[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 5, December 2011].
The new “operating framework for the NHS in England 2012/13” defines the business and planning arrangements for the NHS in England for the coming year. It describes national priorities, and clarifies the “levers and enablers” required for NHS organisations to maintain and improve the high quality standard of services, and deliver transformational change, while maintaining financial stability. The aim is to enable the NHS to negotiate a smooth transition towards the modernised system envisaged in Liberating the NHS.
On Dignity and Nutrition
Shortcomings in dignity and basic care as identified by the Care Quality Commission and the Patients’ Association have been a cause for concern. This NHS Operating Framework accordingly includes requirements for clinical audit of key areas of basic care, further inspections by the Care Quality Commission, continued emphasis on implementation of the National Dementia Strategy and better support for carers.
On Dementia and Elderly Care
One of the areas requiring further attention during 2012/13 will be dementia and care of older people. An outcomes-focused approach should help to improve services for older people. Steps are required to ensure organisations work together:
- Commissioners must ensure providers are compliant with NICE quality standards and publish information about the quality of their services.
- Commissioners must work with GP practices to achieve ongoing improvements to the quality of general practice and community services. Patients should only go into hospital if this is likely to yield a positive clinical outcome.
- National clinical audits into services for older people are required.
- The aim is to achieve a two-thirds reduction in the use of antipsychotic medicines. Reductions in the level of inappropriate prescribing of antipsychotics for people with dementia should bring about improvements to the quality of life and survival rates.
- The aim is to improve diagnosis rates, particularly in those areas with the poorest performance.
- Data on inappropriate emergency admission rates should be considered as a performance measure in national reporting.
- Non-payment should be considered for emergency re-admissions within 30 days of discharge following an elective admission.
- PCT clusters should ensure all local providers have a systematic approach (1) to improve dignity in care for patients, (2) to give staff appropriate training and (3) to incorporate “learning from the experience of patients and carers” into their work.
PCTs were asked to work with their local authorities in 2011/12, to support local accountability. They are required to publish dementia plans locally which explain the progress being achieved against the National Dementia Strategy. This requirement will continue in 2012/13, with the additional requirement to include local or national CQUIN goals.
Carers play a vital role and deserve help and support from local organisations. Joint assessments of local needs should be published, with plans. PCT clusters must agree policies, plans and budgets to support carers, with the involvement of local authorities and voluntary groups. Direct payments and personal budgets should be explored. Plans for 2012/13 must be in line with the Carers Strategy. Plans must be agreed explicitly and signed off by both local authorities and PCT clusters.
Financial contributions to support carers, from both local authorities and PCT clusters, need to be made clear; as must transfers of funds from the NHS to local authorities. It should be possible to identify how much is being spent on carers’ breaks, with some indication of the breaks that should be afforded by that funding
On CQUIN Frameworks
CQUIN is a quality increment which applies strictly to a level of service over and above the standard contract. In 2012/13, CQUIN will be developed. A number of national goals include targets on (1) VTE risk assessment, (2) responsiveness to personal needs of patients, (3) improving diagnosis of dementia in hospitals, (4) incentivising use of the NHS Safety Thermometer and (5) ensuring continuing CQUIN funding happens only where commissioners are satisfied this is still necessary to maintain any prior improvements.
On Joint Working With Local Authorities
PCT clusters will continue to transfer social care funding to local authorities who may invest in social care services in order to bring about overall health benefits.
PCT clusters should work with local authorities to agree priorities, plans and outcomes for investment in integrated care. These might include current services such as telecare, community directed prevention (including falls prevention), community equipment and adaptations, and crisis response services. They might also embrace new services such as funding for the social care aspects of the National Dementia Strategy, working on Delayed Transfers of Care, and developing the local provision of post-discharge care and those support services which are the responsibility of social services.
DH/NHS Finance, Performance and Operations (2011). The Operating Framework for the NHS in England 2012-13. London: Department of Health, November 24th 2011. Gateway Reference No. 16890.