Actions: Extend patient choice | Put patients in charge | Publish detailed performance data | Introduce Personal health budgets | Create HealthWatch | Strengthen Care Quality Commission

1.1 Extend patient choice – including how, and by whom, care is delivered

i. Amend the NHS operating framework to allow patients to choose any healthcare provider (from all sectors) to deliver care within the NHS, at NHS standards and within the NHS tariff – (Start Jun 2010)
ii. Publish proposals for extending choice in White Paper – (Start Jul 2010)
iii. Begin preparatory work to give every patient the right to register with the GP practice they want, without being restricted by where they live – (Start Jul 2010)
iv. Give patients the right to register with GP practice of their choice – (Start 2012)
v. Begin preparations for a 24/7 urgent care service (new 111 access number) – (Start Jul 2010)
vi. Begin implementation of comprehensive urgent care services, joining together services such as the ambulance service, GP out-of-hours services, and NHS Direct – (Start Apr 2011)
vii. 24/7 urgent care service operational in every area of England – (Start Apr 2012)

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1.2 Put patients in charge of decisions about their care, giving control of health records

i. Outline “information revolution” proposals in White Paper – (Start Jul 2010)
ii. Publish information strategy – (Start Sep 2010)
iii. Consult on information needs and the best methods for structure, collection and distribution, encouraging more organisations to provide information to patients – (Start Sep 2010 – end Jan 2011)
iv. Begin implementation of patient-held records – (Start Apr 2011)

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1.3 Begin regular publication of detailed performance data, in an open and standardised format, on all healthcare providers

- (Start Jun 2010)

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1.4 Introduce personal health budgets for people with chronic/long-term conditions

i. Continue piloting of personal health budgets – (Start Jun 2010 – end Oct 2012)
ii. Publish final evaluation report of pilot sites – (Start Oct 2012)
iii. Initiate national roll-out, informed by the results of the evaluation – (Start Oct 2012)

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1.5 Create HealthWatch, a new body to act as the voice for patients and the public

i. Publish proposals for HealthWatch in White Paper – (Start Jul 2010)
ii. Begin transformation of patient Local Involvement Networks into local HealthWatch – (Start Apr 2011)
iii. Launch HealthWatch nationally – (Start Apr 2012)

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1.6 Strengthen the role of the Care Quality Commission

i. Publish White Paper including proposals for the strengthening of the Care Quality Commission and include provisions in Health Bill – (Start Jul 2010)
ii. Implement proposals set out in White Paper, so that the Commission will inspect on the basis of essential standards – (Start Aug 2010 – end Apr 2012)

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Actions: Scrap targets | Reform Payment by Results | Improve support to hospices | Introduce a value-based pricing system | Introduce new dentistry contract

2.1 Scrap process targets and introduce national health outcome measures to prioritise the health results that really matter, and promote best practice through greater transparency

i. Remove process targets with no clinical justification – (Start Jun 2010)
ii. Instruct NICE to begin publication of quality standards – (Start Jul 2010)
iii. Develop incentives to improve access to primary care in disadvantaged areas – (Start Apr 2011)
iv. Fully implement new outcomes framework – (Start Apr 2012)

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2.2 Reform Payment by Results to provide incentives for health care services to deliver high quality care

i. Publish revised Operating Framework and pay for performance plan – (Start Jun 2010)
ii. Start to implement reformed Payment by Results in hospitals – (Start Apr 2011)
iii. Extend Payment by Results to community services, mental health and end-of-life care – (Start Apr 2012)

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2.3 Improve support to hospices

i. Review funding model for hospices – (Start Jul 2010 – end Summer 2011)
ii. Funding model on preferred option(s) developed – (Start Summer 2011 – end Oct 2011)
iii. Decision on final option – (Start Dec 2011)

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2.4 Introduce a value-based pricing system to align treatments with outcomes

i. Publish proposals in White Paper to reform NICE and place it on a firmer statutory footing – (Start Jul 2010)
ii. Create a Cancer Drugs Fund to enable patients to access an increased range of cancer drugs to operate until full transition to new pricing process – (Start Apr 2011)
iii. Begin work to develop new pricing process with drug companies – (Start Apr 2011)
iv. New pricing process operational – (Start Jan 2014)

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2.5 Introduce new dentistry contract, with particular focus on oral health of children

i. Publish proposals for pilots to inform development of contract – (Start Dec 2010)

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Actions: Improve commissioning and resource allocation | GP commissioning | Reduce bureaucracy | Set providers free | Strengthen local democratic legitimacy | Increase local say over reconfigurations| Develop Monitor into an economic regulator

3.1 Improve the effectiveness of commissioning and resource allocation

i. Publish commissioning proposals in White Paper – (Start Jul 2010)
ii. Establish NHS Commissioning Board in shadow form – (Start Apr 2011)
iii. Complete abolition of Strategic Health Authorities – (Start Apr 2013)
iv. NHS Commissioning Board fully established – (Start Apr 2012)
v. NHS Commissioning Board makes allocations to GP consortia for 2013/14 – (Start Autumn 2012)

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3.2 Enhance commissioning to give GPs greater autonomy

i. Launch engagement on proposals for GP commissioning consortia – (Start Jul 2010)
ii. Begin to establish GP commissioning consortia in shadow form – (Start Apr 2011)
iii. Formally establish GP commissioning consortia – (Start Apr 2012)
iv. GP consortia take full responsibility for commissioning – (Start Apr 2013)

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3.3 Reduce bureaucracy

i. Publish review of Arm’s Length Bodies – (Start Summer 2010)
ii. Legislate to abolish unnecessary Arm’s Length Bodies – (Start Oct 2010 – end Nov 2011)
iii. Incorporate health protection functions into the Public Health Service – (Start Apr 2012)
iv. Abolition of Primary Care Trusts once NHS Commissioning Board and GP commissioning are in place – (Start Apr 2013)

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3.4 Set providers free and reduce political interference

i. Publish proposals in White Paper to reform Foundation Trust governance – (Start Jul 2010)
ii. Establish “turn-around team” for NHS Trust transition to Foundation Trust status – (Start Sep 2010)
iii. Complete transition to Foundation Trust status – (Start 2013/14)

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3.5 Strengthen local democratic legitimacy by creating a greater role for local government in health and well-being

i. Publish proposals in White Paper for consultation – (StartJul 2010)
ii. Begin implementation of proposals – (Start Apr 2011)
iii. Full implementation of proposals – (Start Apr 2013)

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3.6 Increase local say over reconfigurations

i. Local authorities have the right to challenge health organisations over the closure of local services, and refer cases for national arbitration – (Start Jun 2010)
ii. Stop the centrally-dictated closure of A&E and maternity wards, so that people have better access to local services – (Start Jun 2010)

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3.7 Develop Monitor into an economic regulator that will oversee regulation to ensure access, choice, competition and price-setting for health and social care

i. Publish proposals for developing Monitor into an economic regulator – (Start Jul 2010)
ii. Include provisions in Health Bill for Monitor to become an economic regulator – (Start Nov 2010)
iii. Launch Monitor as an economic regulator – (Start Apr 2012)
iv. Monitor regulates all providers – (Start 2013/14)

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Actions: Establish Public Health Service | Give local communities greater control | Implement Public Health Responsibility Deal recommendations | Improve quality of occupational health services | Revise public health marketing strategy | Ensure greater access to talking therapies | Ensure hospitals share non-confidential gun/knife crime data with police | Prioritise dementia research | Recruit 4,200 extra Sure Start health visitors

4.1 Establish Public Health Service, including relevant health protection functions, and incorporate into DH the nutrition functions of Food Standards Agency

i. Incorporate FSA nutrition functions into DH – (Start Oct 2010)
ii. Publish White Paper on public health – (Start 2010)
iii. Begin implementation of Public Health Service – (Start Apr 2011)
iv. Public Health Service fully established – (Start Apr 2012)

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4.2 Give local communities greater control over public health budgets, with payment by the outcomes they achieve in improving the health of local residents

i. Publish proposals in White Paper – (Start Dec 2010)
ii. Publish subsequent consultation document, including guidance on the most effective behaviour change techniques – (Start Dec 2010)
iii. Ring-fence public health allocations and establish “health premium” rewarding local authorities for tackling health improvement challenges among disadvantaged communities, and targeting public health resources on those with poorest health – (Start Apr 2012)

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4.3 Begin to implement Public Health Responsibility Deal recommendations

- (Start Oct 2010)

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4.4 Improve the quality of occupational health services and promote healthy workplaces with a focus on small businesses

i. Begin improvement of standards for occupational health by working with business, NHS+, Faculty of Occupational Medicine and the NHS Review – (Start Jun 2010)
ii. Work with business to implement the Responsibility Deal on health and employment – (Start Jun 2010)
iii. Introduce accreditation system for the new occupational health standard – (Start Early 2011)

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4.5 Revise public health marketing strategy

i. Ensure all activity demonstrates a clear return on investment – (Start Jul 2010 – end Dec 2010)
ii. Include new requirements for private sector participants to demonstrate significant changes in business practices – (Start Jul 2010 – end Dec 2010)

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4.6 Ensure greater access to talking therapies to reduce long-term costs for the NHS

- (Start Jun 2010)

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4.7 Work with Home Office to ensure that hospitals share non-confidential information with the police so they know where gun and knife crime is happening

- (Start Jun 2010 – end Apr 2011)

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4.8 Prioritise dementia research within the health research and development budget

- (Start Jun 2011)

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4.9 Recruit 4,200 extra Sure Start health visitors, subject to the Spending Review

i. Develop goals and scope of implementation programme – (Start Jun 2010 – end Aug 2010)
ii. Develop initiatives and incentives to drive return to practice- (Start Aug 2010 – end Nov 2010)
iii. Develop plans to increase health visitor training places – (Start Aug 2010 – end Nov 2010)
iv. Identify appropriate commissioning structure to deliver specified number of visits – (Start Aug 2010 – end Nov 2010)
v. Develop new curriculum reflecting enlarged scope of health visitor role – (Start Aug 2010 – end Nov 2010)
vi. Communicate our priorities for enlarged scope of health visitor role to the Nursing and Midwifery Council – (Start Jan 2011)
vii. Begin implementation, subject to the Spending Review – (Start Jan 2011)

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Actions: Reform funding of social care system | Extend roll-out of health and social care personal budgets | Improve access to respite care | Remove barriers between health and social care funding | Support work of local authorities and providers

5.1 Reform funding of the social care system

i. Establish a commission on the funding of long-term care to consider a range of ideas, including both (a) a voluntary insurance scheme to protect the assets of those who go into residential care, and (b) a partnership scheme – (Start Jul 2010 – end Jul 2011)
ii. Publish vision for social care reform setting out ambitions for greater independence and choice for users of social care – (Start Nov 2010)
iii. Publish White Paper on social care – (Start Oct 2011)
iv. Introduce legislation – (Start Nov 2011)

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5.2 Extend the greater roll-out of health and social care personal budgets to give people and their carers more control and purchasing power

i. Agree new milestone for roll-out of social care personal budgets with ADASS/LGA – (Start Apr 2011)
ii. Set up additional personal health budget pilot sites, and investigate how personal health budgets and personal budgets for social care can be joined together – (Start Jul 2010 – end Oct 2012)
iii. Evaluate results from pilots and develop proposals for national implementation – (Start Oct 2012)

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5.3 Improve access to respite care by using direct payments to carers and better community-based provision

i. Publish a re-focused carers’ strategy – (Start Apr 2011)

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5.4 Remove barriers between health and social care funding to incentivise preventative action

i. Introduce new post-discharge tariff requiring NHS and social care joint working to manage 30-day hospital discharge and reduce re-admissions, including provision of re- ablement services – (Start Apr 2011)
ii. Begin evaluation of dementia strategy’s progress – (Start Oct 2010)

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5.5 Support the work of local authorities and provider organisations to deliver gains in efficiency and effectiveness through best practice

i. Work with the sector to disseminate best practice in terms of efficiency and effectiveness – (Start Jan 2011)
ii. Create the necessary support tools to achieve best practice at a local level – (Start Jan 2011 – end Dec 2011)

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