CLAHRC NDL prepares briefings on pertinent Health and Social Care documents and policy for ease of reference. However, there may be omissions [perceived or actual] in the briefing: a link to the full document is therefore provided.

  1. Published on 24 November 2011, the Operating Framework sets out the business and planning arrangements for the NHS over the next 18 months, describing the national priorities and systems needed to maintain and improve the quality of services provided while delivering transformational change and maintaining financial stability.

The full DH document (50 pages) can be found at

The NHS Confederation 12 page summary can be found at

  1. Four key themes for all NHS organisations:
  • Putting patients at the centre of decision making
  • Preparing for the reforms which come into place in 2013 / 2014, and completing the last year of transition to the new system, building the capacity of clinical commissioning groups (CCGs), and supporting the establishment of Health and Wellbeing Boards
  • Increasing the pace of the Quality, Innovation, Productivity and Prevention (QIPP) challenge
  • Maintaining a strong grip on service and financial performance
  1. QUALITY: Meeting the quality and productivity challenge:

Innovation will be critical, along with the rapid diffusion of good practice. There is a forthcoming Innovation Review (due December 2011) which will set out specific measures to achieve this.

3.1Key areas for improvement:

  • Dementia and care of older people
  • Carers’ support
  • Military and veterans’ health, including improving mental health services for veterans
  • Health visitors and family nurse partnerships

3.2 Outcomes are detailed for:

  • Preventing people from dying prematurely
  • Enhancing quality of life for people with long term conditions
  • Helping people recover from episodes of ill health or following injury
  • Ensuring that people have a positive experience of care
  • Treating and caring for people in a safe environment and protecting them from avoidable harm
  1. REFORM: Development of the new system for delivery
  • Emphasis on local accountability, supporting Health and Wellbeing Boards and a new public health system
  • Extension of Any Qualified Provider (AQP): PCT clusters should start to offer patients choice of AQP in at least three services which are local priorities
  • Further guidance on the transfer of responsibilities from PCTs to the NHS Commissioning Board and Clinical Commissioning Groups (CCGs)
  • ‘As far as possible CCGs should be coterminous with a single Health and Wellbeing Board’
  • Clinical senates will be established during 2012/13
  • Public Health England (PHE) will be in a shadow year of operation during 2012/13 and will be a statutory Executive Agency from April 2013. Significant functions from the current NHS commissioning infrastructure will need to transfer to PHE
  • PCT clusters should prepare for a wider roll out of personal health budgets following the successful evaluation of the pilot programme
  • Key NHS data sets have been identified for public release and these will be added to during 2012 /13. There is a forthcoming Information Strategy
  • NHS organisations are expected to use the NHS number consistently and this will be linked to contractual payments. All NHS organisations must be fully compliant by 31 March 2013
  • NHS trusts are expected to reach Foundation status on their own or become part of an existing NHS FT or in another organisational form by April 2014
  • The new NHS Leadership Academy will provide talent management for all those involved in leadership of healthcare, NHS organisations must sustain a talent pipeline for critical posts, and NHS organisations should improve staff health and wellbeing.
  • SHAs remain accountable for education funding and must plan for the transfer of education and training contacts to new providers, and the implementation of revised education and training tariffs
  1. FINANCE AND BUSINESS RULES
  • From 2013/14 the running cost allowance for CCGs is expected to be £25 per head of population per anum
  • PCT recurrent allocations will grow by at least 2.5%
  • The running costs for the core functions of the NHS commissioning board will be at least £492 million
  • Tariff changes and best practice tariffs will be introduced, and Payment by Results will expand to incentivise best clinical practice and patient outcomes
  • CQUIN framework (Commissioning for Quality and Innovation) will be further developed in 2012/13 so that for all standard contracts the amount providers can earn will be increased to 2.5%
  • Commissioners and providers should refer to the Innovation Review (due December 2011) when developing CQUIN schemes for 2012/13
  • Joint working with local authorities: PCT clusters will need to work with local authorities to jointly agree priorities for the investment of funds allocated for reablement, and will need to continue to transfer social care funding within allocations to local authorities to invest in social care services
  • Procurement Strategy to be launched by April 2012
  • Principles and rules for Co-operation and Competition (PRCC): PCTs must review their practices in line with the Co-operation and Competition panel’s report on the operation of AQP in elective care to ensure they are compliant with PRCC
  1. PLANNING AND ACCOUNTABILITY
  • SHAs will continue to work through SHA clusters to hold PCT clusters to account. From 2013/14 the NHS Commissioning Board will be held to account by DH and commissioners should expect a more outcomes-based approach
  • Three groups of indicators will be used to nationally assess the performance of PCT and SHA clusters: quality (including safety, effectiveness and experience), resources (covering finance, workforce, capacity and activity) and reform (covering commissioning, provision and patient empowerment)
  • PCT clusters will also be monitored against key milestones for transformational change elements of QIPP and reform
  • By the end of March 2012 all PCT clusters should have an integrated plan as specified above which has been assured by SHA clusters.

Liz Lesquereux

29 November 2011

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