Three year NHS priorities – Be afraid, very afraid?

On October 2nd 2002 The Department of Health published ‘Improvement, Expansion and Reform: The Next 3 Three Years’, its planning and priorities framework for 2003–2006. This document sets out what NHS organisations need to do over the next three years and identifies the national priorities and targets that organisations need to build into their local plans. In the preface to the document, Nigel Crisp, NHS Chief Executive, explains that making progress over the next three years will be demanding and difficult and that all NHS organisations will need to:

• focus on priorities whilst accepting that the NHS 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 the services.

Underpinning these aims are an acceptance that the NHS needs to go through a cultural change at all levels in order to embrace diversity in provision and choice for patients and that this can only be achieved by the increased involvement of the pub-lic, NHS staff, service users and other local partners. To encourage these changes, a new system will be introduced that will link payments to results and so increase the incentive for delivery.

The planning framework

In the past the NHS has based all of its planning around an annual cycle. This has lead to time pres-sures for staff, the requirement to develop multiple plans and claims of not being able to plan for the medium term. In order to address these issues, a new system is to be introduced that will allow health services to be planned over a three three-year period supported by three-year budgets from April 2003. Running in parallel with health, local authorities will also be able to plan the distribution of resources required for social services over a three-year period. Against this background, the following six steps are expected to be followed by each NHS and local authority organisation:

• 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.

The priorities

The document clearly identifies the health and social care priorities for the next three years, which are:

• Improving access to all services through better emergency care, reduced waiting times and more choice for patients
• Focusing and improving services and outcomes in five main areas
  • 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.

If you are currently promoting products which are linked to the priorities above, e.g. a statin or an atypical antipsychotic, then you are likely to be welcomed by your customers, particularly if you can demonstrate how your product can help the NHS achieve the targets linked to these areas.

Building capacity

In order to deliver on the priority areas described above, it is accepted that additional capacity will be required in terms of staff, facilities and equipment and it may also be necessary to involve new organisations in providing service and care, includ-ing the private sector. The guidance gives details about the national assumptions that have been made in respect of the level of capacity that will be needed to deliver the targets in each priority area and organisations will be expected to take these into account when developing their plans although local circumstances can also be taken into account. Each NHS organisation is expected to work with local authorities and other local partners to clearly identify the increases in capacity needed in the following three key areas:

• Physical facilities
• Workforce
• Information management and technology.

Guidance is also given on the national requirements in each of these areas.

Organisational responsibilities

The implementation of the plans will depend on the NHS adopting a whole system approach that ensures that there is local sharing of performance and financial data, particularly between PCTs and health care providers such as acute hospital trusts and GPs, to inform local planning. The planning process will need to involve all the relevant organi-sations and the front-line staff that are needed to make the vision happen, e.g. staff in GP practices will need to be involved through improved engage-ment with PCTs. The planning framework identifies a lead agency which will be responsible for ensuring that the process of developing plans is robust and which will take responsibility for the final product. The priority areas are divided between the NHS and social services as illustrated in Table 1 below. Where the NHS is the lead, strategic health authorities will be responsible for ensuring that the process and the outcome of planning is robust. Where the lead is joint, PCTs and local authorities should locally agree lead arrangements at the beginning of the planning process. If you are promoting a product in mental health or for older people it is possible that you may need to identify key targets in the local authority or social services department if you want to influence the local planning process. This has not been a tradi-tional area for members of the pharmaceutical industry to engage with and guidance may be needed from pharmaceutical companies’ medical departments to ensure that the ABPI code of prac-tice is not breached by promoting products to non-clinical staff.

Planning – a bottom-up approach

Within the NHS, planning will be from the bottom up, starting with those professionals actively involved in the delivery of healthcare to patients. PCTs will take the lead on planning and will be responsible for creating local plans which describe health and service improvement in their area. These plans will be developed using local clinicians’ knowl-edge, as well as patients and the public, and will address the needs of the community as a whole and incorporate 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. Strategic Health Authorities will bring together these plans and will work with Workforce Development Confederations to create the Local Delivery Plan, which will include the workforce plan. The Local Delivery Plans when taken together will make up a coherent national picture and councils should also contribute to these plans, particularly where they are leading on one of the joint priority areas.

Local Delivery Plans - a new planning process

A new NHS planning system has been designed to allow organisations to produce a three-year Plan. 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 govern-ment planning requirements. The Local Delivery Plan will be significantly different from previous plans e.g. HIMPs and SaFFs, and it will need to clearly identify the expected progress or milestones for each priority area over the three-year period. 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. The Local Delivery Plan itself will be a ‘“live”’ document which can be amended, with corrective action being taken if delivery goes off course or if new initiatives are being taken as new opportunities arise. These adjustments will generally be made fol-lowing quarterly and annual monitoring. There will not be an annual planning round to replace the cur-rent Service and Financial Frameworks (SaFFs) pro-cess but a new three-year plan will need to be developed within the third year. This could be vitally important for new product launches that may have an impact on local budgets because if they are not accounted for in the three-year financial plan it is possible that they could be ‘“locked out”’ until the next planning cycle and not used locally. The three-year financial allocations to PCTs will be announced in November 2002 together with a national price tariff which will detail the costs that a PCT should expect to pay for a defined procedure from an Acute Trust. This means that PCTs will be very busy this year as they deal with the manage-ment of a three-year plan and a three-year budget for the first time. The final Local Delivery Plans will be published in March 2003 and it will be a key documents for local sales teams to access in order to ensure that they are aligning their activities locally with the priorities of their customers.

Performance Management

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. The arrangements for monitoring and performance management in the NHS are :

• each organisation will have its own system. In addition each organisation will need to make arrangements to report to their staff and the public on performance
• PCTs will hold provider organisations to account for the delivery of services which they have commissioned StHAs will hold all local NHS organisations to account for performance
• The Department of Health will hold StHAs to account for the performance of the NHS within their area.

Monitoring and performance management will focus on the targets for the next three years and there will be routine monitoring of national standards where appropriate. Part of this new system will be the development of new inspectorates for both health and social care which will have the responsibility for assessing overall performance of organisations and for the publication of perfor-mance ratings.

Improving accountability and demonstrating added value

The NHS is transforming itself into an organisa-tion which truly focuses on its patients, designs its services around them and offers them choice and involvement. Its success will depend on the involve-ment of very many people and organisations and on the support of patients and the public. The core document for the public will be the PCT’s Patient Prospectus which describes services and perfor-mance in their area. Every NHS organisation should be able to demon-strate the value that is being added and this will depend on its activities and local circumstances. It is expected that every organisation will be able to demonstrate that is has added value at least to the level of any additional funding it has received and that it has secured a minimum 1% increase in cost efficiency and a minimum increase in quality equiv-alent to 1% of its budget. ConclusionThe new Local Delivery Plans are going to show how the NHS, working with social services and other partners, will make visible improvements, expand and reform services over the next three years. The national picture is important but it will be the local plans developed by each PCT that must be under-stood and utilised by local sales teams if they are to effectively engage with their customers over the next three years. The delivery of these local plans will lie with the people you call on every day – the front-line staff – and therefore anything you can do to help them deliver will be valued. Why not ask your marketing colleagues how they intend to help you sell your products in light of the new environment, because change is needed and it needs to start now!

By Andrew Platten MSc MRPharmS HealthGain Solutions Andrew is the NHS Alignment Manager at HealthGain Solutions Limited. He is a pharmacist with experience in community pharmacy, NHS pharmaceutical advice and has over seven years experience in a variety of sales and marketing positions in the pharmaceutical industry. copyright HealthGain Solutions