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NHS WESTMINSTER
BOARD MEETING
28 September 2010
Agenda Item: 3.3
Title of Paper: Responding to the new health agenda
Responsible Director/Lead: Karen Broughton, Deputy Chief Executive/Borough Director
This paper supports: The corporate objective of ensuring that NHS Westminster is an
organisation fit for the future to support a patient-led NHS.
Strategic Plan Goal: This paper supports the Trust’s Corporate Plan which enables the
delivery of all Strategic Plan Goals
World Class Commissioning Competency: Recognised as the local leader of the NHS
Summary:
This report provides summary information about the changes which have occurred in the
NHS since the election in May, including the publication of the Coalition Government’s
White Paper, Equity and Excellence: Liberating the NHS. This paper sets out the
Government’s vision for the NHS and proposes substantial changes to the commissioning
system, including the abolishment of Primary Care Trusts (PCTs) and Strategic Health
Authorities (SHAs).
NHS Westminster’s does not seek to prejudge the outcome of the White Paper
consultation; however the PCT does believe that it is important to think through the
possible changes. The PCT has therefore had a number of discussions with staff,
Practice Based Commissioners and Westminster City Council about the implications of
the White Paper.
In addition, the NHS was required, by the previous Government, to deliver a reduction in
management costs. As NHS Westminster’s management costs were well above the
national average, this has created a requirement to reduce management costs by 66% by
2012/13. This report outlines how this year’s reduction of management costs will be
achieved.
Revenue/Resource implications: £2m Management cost reduction in 2010/11.
Board Action Required:
The Board is asked to:
Note the report and recommend any other action which the PCT should be taking
in the light of the new NHS agenda.
Health Inequalities (evidence how these are addressed in the paper)
Race/Gender/Disability Equality (evidence how this is addressed in the paper)
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Summary of Patient and Public Involvement and/or feedback (scope and how feedback
was incorporated/actioned)
Evidence of Best Practice nationally/internationally
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NHS WESTMINSTER
Board Meeting: 28 September 2010
RESPONDING TO THE NEW HEALTH AGENDA
1. The White Paper, ‘Equity and Excellence: Liberating the NHS’
As Board Members are aware, the General Election in May 2010 resulted in a change of
Government and a different health agenda. The Coalition Government’s White Paper,
‘Equity and Excellence: Liberating the NHS’, was published on 12 July 2010 and set out a
radical new vision for the health service in England. It has three key principles which are
as follows:
Putting patients at the centre of the NHS.
Changing the emphasis of measurement to clinical outcomes.
Empowering health professionals, particularly GPs.
The key points for NHS Westminster in the paper are:
The £80 billion budget to commission community, hospital and mental health services
will move from PCTs to GPs, giving them greater direct control over the services they
deliver. As the NHS budget currently stands at £105 billion, 80% of the budget will be
given to GP commissioning.
Spending will be exercised by formed GP consortia who will be accountable to patients
(rather than PCTs) for the services they commission.
An independent NHS Board will be set up to oversee the commissioning of services.
The role of Monitor, the foundation trust regulator, will be strengthened as all hospitals
will be given foundation status.
Increased responsibilities for Local Authorities.
The Care Quality Commission will continue to safeguard standards.
The 150 PCTs, and 10 SHAs, will be abolished. PCTs will be replaced by GP consortia
while SHAs will be replaced by the NHS Board.
The publication of ‘Equity and Excellence: Liberating the NHS’ sets in train a number of
national consultations on detailed elements of the proposals. These are:
Commissioning for Patients – this seeks views on how the new system of GP consortia
and the NHS Board will work in practice.
Increasing Democratic Legitimacy – this seeks views on strengthening local
partnerships between NHS commissioners and local authorities.
The Arm’s Length Body Review – this seeks views on changes to a range of our
supporting organisations.
Freeing providers and economic regulation – this seeks views on how best to give real
freedoms to hospitals and community services and on a new system of regulation.
The NHS Outcomes Framework – this seeks views on a new framework to establish the
improvement of quality and healthcare outcomes as the primary purpose of all NHS-
funded care.
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The Government’s consultation on the White Paper runs until 5 October while the
consultations on its supporting documents run until 11 October. NHS Westminster is
currently collating the professional views of its staff through written submissions and a
series of focus groups based on each of the consultations.
Draft legislation for the White Paper will enter Parliament in the autumn and, subject to
parliamentary approval, the Bill could receive Royal Assent by summer 2011. These
timescales could, however, be delayed by the legal action which UNISON has taken
against the Secretary of State for Health.
In addition, a new Public Health White Paper is expected later this year together with
publications on the future of education and training. An information strategy is also
scheduled for later in the year.
NHS Westminster’s does not seek to prejudge the outcome of the White Paper
consultation; however the PCT does believe that it is important to think through the
possible changes. The PCT has therefore had a number of discussions with staff, Practice
Based Commissioners and Westminster City Council about the implications of the White
Paper.
2. Management Cost Reductions
The management cost reductions which we have to deliver by 2012/13 are not a feature of
the White Paper. The NHS was, however, required by the previous Government to deliver
a reduction in management costs and PCTs still have to make these savings over the
coming years.
As NHS Westminster’s management costs were well above the national average, this has
created a requirement to reduce management costs by 66% by 2012/13.
Table 1 below indicates:
The management cost savings which need to be made each financial year until
2012/13.
The funding which will be available each year for management costs.
The number of whole time equivalent (WTE) staff who we expect to be able to employ
based on the average NHS Westminster salary.
Table 1: The scale of management cost reductions 2010 - 2013
2010/11 2011/12 2012/13
Saving £2.0m £5.1m £2.9m
Management cost £11.1m £5.9m £3.0m
after saving
(residual spend)
Staff c.175 WTE c.92 WTE c.44 WTE
NHS Westminster is currently on track to deliver its £2 million (15%) reductions in 2010/11.
Table 2 below demonstrates how we are achieving the 2010/11 reduction. It should be
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noted that we have been able to save a number of positions this year by making some
temporary positions permanent and therefore saving on agency costs.
Table 2: Year 1 management savings
Activities People Impact (WTE) Financial Impact
Reduce interims in IT 13 £437K
Reduce interim/agency 7 £261K
staff in Finance &
Investment
Hold vacancies in 3 £116K
Communications
Shared Informatics with 1.5 £102K
Partners
Reduce interim staff in 12 £882K
Service Development
End 4 fixed-term 4 £123K
contracts early
Reduce interims in 1.5 £38K
Informatics
Totals 42 £1,959
In addition to these savings, a national ‘Mutually Agreed Resignation Scheme’ (MARS) has
been launched to support Trusts in meeting the challenges which are currently facing the
NHS. This national scheme aims to help employers manage cost reductions and the
workforce implications of redesigning services. It applies to special health authorities,
SHAs and all NHS trusts, apart from foundation trusts. The MARS is not redundancy but
the scheme will enable individual employees (in agreement with their employer) to choose
to leave their employment voluntarily in return for a severance payment. MARS will run
from mid-September until the end of October 2010.
3. The Change Programme
In order for NHS Westminster to deliver the management cost reductions, the PCT has put
together a structured change programme.
The change programme, which reports to the senior management team, is supported by
three individual workstreams: (1) Human Resources; (2) Finance; and (3) Communications
and Engagement.
The management leads, and objectives, for each of the workstreams are as follows:
1. Human Resources Workstream
This is led by the Director of Integrated Governance and its purpose is as follows:
To ensure a fair, consistent HR process.
To align NHS Westminster HR process to sector/national HR processes.
To ensure staff are treated well and supported.
To liaise with occupational health to devise a support programme for staff.
To explore outplacement support.
To ensure that HR changes are delivered to time.
To produce accurate organisational structures and diagrams to reflect budgets.
2. Finance Workstream
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This is led by the Director of Finance and its purpose is as follows:
To put in place systems to identify the monthly savings realised.
To provide assurance that savings are being delivered in line with our savings
profile.
To provide year end forecasts to ensure that we stay within the management cost
envelope.
To deliver a development programme to improve budget management skills for
managers.
To lead the introduction of new budget arrangements for Practice Based
Commissioning (PBC) clusters.
To deliver a development programme for clusters to better understand the NHS
financial regime.
To lead the development of a new establishment control process.
To participate in sector wide programmes/projects.
3. Communications and Engagement Workstream
This is led by the Director of Inclusion, Communications and Engagement and its purpose
is as follows:
To ensure consistent, up to date information on organisational changes are
produced.
To lead and deliver a monthly communications and stakeholder plan.
To ensure staff and stakeholders are well informed about the changes.
To lead the arrangements for staff/stakeholder events.
To produce organisational responses to staff and stakeholder questions/issues and
ensure these are available to others.
4. Conclusion
NHS Westminster is planning for the future as well as continuing to deliver agreed
organisational priorities. A structured programme has been put in place to ensure the
required management cost reductions are delivered this year and beyond.
Until the outcome of the White Paper consultation there is obviously a level of uncertainty
within the Trust. However, we are confident that we have the right systems in place to
ensure that this transition phase is as seamless as possible for Westminster residents and
NHS Westminster staff, and that our high standard of organisational performance is
maintained.
Karen Broughton
Deputy Chief Executive/Borough Director
September 2010
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