IMPROVEMENT, EXPANSION AND REFORM:
THE NEXT 3 YEARS
PRIORITIES AND PLANNING FRAMEWORK 2003 - 2006
Improvement, Expansion & Reform: The Next Three Years
2
Preface
The extra money coming into Health and Social Services gives
us the opportunity to make real
improvements. We can expand through recruiting new staff,
developing new services and creating
new facilities. Even more importantly we can transform the
quality of services by raising
standards, tackling inequality, becoming more accessible and
flexible and designing our services
around the needs and choices of the people we serve.
This is about both quality and growth. The real test for
success will be whether people can feel the
difference and believe the services they receive are truly
designed around them.
These are hugely ambitious goals. They will take time to
deliver. Making progress over the next
three years will be demanding and difficult and require real
determination and discipline. It will
need us to:
· focus on priorities, we cannot make progress at the same
pace in every area
· extract the maximum value from every pound
· be prepared to change old practices, be creative and take
uncomfortable and difficult decisions
in the drive to improve quality and respond to people using
services
Local plans
This document sets out what organisations need to do over
the next three years. It identifies
national priorities and targets which organisations need to
build into their local plans. These
targets are challenging but simply achieving them will not
be enough to guarantee success.
Organisations need to challenge old perceptions of public
service and build public confidence in
new systems. 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 cultural change can only be achieved through the
increased involvement of the public, staff,
service users and our partners. Each brings their own perspective.
We need each of them to
contribute to progress.
Developing these plans should itself involve all these
different people and be part of that cultural
change. In every area our staff, the people using services
and the public need to understand what
we are doing, what progress is being made. They need to be
able to advise and share in the drive
for improvement and quality.
Nigel Crisp
Chief Executive
Improvement, Expansion & Reform: The Next Three Years
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1. Introduction
1.1 The NHS Plan will deliver for the people of the country
a health service fit for the 21st
century with services designed around the needs of patients
and improved health
outcomes, particularly for the poorest in our society.
Similarly the aims for social care are
to improve services, promote independence and well being,
and protect and support the
most vulnerable.
1.2 The vision is to offer prompt, convenient, high quality
services with people exercising
greater choice. It is a vision where staff are fairly
treated, properly rewarded and able to
use their skills to the full.
1.3 Over the next three years we need to increase the range
and quality of services, and
improve the service user’s experience. The emphasis will be
on:
· making measurable progress, particularly in the highest priority
areas
· developing the capacity needed to deliver these plans:
increasing staffing numbers
and providing more facilities, more equipment and more
providers of services and
care
· changing the way the whole system works to help staff and
organisations deliver on
these ambitious goals particularly by ensuring patients and
users have greater
choice over services
1.4 It is about improvement, expansion and reform.
1.5 This paper sets out the priorities for the next three
years for the NHS and social services
and describes what local organisations and communities need
to do to plan for and
implement these improvements.
1.6 During these three years the whole health and social
care system will be changing with
most notably:
· more choice for patients
· payment being made for results in the NHS so increasing
the incentive for delivery
(a consultation document on Reforming NHS Financial Flows
will be published
shortly)
· new incentives for both social services and health to
provide appropriate services for
older people outside hospital
· increasing freedom for high performing organisations,
including the establishment of
the first foundation hospitals in the NHS
1.7 At the same time every organisation needs to:
· ensure the safety of its patients and users and the
quality of its services, including
developing clinical governance arrangements
· ensure people are fully informed and involved in their own
care and in planning and
reviewing services and that services are provided equitably
to all who need them
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· take into account in its planning the progressive
implementation of the working time
directive and the expected introduction of new contracts.
· take part in emergency planning and ensure that the
necessary arrangements are in
place
· continue to modernise the way in which services are
delivered, with the learning
about good practice being spread between organisations
· provide for the continuing training, re-training and
development of individuals,
offering new skills and competencies
· be involved in the introduction of new information and
communications systems
2. Planning framework
2.1 Planning in the past has been done annually and
constrained by time pressures and the
requirement for multiple plans. For the first time ever
health services are now able to plan
over a three-year period with, later this autumn, local
health services receiving three-year
budgets. Following the completion of the Local Government
Finance Review, councils will
have some confidence about the distribution of resources
available over the next three
years, including for social services. This will allow
organisations to look in-depth at their
services, plan change with confidence and implement
improvements year on year. Against
this background planning consists of the following six steps
which need to be followed
through in each organisation and community:
· identifying the national and local priorities and the key
targets for delivery over the
next three years
· agreeing the capacity needed to deliver them
· determining the specific responsibilities of each health
and social care organisation
· creating robust plans which show systematically how
improvements will be made
and which are based on the involvement of staff and the
public
· establishing sound local arrangements for monitoring
progress and NHS
performance management which link into national arrangements
· improving communications and accountability to the public
locally so as to
demonstrate progress and the value added year on year
Each of these steps is described briefly in this paper.
3. The priorities
3.1 The priorities for this period are based on the
Department of Health’s Public Service
Agreement which is shown at Appendix A.
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3.2 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
3.3 In each of these priority areas there are key targets
for the next three years. These are
shown in Appendix B. They are relevant to primary care as
well as hospital services and will
not be achieved without close co-operation between health
and social services. Indeed
many rely on achieving a better balance in local service
provision with a greater emphasis
on community-delivered services. Every health and social
care community must plan to
meet each of these targets in the next three years.
3.4 There are, naturally, a very large number of important
services and needs not covered by
these targets:
· local communities will have local priorities related to
their local populations and local
circumstances
· local government has priorities in other important areas
of public services
· nationally, the NHS and social services will be supporting
other areas of public
services including, for example, neighbourhood renewal
And the world will not stand still over the next three
years. There will for example be the
new National Service Frameworks for Children and Renal
Services and the delivery of that
for Diabetes. (Critical milestones for diabetes are included
in the targets set out here.)
3.5 Other than the targets in this document, arrangements
for delivery will be a matter for local
determination. Local organisations and communities will set
their own timescales and
milestones. They will be responsible for reporting to and
accounting to their local
communities for improving these services where necessary.
4. Building capacity
4.1 In order to deliver in the priority areas it will be
necessary in most cases to have additional
capacity available in terms of staff, facilities and
equipment. In some cases this may mean
involving new organisations in providing services and care.
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4.2 Alongside the targets in Appendix B we have set out the
national assumptions about the
level of capacity that will be needed to deliver targets in
each priority area. Organisations
will take these into account in developing their plans.
Whilst the targets themselves are not
negotiable, local organisations and communities can work to
different assumptions where
these can be justified by local circumstances.
4.3 In addition each NHS organisation, working with its
local councils and other local partners,
will need to develop underpinning plans which show the total
increases in capacity in the
three key areas of:
· physical facilities
· workforce
· information management and technology
4.4 Nationally the NHS will be looking for significant
increases and developments in each of
these areas. The national requirements in each area for the
three years are described in
Appendix C.
5. Organisational responsibilities
5.1 Implementing these plans will depend on taking a whole
system approach with each
organisation playing its part in delivery. It will be
important that there is local sharing of
performance and financial data (particularly between PCTs
and providers of health care
such as acute hospital trusts and GP practices) to inform
local planning. The planning
process itself will need to involve all the relevant
organisations and, most importantly, the
front line staff who must make the vision happen. For
example, staff in General Practices
must be actively involved through improved engagement with PCTs.
5.2 Within the new planning framework a lead agency will be
responsible for ensuring that the
process of developing plans is robust to take responsibility
for the quality of the final
product. For the priority areas the division in leadership
between the NHS and social
services is:
NHS lead Joint lead Social services lead
Access to services for
emergency and planned
care
Mental health Life chances for children
Cancer Older people
CHD
Patient experience
Health inequalities
Drug misuse
5.3 Where the NHS is in the lead, strategic health
authorities will be responsible for ensuring
the process and outcome of planning is robust, and similarly
councils will take responsibility
for the social care lead area. Where the lead is joint, PCTs
and councils should locally
agree the lead arrangements at the beginning of the planning
process.
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5.4 Within the NHS planning will be from the bottom up:
· PCTs (and relevant Care Trusts), as the lead planners,
will be responsible for
creating local plans which describe health and service
improvement in their area.
These will be developed using local clinicians’ knowledge as
well as patients and
the public. They will address the needs of the community as
a whole and
incorporate the national priorities.
· each NHS Trust will be responsible for creating its own
plan which shows how it will
deploy its resources to deliver on both national and local
priorities and fit within the
plans of its PCT commissioners
· Workforce Development Confederations will work with the
other organisations to
contribute to these plans and support Strategic Health
Authorities to create the
workforce plan as part of the Local Delivery Plan.
· Strategic Health Authorities will bring together those PCT
plans, as described in the
next section, into a comprehensive Local Delivery Plan for
their area
· taken together these plans will make up a coherent
national picture
5.4 Councils should contribute to Local Delivery Plans as
necessary. In particular, where they
are leading on one of the joint priority areas, the plan
they produce with the NHS should be
built into the Local Delivery Plan for the area. Councils’
planning for their lead priority on
life chances for children should follow local government
requirements taking account of any
special arrangements agreed for the Local Government PSA as
a whole. Both NHS
organisations and Councils should consider how joint
activity will be reflected in local PSAs
and contribute to meeting them.
6. Creating robust plans within a new planning process
6.1 A new NHS planning system has been designed to allow
organisations to produce threeyear
plans. It is simpler and has fewer national requirements and
national targets. The
essence of the new system is for all the current national
planning requirements for the NHS
to be replaced by a single three year local delivery plan.
This mirrors the recent changes
for social care where there is already a reduction in the
number of plans required to be
submitted to the centre and further work being undertaken on
simplifying local government
planning requirements.
6.2 The Local Delivery Plan will be significantly different
from previous plans. It will need to
identify the expected progress or milestones for each
priority area over the three year
period (in programme management terms this means the
“trajectory” of delivery). In
general terms it will need to identify quarterly or annual
milestones but in a small number of
critical deliverables it may need to show planned progress
on a month by month basis.
6.3 It will also need to be supported by a financial
strategy and plan, taking account of the
changes to the financial system during the period, and
showing how resources will be
deployed and value for money will be achieved.
6.4 The Local Delivery Plan will cover a whole Strategic
Health Authority area but will be based
on PCT level plans. It will need to take account of the
various reforms to the systems which
will be happening during this period, (eg on financial
flows), and show how these will
contribute to progress.
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6.5 The Local Delivery Plan itself will be a “live” document
which will be amended with, for
example, corrective action taken if delivery goes off course
or new initiatives taken when
new opportunities arise. These adjustments will generally be
made following quarterly and
annual monitoring. There will not be an annual planning
round to replace the current
SaFFs process. However a new three-year plan will need to be
developed within the third
year.
6.6 The timetable is as follows:
· local planning started during the summer months following
the briefing sessions
which were organised nationally
· technical guidance on the new process will be published
shortly
· a guidance and consultation document on the introduction
of payment for results will
be published shortly
· the national project on Configuring Hospitals will be
publishing an advisory
framework during the autumn. (The focus of the framework is
hospital
configurations but it has been developed in the context of a
whole systems
approach to planning and delivering care.)
· the three year financial allocations to PCTs will be
announced in November,
together with the national price tariff which will apply to
the payment for results
system. (In the meantime organisations will need to work to
sensible assumptions
about the amount of money available to them based on the
national allocation.)
· Strategic Health Authorities have been asked to produce
capacity plans in October
which identify how sufficient capacity will be brought into
use during the three year
period. These will be incorporated into the local delivery
plans which are due in
March. However some aspects of the capacity plans which are
time critical eg for
capital projects or key appointments will need to be
actioned before March.
6.7 Whilst the final plans are required in March, all NHS
organisations will need immediately to
design their local planning processes, where they have not
already done so. In addition
there will need to be constant and continuing discussion
between StHAs and the
Department of Health over these plans throughout the next
few months to ensure that they
can be agreed before the start of the next financial year.
6.8 As part of this new planning process the Department of
Health has set out the key priorities
for the next three years. It will do everything possible to
ensure that these are maintained
and to minimise any changes which may result from unforeseen
risks or events and
changes in local or national circumstances. The vast
majority of NHS resources will be in
the hands of PCTs, thereby reducing the scope over this
period for new initiatives and
programmes.
6.9 However the three-year period will inevitably bring
about some change. Where this
happens, the Department will consult with Strategic Health
Authorities, councils with social
services responsibilities – and where possible with the NHS
more widely – about how to
introduce changes to this framework.
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7 Arrangements for monitoring and NHS performance management
7.1 Under the new arrangements, it will be much more
important for local organisations to have
good monitoring arrangements in place so that they can amend
their plans and take action
where necessary during the course of these three years.
Wherever possible individual
organisations should be taking action themselves rather than
waiting for intervention to be
initiated by others.
7.2 The arrangements for monitoring and performance
management in the NHS are that:
· each organisation will have its own system. In addition each
organisation will need
to make arrangements, as described in the next section, to
report to their staff and
public on performance.
· PCTs will hold provider organisations to account for the
delivery of services which
they have commissioned
· StHAs will hold all NHS organisations to account for
performance
· The Department of Health will hold StHAs to account for
the performance of the
NHS within their area.
7.3 Monitoring and performance management will focus on the
targets for the next three years.
There will be routine monitoring of national standards and
past targets where appropriate to
ensure they continue to be met.
7.4 During the year, SSI will track councils’ progress
against the local improvement plan.
Monitoring information will continue to be used to
contribute to the overall assessment of
social services performance that leads to the award of star
ratings.
7.5 As part of this system, new inspectorates are to be put
in place for both health and social
care. They will have the responsibility for assessing the
overall performance of
organisations and for the publication of performance
ratings.
8 Improving NHS accountability and demonstrating added value
8.1 The NHS is transforming itself into an organisation
which truly focuses on its patients,
designs its services around them and offers them choice and
involvement. Its success
depends on the involvement of very many people and
organisations and on the support of
patients and the public.
8.2 PCTs have responsibility for publishing an annual
Patient Prospectus which describes
services and performance in their area. This will be a core
document for the public. In
addition, however, each organisation will continue to bear
responsibility for its own
communication and involvement of stakeholders. It is therefore
essential that each NHS
Board reviews its arrangements for involving and
communicating with all its stakeholders –
its patients, its public, its staff and its partners. It
will need to involve these stakeholders in
preparing and advising on the plans. It must also show in
its plans how it will continue to
involve and communicate with them and report on performance
and progress for each of
these groups.
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8.3 The arrangements for reporting to stakeholders will,
amongst other things, need to
demonstrate how extra funding has been used to add value to
services provided by or
commissioned through the organisation, for example by
investment in new facilities or in
training or in extending the availability of services to
people.
8.4 The precise way that an organisation demonstrates the
value that is being added will
depend on its activities and local circumstances. However,
in every case the organisation
should be able to demonstrate that it has added value at
least to the level of any additional
funding, that it has secured a minimum 1% increase in cost
efficiency and a minimum
increase in quality equivalent to 1% of its budget. Further
guidance covering methodology
will be issued to organisations in due course.
9 Conclusion
9.1 This document sets out the national requirements for
local planning. Taken together these
local delivery plans will show how the NHS, working with
social services and other partners,
will make visible improvements, expand and reform services
over the next three years.
9.2 This national picture is very important. However, it is
equally important that plans make
sense locally and that they are understood and owned by all
the local parties. Delivery of
improvements will depend on the involvement and
determination of front-line staff and the
involvement of patients and the public in shaping services.
PCTs, as fully inclusive
organisations, must ensure that the plans produced as part
of this process must be about
local accountability and local action as much as being about
national accountability and the
delivery of national targets.
Department of Health
September 2002
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APPENDIX A
DEPARTMENT OF HEALTH – PUBLIC SERVICE AGREEMENT
AIM: Transform the health and social care system so that it
produces faster, fairer services that
deliver better health and tackle health inequalities.
Objective I: improve service standards.
1. Reduce the maximum wait for an outpatient appointment to
3 months and the maximum wait
for inpatient treatment to 6 months by the end of 2005, and
achieve progressive further cuts
with the aim of reducing the maximum inpatient and day case
waiting time to 3 months by
2008.
2. Reduce to four hours the maximum wait in A&E from
arrival to admission, transfer or
discharge, by the end of 2004; and reduce the proportion
waiting over one hour.
3. Guarantee access to a primary care professional within 24
hours and to a primary care doctor
within 48 hours from 2004.
4. Ensure that by the end of 2005 every hospital appointment
will be booked for the convenience
of the patient, making it easier for patients and their GPs
to choose the hospital and consultant
that best meets their needs.
5. Enhance accountability to patients and the public and
secure sustained national improvements
in patient experience as measured by independently validated
surveys.
Objective II: improve health and social care outcomes for
everyone.
6. Reduce substantially the mortality rates from the major
killer diseases by 2010: from heart
disease by at least 40 % in people under 75; from cancer by
at least 20% in people under 75.
7. Improve life outcomes of adults and children with mental
health problems through year on year
improvements in access to crisis and CAMHS services, and
reduce the mortality rate from
suicide and undetermined injury by at least 20% by 2010.
8. Improve the quality of life and independence of older
people so that they can live at home
wherever possible, by increasing by March 2006 the number of
those supported intensively to
live at home to 30 % of the total being supported by social
services at home or in residential
care.
9. Improve life chances for children, including by:
· improving the level of education, training and employment
outcomes for care leavers aged
19, so that levels for this group are at least 75% of those
achieved by all young people in
the same area, and at least 15% of children in care attain
five good GCSEs by 2004. (The
Government will review this target in the light of a Social
Exclusion Unit study on improving
the educational attainment of children in care.);
· narrowing the gap between the proportions of children in
care and their peers who are
cautioned or convicted; and
· reducing the under-18 conception rate by 50% by 2010.
10. Increase the participation of problem drug users in drug
treatment programmes by 55% by
2004 and by 100% by 2008, and increase year on year the
proportion of users successfully
sustaining or completing treatment programmes.
11. By 2010 reduce inequalities in health outcomes by 10% as
measured by infant mortality and
life expectancy at birth.
Objective III: improve value for money
12. Value for money in the NHS and personal social services
will improve by at least 2% per
annum, with annual improvements of 1% in both cost
efficiency and service effectiveness.
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APPENDIX B
IMPROVE ACCESS FOR BOTH EMERGENCY CARE AND PLANNED CARE
Objective
The overall objective is to provide fast, safe and high
quality emergency care and fast convenient
access and patient choice for planned care.
Throughout the country, there will be:
· Universally high quality primary care services which are
accessible and responsive to patients'
needs and preferences.
· Integrated networks of emergency care involving health and
social services that link together
primary care, social care, hospital care, ambulance
services, voluntary services and NHS
Direct all of whom will play their part.
· Increasing separation of elective and emergency capacity.
· Efficient systems for booking appointments and admissions
that offer patient choice and fast
access to planned care.
· Local systems to ensure that guarantees to patients are
met including the NHS Plan cancelled
operations guarantee. (From 1 April 2003 this will apply to
patients cancelled at "the last
minute" and not just those cancelled "on the day
of surgery".)
Targets
For emergency care:
· Reduce to four hours the maximum wait in A&E from
arrival to admission, transfer or
discharge, by March 2004 for those Trusts who have completed
the Emergency Services
Collaborative and by the end of 2004 for all others. A
target will be set relating to a reduction in
the proportion of patients waiting over one hour, following
consultation with the service over its
precise definition.
· By December 2004 a single phone call to NHS Direct will be
a one-stop gateway to out-ofhours
healthcare, with callers passed on where, necessary, to the
appropriate GP co-operative
or deputising service.
For planned care:
· Ensure 100% of patients who wish to do so can see a
primary health care professional within 1
working day and a GP within 2 working days by December 2004.
· Achieve a maximum wait of 4 months (17 weeks) for an
outpatient appointment and reduce the
number of over 13-week outpatient waiters by March 2004, as
progress towards achieving a
maximum wait of 3 months for an outpatient appointment by
December 2005.
· Achieve a maximum wait of 9 months for all inpatient
waiters and reduce the number of 6-
month in-patient waiters by 40% by March 2004, as progress
towards achieving a maximum 6
month wait for inpatients by December 2005 and a 3 month
maximum wait by 2008, ensuring
an overall reduction in the total list size and a reduction
of at least 80% by March 2005 in the
number of over 6-month in-patient waiters from the March
2003 baseline.
· Increase the level of choice in each year, offering
routine choice of hospital provider at point of
booking for all patients by December 2005 with 100% booking
of day cases and two thirds of
all first outpatient and inpatient elective admissions being
pre-booked by March 2004.
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National capacity assumptions
· Differential between growth in elective activity and GP
referrals of 3% to ensure sufficient
elective capacity to meet waiting time targets and offer
choice.
· Day case rate increased to 75%
· Increased amount of activity taking place in primary and
community settings to contribute to the
national assumption of at least one million more outpatients
appointments (around 10%) take
place in the community rather than in hospital.
· Sufficient bed capacity (including critical care) to
ensure that bed occupancy drops to a level
consistent with admitting emergency cases without delay.
· Support and incentives for routine delivery of fast and
convenient access to primary care
services for all patients by increasing and targeted
resources in those practices or other service
providers with particular resource, management or other
developmental needs.
· Increase the amount of elective activity undertaken in dedicated
facilities (including DTCs) and
non-NHS providers (including the private sector).
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CANCER
Objective
The NHS Cancer Plan sets out a framework for services that
will:
· Save more lives
· Ensure people with cancer get the right professional
support and care as well as the best
treatments
· Reduce inequalities
· Build for the future through investment in workforce and
research for cancer
All patients should have access to prompt, high quality
services for prevention, diagnosis,
treatment and care for cancer as set out in the NHS Cancer
Plan. Services should be developed
through cancer networks (involving the Cancer Services
Collaborative) and be provided in line with
national cancer standards, taking full account of NICE
appraisals and clinical outcomes service
guidance. Providers should ensure full participation in
national cancer comparative clinical audit,
from 2003/04 for lung and breast cancer and from 2004 for
colorectal and head and neck cancers.
Targets
· Maintain existing cancer waiting time standards and set
local waiting time targets for 2003/04
and 2004/05 so that by the end of December 2005 there is a
maximum of one month from
diagnosis to treatment, and two months from urgent referral
to treatment for all cancers.
· Reduce the rate of smoking, contributing to the national
target of: reducing the rate in manual
groups from 32% in 1998 to 26% by 2010; 800,000 smokers from
all groups successfully
quitting at the 4 week stage by 2006
· Extend breast screening to all women aged 65-70 by 2004
· Set local targets to achieve compliance with forthcoming
national standards on supportive and
palliative care (to be derived from NICE supportive and
palliative care guidance)
· Agree, implement and monitor local plans to improve the
outcomes of cancer treatment, as
evidenced by increasing compliance with NICE Improving
Outcomes guidance and the
associated national cancer standards
National capacity assumptions
· Increased investment in cancer services, to contribute to
additional funding nationally of £570
million for cancer services by 2003/04 (baseline 2000/01)
· Increased access to radiotherapy and diagnostic services
(including radiology, pathology and
endoscopy) to enable cancer waiting times targets to be met,
as demonstrated through
increased staffing, improved facilities and equipment.
· Increased investment in specialist palliative care in line
with NICE Supportive and Palliative
Care Guidance and NHS Cancer Plan commitment, contributing
to an extra £50m nationally by
2003/04 (baseline 2000/01)
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CORONARY HEART DISEASE
Objective
The National Service Framework for Coronary Heart Disease
set the framework for action to:
· prevent disease, save more lives and improve quality of
life;
· deliver services that are responsive to the needs and
choices of patients;
· reduce inequalities, through action to reduce the risk of
CHD
All patients should have access to prompt, high quality care
across the patient pathway, as set out
in the NSF. Service development should build on the
experience of the Primary Care and Coronary
Heart Disease Collaborative Programmes, and should take full
account of the results of
comparative clinical audits. In particular all appropriate
units should participate in national CHD
comparative audits for paediatric and adult cardiac surgery
and for myocardial infarction; and
prepare to contribute to the planned national audit on
angioplasty.
Targets
· Improve access to services across the patient pathway and
increase patient choice by
achieving the two week wait standard for Rapid Access Chest
Pain Clinics; setting local targets
to make progress towards the NSF goal of a 3 month maximum
wait for angiography; and
delivering maximum waits of 3 months for revascularisation
by March 2005, or sooner if
possible.
· Deliver a ten percentage point increase per year in the
proportion of people suffering from a
heart attack who receive thrombolysis within 60 minutes of
calling for professional help.
· In primary care, update practice-based-registers so that
patients with CHD and diabetes
continue to receive appropriate advice and treatment in line
with NSF standards and by March
2006, ensure practice-based registers and systematic
treatment regimes, including appropriate
advice on diet, physical activity and smoking, also cover
the majority of patients at high risk of
CHD, particularly those with hypertension, diabetes and a
BMI greater than 30.
· Improve the management of patients with heart failure in
line with the NICE Clinical Guideline
due in 2003, and set local targets for the consequent
reduction in patients admitted to hospital
with a diagnosis of heart failure
National capacity assumptions
· Increased access to diagnostic and surgical capacity to
enable waiting times targets to be met.
· More defibrillators commissioned in public places, working
with the New Opportunities Fund, to
contribute to national target of 3,000 by 2004.
Improvement, Expansion & Reform: The Next Three Years
16
MENTAL HEALTH
Objective
The Mental Health NSF and Suicide Prevention Strategy set
out a modernisation programme to:
· reduce the suicide rate and deaths by undetermined causes
by 20% by 2010
· improve access to general community Mental Health services
Services should be delivered in line with the standards in
the Mental Health NSF, the Mental
Health Implementation Guide, national Mental Health
strategies and compliance with NICE
appraisals/guidance. Comparative clinical audit and
information from the Mental Health Minimum
Data Set (which should be implemented in all Trusts by
03/2003) should be used to develop
services, and the National Institute for Mental Health
England will support development work.
Modernisation will be supported by a new Mental Health
Legislative framework. NHS and social
services joint responsibility will be delivered through
Local Implementation Team partnership.
The Children’s NSF and its emerging findings will set out
the standards and milestones for
improvement in child & adolescent mental health services
(CAMHS), including year on year
improvements in access.
Targets
· Reduce the duration of untreated psychosis to a service
median of less than 3 months,
(individual maximum less than 6 months) and provide support
for the first three years for all
young people who develop a first episode of psychosis by
2004.
· Offer 24-hour crisis resolution to all eligible patients
by 2005.
· By Dec 2003, deliver assertive outreach to the 20,000
adult patients with severe mental illness
and complex problems who regularly disengage from services.
· Increase breaks available for carers and strengthen carer
support and networks to the benefit
nationally of approximately 165,000 Carers of people on CPA
by 2004.
· Improve mental health care in prisons so that all
prisoners with severe mental illness have a
Care Plan by April 2004 (approximately 5000 prisoners
nationally) and ensure appropriate use
of secure and forensic facilities by 2004, contributing to
the national target of moving 400
patients from high secure hospitals by 2004.
· Ensure that by April 2004 protocols are in place across
all health and social care systems for
the care and management of older people with mental health
problems.
National capacity assumptions
· Expanded service capacity in key services, to contribute
to national requirements by 2004 of
335 crisis resolution teams; 50 additional assertive
outreach teams; 50 early intervention
teams; 140 new secure personality disorder places.
· Reduced pressure on acute inpatient units by reduction in
bed occupancy rate
· All child and adolescent mental health services to provide
comprehensive service including
mental health promotion and early intervention by 2006
· Increase child and adolescent mental health services by at
least 10 per cent each year across
the service according to agreed local priorities
(demonstrated by increased staffing, patient
contacts and/or investment)
Improvement, Expansion & Reform: The Next Three Years
17
OLDER PEOPLE
Objective
The NSF for Older People sets out the framework for health
and social care services that will
deliver:
· Person centred care, respecting dignity and promoting
choice
· The promotion of independent living and health and active
life
· User satisfaction through timely access to high quality
services that meet people’s needs
· Partnership with carers
Services will be developed in line with the NSF standards
and milestones. They will be provided in
wider partnerships where appropriate, with the right
professional support and care, to meet the full
range of needs. The Information Strategy for Older People
will be implemented and there will be
systems in place to explore user and care experience.
Councils will implement the policy of offering
eligible individuals the choice of direct payments during assessment
for community care services.
Targets
· Improve the quality of life and independence of older
people so that they can live at home
wherever possible, by increasing by March 2006 the number of
those supported intensively to
live at home to 30% of the total being supported by social
services at home or in residential
care.
· Each year there will be less than 1% growth in emergency
hospital admissions and no growth
in re-admissions.
· By December 2004: all assessments of older people will
begin within 48 hours of first contact
with social services and will be completed within four
weeks, (with 70% within two weeks);
following assessment, all social services will be provided
within four weeks, (with 70% within
two weeks); all community equipment for older people (aids
and minor adaptations) will be
provided by social services within seven working days.
· By 2006, a minimum of 80% of people with diabetes to be
offered screening for the early
detection (and treatment if needed) of diabetic retinopathy
as part of a systematic programme
that meets national standards, rising to 100% coverage of
those at risk of retinopathy by end
2007.
· By April 2004 all general hospitals caring for people with
stroke to have a specialised stroke
service, and all health and social care systems to have
established an integrated falls service
by 2005.
National capacity assumptions
· Intermediate care capacity expanded to meet the NHS Plan
targets of an increase in the
number of intermediate care beds by 5000 and the number of
people benefiting from
intermediate care by 220,000, in 2004 compared with 2000. By
2006 councils increase their
intermediate care places to benefit an extra 70,000 people a
year.
· Service capacity increased in other key services which
support people at home so that in
2006: 30,000 more people a year receive care packages
involving 5 hours or more a week of
home care; 500,000 more pieces of community equipment are
provided; there are 6,900 more
extra care housing places. An increase of 6000 in the number
of people in care homes
supported by councils over the three years to 2006.
· An additional 130,000 carers a year receive services in
2006, using the increased investment
in the existing carers special grant.
· As a result of investment in extra capacity and the
introduction of reimbursement of the NHS
by councils, delayed transfers of care reduce to a minimal
level by 2006.
Improvement, Expansion & Reform: The Next Three Years
18
LIFE CHANCES FOR CHILDREN
Objective
Ensure the NHS and local government work together to improve
life chances for children by:
· promoting the secure attachment of children to carers
capable of providing safe and effective
care for the duration of their childhood;
· enabling looked after children to gain maximum life chance
benefit from educational
opportunities, health care, social care and other services;
· addressing issues identified in the Kennedy Report
including preparation for and
implementation of the first module of the Children's NSF
once this is published; and
· engaging fully with the ongoing development of
cross-agency preventive work to support
children and families, including local prevention
strategies, and the continued development of
Sure Start and Children's Centres.
Targets
· Improve the educational attainment of children and young
people in care by increasing to 15
per cent by 2003-04 the proportion of children leaving care
aged 16 and over with 5 GCSEs at
grade A*-C, and maintain this level up to 2006. (N.B. The
Government will review this target by
the end of 2002 in the light of a Social Exclusion Unit
study on improving the education
attainment of children in care.)
· Improve the level of education, training and employment
outcomes for care leavers aged 19, so
that levels for this group are at least 75 per cent of those
achieved by all young people in the
same area by March 2004, and maintain this level up to 2006.
· Reduce by 2004, the proportion of children aged 10-17 and
looked after continuously for at
least a year who have received a final warning or
conviction, by one third from September 2000
position. (Reduce the proportion from the 2000 national
figure of 10.8 per cent to a local
maximum of 7.2 per cent.) Maintain this reduction up to
2006.
· Maintain current levels of adoption placement stability
(as measured by the proportion of
placements for adoption ending with the making of an
adoption order) so that quality is not
compromised whilst increasing the use of adoption as
follows:
- By 2004-05 increase by 40 per cent the number of looked
after children who are adopted,
and aim to exceed this by achieving, if possible, a 50 per
cent increase by 2006, up from
2,700 in 1999-2000. All councils will bring their practice
up to the current level of the best
performers (band 4 or 5 on PSS PAF indicator C23).
- By 2004-05 increase to 95 per cent the proportion of
looked after children placed for
adoption within 12 months of the decision that adoption is
in the child’s best interests, up
from 81 per cent in 2000-01, and maintain this level (95%)
up to 2006, by locally applying
the timescales in the National Adoption Standards, taking
account of the individual child's
needs.
National Capacity Assumptions
· All Local Authorities to have in place robust mechanisms
for partnership working with relevant
agencies to achieve targets.
· Improvement in the stability and quality of placements for
looked after children including
through recruitment/retention and support to foster carers
over this period to support targets in
line with the Choice Protects Review.
Improvement, Expansion & Reform: The Next Three Years
19
IMPROVING THE PATIENT EXPERIENCE
Objective
The NHS will be transformed through better engagement with
patients, the public and staff. By
regularly seeking out and acting on local feedback, the NHS
will create patient responsive services
that people perceive to be improving.
The 5 key dimensions for a good patient experience are:
· Improving access and waiting
· More information, more choice
· Building closer relationships
· Safe, high quality, co-ordinated care
· A clean, comfortable, friendly environment
Patients and the public will hold their local NHS to full
and proper account for delivering
improvements. They will expect updates on progress through
formal patient and public
involvement structures, and an annual guide to local health
services.
Targets
· Improve the 5 key dimensions of the patient’s experience
as evidenced by increasingly positive
local annual survey results, and other patient focused
performance indicators, including those
developed for the star ratings system. Agree, implement and
jointly monitor local improvement
plans as a result of surveys, with Patient Forums, as they
come on stream during 2003.
· Strengthen accountability to local communities through
improved engagement with them, as
evidenced by annual Patient Forum reports to the Commission
for Patient & Public Involvement
in Health, and annual publication of a patient prospectus
covering local health services.
· Set local targets to contribute to national target of
reducing the value of NHS building backlog
maintenance by 25% by 2004.
· Introduce bedside TV and telephone systems in every major
hospital by December 2003.
· Eliminate Nightingale wards for older people by April
2004.
· Introduce ward housekeepers in hospitals by 2004 and
appoint modern matrons to all
remaining posts by April 2004.
National capacity assumptions
· Active Patient Advisory & Liaison Service
· Regular and systematic approach to obtaining, analysing
and responding to local patient and
public feedback about services
· Partnership working with Patient Forums
Improvement, Expansion & Reform: The Next Three Years
20
REDUCING HEALTH INEQUALITIES
Objective
To reduce inequalities in health outcomes across different
groups and areas in the country. Initially
the focus is on reducing the gap in infant mortality and life
expectancy at birth, and on reducing
teenage pregnancies.
NHS improvement, expansion and reform should narrow the
health gap by:
· ensuring that the distribution of health benefit from
service expansion and development
consistently favours individuals and communities that have
been traditionally under-served,
· ensuring that service planning is informed by an equity
audit and supported by an annual public
health report by the Director of Public Health
· tackling the wider determinants of health - agreeing a
single set of local priorities with local
authorities and other partners, contributing to regeneration
and neighbourhood renewal
programmes, and ensuring the NHS makes a full contribution
to support the Sure Start
programme
· building capacity for public health improvement and
protection in PCTs
Targets
· Deliver a one percentage point reduction per year in the
proportion of women continuing to
smoke throughout pregnancy, focussing especially on smokers
from disadvantaged groups as
a contribution to the national target to reduce by at least
10% the gap in mortality between
“routine and manual” groups and the population as a whole by
2010, starting with children
under one year.
· Deliver an increase of 2 percentage points per year in
breastfeeding initiation rate, focussing
especially on women from disadvantaged groups.
· Achieve agreed local teenage conception reduction targets
while reducing the gap in rates
between the worst fifth of wards and the average by at least
a quarter in line with national
targets.
· Contribute to a national reduction in death rates from CHD
of at least 25% in people under 75
by 2005 compared to 1995-1997, targeting the 20% of areas
with the highest rates of CHD.
· Contribute to a national reduction in cancer death rates
of at least 12% in people under 75 by
2005 compared to 1995-1997, targeting the 20% of areas with
the highest rates of cancer.
· Achieve the target of 70% uptake in influenza immunisation
in people aged 65 years and over,
targeting populations in the 20% of areas with the lowest
life expectancy.
National capacity assumptions
· Improved access to services for disadvantaged groups and
areas, particularly:
- Early antenatal service booking
- Antenatal and child health screening services
- Sexual health services, and breast/cervical screening.
- Strengthened primary care services through increased
numbers of health professionals and
improved facilities in under-served and deprived areas.
Improvement, Expansion & Reform: The Next Three Years
21
DRUG MISUSE
Objective
To contribute to delivery of the National Drugs Strategy by
reducing the harmful effects of
substance misuse.
This will be achieved through expansion and improvement of
drug treatment services, and by
contributing to the Strategy target to reduce the use of
Class A drugs, and frequent use of any illicit
drug by young people.
This will include:
· Agreement through the local DAT of arrangements for
commissioning integrated drug
treatment and prevention programmes jointly with other
partners.
· Implementation of the NTA guidance on maximum waiting
times for drug treatment, Models of
Care, prescribing guidance and action plan on drug-related
deaths.
Targets
· Increase the participation of problem drug users in drug
treatment programmes by 55% by
2004 and by 100% by 2008 (against 1998 baseline), and
increase year on year the proportion
of users successfully sustaining or completing treatment
programmes.
· Reduce drug-related deaths by 20% by 2004 (against 1999
baseline).
National Capacity Assumptions
· An increase in access to general medical services for all
problem drug users (irrespective of
prescribing needs), and GP participation in training
programmes on treatment of drug users.
Improvement, Expansion & Reform: The Next Three Years
22
APPENDIX C
PHYSICAL FACILITIES
Objective
To create a clean, comfortable, well-maintained physical
environment which is fit to deliver
modern, convenient care. This includes delivering sufficient
physical capacity in the right place to
implement the NHS’s key priorities, increasing diversity of
provision through use of non-NHS
providers where appropriate, and ensuring that physical
facilities are modernised in line with the
vision set out in the NHS Plan.
National capacity requirements
· Introduce new providers from the independent sector and
overseas to offer patients a greater
choice over where they obtain diagnosis and treatment.
· Trusts with major capital schemes: achieve financial close
on 29 schemes for new hospitals
announced in February 2001 by June 2005, or sooner if
possible.
· Improve GP premises, to contribute to national target of
3000 GP premises refurbished or
replaced by the end of 2004.
· Establish new one-stop primary care centres, to contribute
to national target of 500 centres by
the end of 2004, 125 more by 2006, and a further 125 by
2008.
· Establish additional inpatient beds and hospital capacity
to meet access and clinical priority
targets.
· Establish new Diagnosis and Treatment Centres operational
in time to make a contribution to
meeting 2005 waiting targets.
· Plan for at least 40% of the total value of the NHS estate
to be less than 15 years old by 2010.
Improvement, Expansion & Reform: The Next Three Years
23
WORKFORCE
Objective
To support delivery of NHS priorities by ensuring there are
sufficient numbers of appropriately
trained, motivated staff working in the right locations. The
HR Strategy for the NHS sets out a
managed programme for a rapid expansion in the NHS
workforce, introduction of more flexible
ways of working and improving the working lives of staff.
Delivery of this strategy is absolutely
central to the achievement of other NHS Plan priorities.
Workforce Development Confederations
will need to work on behalf of Strategic Health Authorities
to develop a local delivery plan for
workforce which:
· ensures sufficient increases in workforce to meet delivery
priorities
· makes optimum use of the new contractual arrangements
· delivers the changes set out in “HR in the NHS Plan”
· addresses critical issues, particularly implementation of
the Working Time Directive
National capacity requirements
· Increase the number of nurses employed by the NHS by 20,000
by 2005 (from a 2000
baseline), and plan to achieve increase of 35,000 by 2008
(from a 2001 baseline).
· Increase the number of consultants by 7,500 and the
numbers of GPs by 2,000 by 2004 (from
a 1999 baseline); increase the number of GPs and Consultants
employed by the NHS by
10,000 by 2005 (from a 2000 baseline); plan to achieve
increase of 15,000 doctors by 2008
(from a 2001 baseline). This will include: 1,000 cancer
consultants by 2005; and increasing
total numbers of cardiologists to 685 and cardiothoracic
surgeons to 217 by 2004, (enabling
single handed cardiologist posts to be eliminated).1
· Increase the number of therapists and scientists employed
by the NHS by 6,500 by 2004 (from
a 1999 baseline), and plan to achieve an increase of 30,000
by 2008 (from a 2001 baseline).
· Increase the number of health care assistants employed by
the NHS by 27,000 by 2005 (from
a 2002 baseline).
· By 2004 expand the mental health workforce by: 1,000 new
graduate workers in primary care;
500 community mental health “Gateway” workers; 700 more
staff to support carers; 300 prison
in-reach staff to ensure prisoners with severe mental
illness have an appropriate care plan and
care co-ordinator on release; 400 staff to support secure
step-down.
· By 2006 expand the mental health workforce by: 300 extra
prison in-reach staff, 500 community
development workers for black and minority ethnic
communities; 200 staff and 6 outreach teams
for personality disorder and training of 3000 Support, Time
and Recovery Workers (STR).
· Increase workforce capacity and productivity through skill
mix and continuing professional
development; moving work from doctors to other healthcare
professionals and from healthcare
professionals to the support workforce, supported by pay
modernisation, and service redesign.
1 Further explanation of these baselines and national
requirements for increasing the number of doctors will
be issued with the technical guidance
Improvement, Expansion & Reform: The Next Three Years
24
IM&T
Objective
To provide information management and technology to support
deliver of fast, seamless and
convenient care to patients. IM&T will facilitate
greater patient choice, giving patients better
information about options for their care. At the same time it
will improve working lives for staff by
reducing paper-based bureaucracy, enabling more effective
communications between
professionals and provide support for clinical and
management decision-making. There will be a
nationally-led programme for IM&T and all NHS
organisations as part their Local Delivery Plans will
need to implement the National Strategic Programme,
(described in the document “Delivering 21st
Century IT Support for the NHS”). In the years 2003-06 the
elements to be delivered involve
infrastructure, records, prescribing and booking.
National Programmes
· infrastructure - deliver broadband access to NHS net for
NHS clinicians and support staff by
April 2004. This will be a single national procurement of a
new NHS network. StHAs and
trusts should be aware of the national procurement and make
arrangements for local networks.
· booking - implement electronic booking by December 2005.
The chosen architecture is
decided upon and early adopters (enterprise communities) are
developing. Local communities
should respond to the national roll out programme.
· national prescriptions service - this will be 50%
implemented by December 2005 and 100% by
December 2007 with full clinician and patient functionality.
Pilots are being conducted in order
to define a specification for a national programme. Local
communities will need to respond to
the national programme.
· electronic records - implement key elements of electronic
records by December 2005. There
will be a national health records infrastructure accessible
nationally for out-of-hours reference
and an electronic staff record. Existing systems and new
procurements will need to be made
part of the Integrated Care Records Service, the
specification of which is out to consultation. A
central advisory group is being set up to evaluate and
answer questions about current
procurements.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4070202.pdf