Glossary of Health and Social Care Terms
- The NHS Constitution
- The NHS Five Year Forward View
- The Public Services (Social Value) Act 2012
- Public Health Outcomes Framework
- NHS Mandate
The NHS Constitution
The NHS Constitution for England is a formal constitution which, in one document, intends to lay down the objectives of the National Health Service, the rights to which patients, public and staff are entitled, and pledges that the NHS is committed to achieving. It also sets out responsibilities, which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively.
These rights cover how patients access health services, the quality of care you’ll receive, the treatments and programmes available to you, confidentiality, information and your right to complain if things go wrong. In return, the NHS expects you to take responsibility of your own health and use the NHS with respect. This includes:
- registering with a GP practice
- following courses of treatment you’ve agreed to
- always treating NHS staff and other patients with respect
- keeping GP and hospital appointments – or if you have to cancel, doing so in good time
- giving feedback – both positive and negative – about treatment you’ve received
No government can change the Constitution without the full involvement of staff, patients and the public. The Constitution is a promise that the NHS will always be there for you.
To find out more, and view the NHS Constitution, visit https://www.gov.uk/government/publications/the-nhs-constitution-for-england
The NHS Five Year Forward View
The NHS Five Year Forward View (5YFV) was published on 23 October 2014 and sets out a new shared vision for the future of the NHS based around new models of care. It has been developed by the partner organisations that deliver and oversee health and care services including the Care Quality Commission, Public Health England and NHS Improvement (previously Monitor and the National Trust Development Authority).
Patient groups, clinicians and independent experts have also provided their advice to create a collective view of how the health service needs to change over five years if it is to close the widening gaps in the health of the population, quality of care and the funding of services.
The Executive Summary
Reproduced from https://www.england.nhs.uk/ourwork/futurenhs/nhs-five-year-forward-view-web-version/5yfv-exec-sum/
- The NHS has dramatically improved over the past fifteen years. Cancer and cardiac outcomes are better; waits are shorter; patient satisfaction much higher. Progress has continued even during global recession and austerity thanks to protected funding and the commitment of NHS staff. But quality of care can be variable, preventable illness is widespread, health inequalities deep-rooted. Our patients’ needs are changing, new treatment options are emerging, and we face particular challenges in areas such as mental health, cancer and support for frail older patients. Service pressures are building.
- Fortunately there is now quite broad consensus on what a better future should be. This ‘Forward View’ sets out a clear direction for the NHS – showing why change is needed and what it will look like. Some of what is needed can be brought about by the NHS itself. Other actions require new partnerships with local communities, local authorities and employers. Some critical decisions – for example on investment, on various public health measures, and on local service changes – will need explicit support from the next government.
- The first argument we make in this Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. Twelve years ago Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.
- The NHS will therefore now back hard-hitting national action on obesity, smoking, alcohol and other major health risks. We will help develop and support new workplace incentives to promote employee health and cut sickness-related unemployment. And we will advocate for stronger public health-related powers for local government and elected mayors.
- Second, when people do need health services, patients will gain far greater control of their own care – including the option of shared budgets combining health and social care. The 1.4 million full time unpaid carers in England will get new support, and the NHS will become a better partner with voluntary organisations and local communities.
- Third, the NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.
- England is too diverse for a ‘one size fits all’ care model to apply everywhere. But nor is the answer simply to let ‘a thousand flowers bloom’. Different local health communities will instead be supported by the NHS’ national leadership to choose from amongst a small number of radical new care delivery options, and then given the resources and support to implement them where that makes sense.
- One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care – the Multispecialty Community Provider. Early versions of these models are emerging in different parts of the country, but they generally do not yet employ hospital consultants, have admitting rights to hospital beds, run community hospitals or take delegated control of the NHS budget.
- A further new option will be the integrated hospital and primary care provider – Primary and Acute Care Systems – combining for the first time general practice and hospital services, similar to the Accountable Care Organisations now developing in other countries too.
- Across the NHS, urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Smaller hospitals will have new options to help them remain viable, including forming partnerships with other hospitals further afield, and partnering with specialist hospitals to provide more local services. Midwives will have new options to take charge of the maternity services they offer. The NHS will provide more support for frail older people living in care homes.
- The foundation of NHS care will remain list-based primary care. Given the pressures they are under, we need a ‘new deal’ for GPs. Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years. GP-led Clinical Commissioning Groups will have the option of more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services. The number of GPs in training needs to be increased as fast as possible, with new options to encourage retention.
- In order to support these changes, the national leadership of the NHS will need to act coherently together, and provide meaningful local flexibility in the way payment rules, regulatory requirements and other mechanisms are applied. We will back diverse solutions and local leadership, in place of the distraction of further national structural reorganisation. We will invest in new options for our workforce, and raise our game on health technology – radically improving patients’ experience of interacting with the NHS. We will improve the NHS’ ability to undertake research and apply innovation – including by developing new ‘test bed’ sites for worldwide innovators, and new ‘green field’ sites where completely new NHS services will be designed from scratch.
- In order to provide the comprehensive and high quality care the people of England clearly want, Monitor, NHS England and independent analysts have previously calculated that a combination of growing demand if met by no further annual efficiencies and flat real terms funding would produce a mismatch between resources and patient needs of nearly £30 billion a year by 2020/21. So to sustain a comprehensive high-quality NHS, action will be needed on all three fronts – demand, efficiency and funding. Less impact on any one of them will require compensating action on the other two.
- The NHS’ long run performance has been efficiency of 0.8% annually, but nearer to 1.5%-2% in recent years. For the NHS repeatedly to achieve an extra 2% net efficiency/demand saving across its whole funding base each year for the rest of the decade would represent a strong performance – compared with the NHS’ own past, compared with the wider UK economy, and with other countries’ health systems. We believe it is possible – perhaps rising to as high as 3% by the end of the period – provided we take action on prevention, invest in new care models, sustain social care services, and over time see a bigger share of the efficiency coming from wider system improvements.
- On funding scenarios, flat real terms NHS spending overall would represent a continuation of current budget protection. Flat real terms NHS spending per person would take account of population growth. Flat NHS spending as a share of GDP would differ from the long term trend in which health spending in industrialised countries tends to rise as a share of national income.
- Depending on the combined efficiency and funding option pursued, the effect is to close the £30 billion gap by one third, one half, or all the way. Delivering on the transformational changes set out in this Forward View and the resulting annual efficiencies could – if matched by staged funding increases as the economy allows – close the £30 billion gap by 2020/21. Decisions on these options will be for the next Parliament and government, and will need to be updated and adjusted over the course of the five year period. However nothing in the analysis above suggests that continuing with a comprehensive taxfunded NHS is intrinsically un-doable. Instead it suggests that there are viable options for sustaining and improving the NHS over the next five years, provided that the NHS does its part, allied with the support of government, and of our other partners, both national and local.
To find out more, visit https://www.england.nhs.uk/ourwork/futurenhs/
The Public Services (Social Value) Act 2012
Reproduced from http://socialvaluehub.org.uk/
The Public Services (Social Value) Act 2012 came into force on 31st January 2013. It requires public bodies to consider how the services they commission and procure might improve the economic, social and environmental well-being of the area.
Value for money is the over-riding factor that determines all public sector procurement decisions. In recent years there has been a shift in understanding how value for money should be calculated, and growing support for the idea that it should include social and economic requirements.
However, many people have been held back by uncertainty over whether a social value approach is compatible with the EU’s procurement regulations.
The Public Services (Social Value) Act was designed to clarify the law in this area and complements a growing body of EU documentation encouraging the use of social value in procurement. Tabled as a Private Member’s Bill by Chris White MP, the Act received Government backing as well as cross-party support in both the Commons and the Lords.
All English and some Welsh bodies (those primarily under the jurisdiction of the Westminster Government) are required to comply with the Act. This includes local authorities, government departments, NHS Trusts, CCGs, fire and rescue services, and housing associations.
What does the Act apply to?
The Act applies to contracts for public services, including contracts that are primarily for public services with an element of goods or works, which are over the EU threshold (currently £111,676 for central government and £172,514 for other public bodies). This includes all public service markets, from health and housing to transport and waste. Commissioners are required to factor social value in at the pre-procurement phase, allowing them to embed social value in the design of the service from the outset.
The Act does not require social value to be considered in contracts for public works and public supply (goods), or in contracts for services below the EU threshold. This does not mean that commissioners can’t apply social value in these contracts – only that it is not compulsory. In fact, many public bodies have found it more straightforward to apply the Act to all contracts and the government promotes the inclusion of social value in all contracts as best practice.
What is social value?
Social value is “the benefit to the community from a commissioning/procurement process over and above the direct purchasing of goods, services and outcomes”.
There is no authoritative list of what these benefits may be – the Act is deliberately flexible because social value is best approached by considering each local context and needs. For example, in one area youth unemployment might be a serious concern, whilst in another health inequalities might be more pressing.
The Act therefore gives commissioners and procurement officials the freedom to determine what kind of additional social or environmental value would best serve the needs of the local community as well as creating an opportunity for providers to innovate.
There are plenty of examples to draw upon for inspiration from public bodies that have implemented the Act. For more details and examples, see the Social Value Hub resources section.
(Taken from http://socialvaluehub.org.uk/)
Public Health Outcomes Framework
The Public Health Outcomes Framework Healthy lives, healthy people: Improving outcomes and supporting transparency sets out a vision for public health, desired outcomes and the indicators that will help us understand how well public health is being improved and protected.
The framework concentrates on two high-level outcomes to be achieved across the public health system, and groups further indicators into four ‘domains’ that cover the full spectrum of public health. The outcomes reflect a focus not only on how long people live, but on how well they live at all stages of life.
The data published in the tool are the baselines for the Public Health Outcomes Framework, with more recent and historical trend data where these are available. The baseline period is 2010 or equivalent, unless these data are unavailable or not deemed to be of sufficient quality.
For further information, visit http://www.phoutcomes.info/
The mandate to NHS England sets out the government’s objectives for NHS England, as well as its budget.
The mandate helps set direction for the NHS and helps ensure the NHS is accountable to Parliament and the public. The mandate must be published each year, to ensure that NHS England’s objectives remain up to date. This mandate was produced following public consultation.
By setting a multi-year mandate with a multi-year budget the government is enabling the NHS to plan more effectively to deliver the long-term aim of achieving the transformation set out in the NHS’s Five Year Forward View and create a fully 7-day NHS.
This mandate reaffirms the government’s commitment to an NHS that remains available to all, based on clinical need and not ability to pay, and that is able to meet patients’ needs and expectations now and in the future.
The financial directions accompanying the mandate set out certain additional and expenditure controls to which NHS England must adhere. These stem from budgetary controls that HM Treasury applies to the Department of Health.
For further information, visit https://www.gov.uk/government/publications/nhs-mandate-2016-to-2017