber Mental health
trust Lincolnshire Ambulance Emergency ambulance
PTS trust
NHS DIRECT South Yorkshire / South Humber
North and East Yorkshire Northern
Lincolnshire Health Authority
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NHS Priorities
NHS Plan10 Year Plan for NHS

• Access
• Cancer
• Capacity
• Coronary Heart Disease ( CHD )
• Childrens services
• Mental health
• Older people
• Health inequalities
• Workforce

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NHS Plan2002/03 Must Dos

• Access Improve access to care in line with
  patients needs
• Key themes
• Reducing maximum waiting times for inpatient
  and outpatient treatment
• Abolish waiting lists and replace them with
  booking systems
• Reduce wait for primary care appointments
• Cancer waiting times

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NHS Plan2002/03 Must Dos

• Emergency Care Improve the organisation and
  delivery of emergency care services across
  primary care, community, social and secondary
  care
• Key themes
• Implementation plans for single telephone
  access, through NHS Direct, to GP out of hours
  care
• 90 of patients spend no more then 4 hours in
  AE from arrival to admission, transfer or
  discharge
• Ambulance services to respond to 75 of
  category A calls within 8 minutes

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Local Health Needs

• Diabetes
• Teenage pregnancy
• Child and adolescent mental health
• People with learning disability
• People with physical disability
• Substance misuse
• Smoking
• Dental health

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Increasing NHS accountability

• Commission for Healthcare Audit and
  Inspection (CHAI )
• Inspect NHS organisations
• Conducting NHS value for money audits
• Validating performance assessment statistics,
  including waiting lists
• Publishing star ratings ( Health Social Care
  )
• Independent scrutiny of patient complaints

Decentralisation Inspection Regulation
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Increasing NHS accountability
Patients Forums
Overview Scrutiny Committees (OSCs)
Commission for Patient Public Involvement in
Health
Patient Advisory Liaison Service (PALS )
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Patients Forums
Independent forum for every NHS and Primary Care
Trust tasked with monitoring and reviewing
services and influencing management
decision-making
Specific aims
To represent views of local communities
Monitor service delivery from a patients
perspective
Inspect NHS premises from the perspective of a
patients experience of services
To elect one of their members as a non-executive
director on the trust board
To monitor the quality of PALS
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Local challenges

• New strategic health authority and new region
• Local health needs
• Workforce issues
• NHS funding formula
• New roles and responsibilities
• Building the PCT network

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Current PCT Priorities

• PCT estates strategy
• Capacity plan
• Partnership Board
• Mental Health
• Local Strategic Partnership
• Delayed transfers of care
• Prescribing

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Performance Management Measures applied to the PCT

• Strategic Health Authority Annual Accountability
  Agreement
• Sets out the PCTs proposals to meet
• NHS plan targets and specifically
• Emergency care,
• Reduced Waiting Times
• Cancer
• Coronary Heart Disease
• Mental Health
• Older People
• Capacity
• It also includes finance targets on
• cash limits, resource limits and
• breaking even

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Performance Management Measures applied to the PCT

• Resource Accounting Budgeting
• Monthly reports to the StHA on PCT
• financial and activity performance as
• well as waiting time and access
• targets
• Monthly reports to the Board and
• Executive also report on NHS Plan
• targets such as activity and waiting
• times

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Performance Management Measures applied to the PCT

• Performance Management
• Framework
• This PCT document identifies reporting mechanisms
  in several key areas, including
• Commission for Healthcare Audit
• Inspection (CHAI )
• Controls Assurance, RPST
• CNST
• Korner Reporting
• Local Implementation Strategy
• Surestart
• Macmillan Marie Curie

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Performance Management Measures applied to the PCT

• Audit Performance management
• Audit of Annual Accounts by Audit
• Commission
• VFM and Ad Hoc reviews by the
• Audit Commission
• Review of Internal Controls by
• Internal Audit
• Review of Executive Compliance
• with Audit by the Audit Committee

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Performance Management Measures applied by the PCT
Containing costs to within the overall financial
envelope
Achievement of National Targets (or better) for
Inpatient Outpatient Waiting Lists and Times
Achievement of the Cancer 2 week wait target
Where NEL PCT is main commissioner

• Indicators of Demand and Pressures
• Number of Delayed Transfers of Care
• Number of Trolley Waits in excess of
• 4 hours
• Number of cancelled operations
• Where NEL PCT is main
  commissioner