1. ‘Liberating the NHS: Legislative
Framework and Next Steps’
Implications for ‘Putting
Patients and the Public First’
Joan Saddler
National Director of Patient & Public Affairs

2. NHS reforms still depend
on effective Engagement
 3 Coalition reforms restated in Command
Paper: (prioritises Patient and Public Engagement (PPE)
A ‘patient-led NHS’ - highlights PPE
Focus on outcomes - must involve
patient experience as part of ‘quality’
Empowering professionals - GP
commissioning requires PPE
 ( Reforms to public health and social care not
included here - but part of ‘wider strategy’ )

3. Command Paper:
Contents
 Introduction
 Putting patients and public first
 Improving healthcare outcomes
 Commissioning for patients
 Local democratic legitimacy
 Regulating healthcare providers
 Implementation and transition

4. 1)Transition for cultural
Change
Key changes following consultation- 1
 Longer transition period for reforms
 Stronger Health and Wellbeing Boards
and joint working in health & soc. care
 GPC 'Pathfinder' programme
 HWB 'Early Implementer' programme
 HealthWatch England to have more
distinct identity
 More transparency for GPCs

5. Key changes following
consultation - 2
 Maternity services commissioned by
GPCs, not NHS Cmsg Board
 Scrutiny role stays with LG - not HWBs
 Flexibility in commissioning NHS
complaints advocacy
 GPCs to have stronger role in primary
care quality improvement
 Arms Length Bodies to have explicit
duty to cooperate with each other

6. 2. Confronting the tension between
mandatory and discretionary PPE
levers
Why you should engage patients and public and take account of
their individual and collective experiences:
• Understanding patient and carer experiences of services can help
you identify how to improve services from a patient perspective
• Understanding patient experience of services allows you to define
the outcomes of service reconfigurations from the patient and
public perspective as a ‘measurable’ patient experience where
redesigned care pathways are more patient friendly, efficient and
understood by diverse populations.
• Involving patients in their own health and care has the potential
to boost outcomes, reduce unnecessary consultations, reduce
health inequalities and unwarranted variations, improve patient
experience, improve concordance with treatment and save money.

7. 2. Confronting the tension between
mandatory and discretionary PPE
levers
Why you have to engage patients and public
and take account of patient experience
Consortia will be required by law (subject to parliament):
– to involve and consult
– to report on involvement in Annual Report
– to consult LAs about substantial service change
– to have processes to handle complaints, both about their own activities
and for complaints escalated to them in their role of commissioner
– to have regard to the NHS Constitution in carrying out their functions
– to promote the involvement of patients in decisions about their care and
promote choice
– to reduce inequalities between patients with respect to outcomes
achieved
– to consult about service designation
You could be at risk of judicial review and /or referral to NHSCB and SoS.
This could likely result in additional costs and delay and damage to local
relationships and reputation
– Operating Framework

8. 3. Understand and using existing
data/evidence on what patients and the
public want, need and get from the NHS
Why
– Most patients say they want more involvement in decisions
about their care, not less
– UK performs quite well in most international health comparisons,
but it is worst out of seven comparator countries when it comes
to delivering patient-centred care
– Patient experience is closely related to and influences clinical
effectiveness and safety
– Organisations that are more patient-centred have better clinical
outcomes
– Individuals’ anxiety and fear can delay healing
(National Patient Survey, Picker, Kings Fund, NHS Alliance)
We also need to ensure that engagement processes are efficient

9. Developing lean, evidence based
approaches to patient and public
engagement and in GP commissioning
A practical development framework for emerging
consortia over the next 12 months
• This is a practical framework to help emerging consortia and their
clinical leaders to think through and begin to tackle how they build
engagement and experience into their consortia from the outset
• What emerging consortia need to be thinking about and doing
• Developed with clinical stakeholders, it also identifies sources of
support and advice. More information about the examples can be
found at the Commissioning Zone

10. Improving Public & Patient
Engagement and experience is a
long haul, not a quick fix
As much about cultural change as is it is about
availability of data:
“Small measurable improvements in patient
experience may be achieved over short projects.”
“Sustaining more substantial change is likely to require
organisational strategies, engaged leadership, cultural
change, regular measurement and performance feedback,
and experience of interpreting and using survey data.”
(Davies et al 2008)
10

11. Where to go for help and
support
• Commissioning Zone and Pathfinder Learning websites
• Invest in Engagement website (Picker), PWC and Frontline products
• SHA / PCT engagement leads ( LA engagement leads)
• NHS Institute for Innovation and Improvement
• DH policy teams and website
• RCGP, BMA, NHS Alliance and NAPC
• The Independent Reconfiguration Panel (http//www.irpanel.org.uk)