Publications gateway number: 00183

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Welcome to the latest edition of my Chief Nursing Officer’s Bulletin – Jane Cummings, Chief Nursing Officer, NHS England

CNO Conference – 2013

I am pleased to announce that my 2013 Annual CNO Conference is to be held on the 26 and 27 November 2013.

Building on the success of last year’s event in Manchester, we are working in partnership with the Nursing Times to produce an even bigger and more successful conference for 2013.

We are busy developing another packed agenda and will hopefully have some extremely high profile speakers. The focus for the event is the implementation of Compassion in Practice – looking at new models of care and best practice in embedding the 6Cs. We will be sharing our learning on how the 6Cs and Compassion in Practice has delivered positive outcomes for patients and staff.

We will also be looking at examples of excellence in practice across Health and Social Care and how great leadership is essential to changing culture and behaviours.

The event is designed to attract an audience of up to 500 senior decision makers and nursing leaders and will be special invitation only.

Compassion in Practice

This edition we focus on action Area 3 – Delivering high quality care and measuring the impact

The priorities within this area of work are:

• Identifying indicators and measures of high quality care across all health and care settings
• Working with the National Support Centre to collect data across England on quality of care provided and share examples of excellence in practice through channels including the 6Cs Live! Communications Hub.

The 6Cs Live! Communications Hub

The Hub is a web based resource that will provide a one-stop shop for nurses, midwives and care staff to access a range of tools, resources and best practice guidance. Signing up will enable you to stay up to date with news, webinars and events and share ideas and examples of excellence. The site will be launched in early July 2013.

6Cs Live! ‘Week of Action’

Watch out for more information about our first 6Cs Live! Road Show event, being delivered as part of our first 6Cs Live! ‘Week of Action’. This week of action will begin on Monday 19^th August and will focus on Action Area 3, exploring measurement, transparency of care and the benefits of investing in behaviours. It will provide opportunities to engage with the experts, connect with colleagues and share excellence in practice. For more information please email the 6Cs Live team.

Care Makers at the NHS Confederation 2013 annual conference

This conference was attended by five influential Care Makers and other NHS leaders were keen to hear about their role as ambassadors of compassionate, patient-centred care. The Care Makers were eager to talk to as many people as possible to ensure the 6Cs and Compassion in Practice message reaches the highest levels in the NHS.

Sir David Nicholson, Sir Keith Pearson, Chair of Health Education England; Jan Sobieraj, Managing Director of the NHS Leadership Academy and I were just some of the people who wanted to hear what the Care Makers had to say. The Care Makers Claire Flatt, David Smith, Matthew Bolton, Jenn Rawles and Jessica Partington also joined myself, Sir David and Marie Batey Head of Acute and Older People on the NHS England stand as well as attending workshop and speaker sessions to hear the latest strategic thinking on healthcare.

Community Nurse Development Programme

I will be leading a national two year programme for greater commissioning development and innovation in community nursing including primary care work to enable delivery of care closer to home. To be able to move care from an acute setting to home, commissioners need to have clear and robust plans for community nursing services, both now and in the future.

I will lead the programme in partnership with the Department of Health, Health Education England and the Queens Nursing Institute and we will have several key workstreams. I will update you with more detail in the next edition.

As preliminary support for this work, the Nursing Directorate at NHS England is mapping the impact of commissioning practice on community, district nursing and general practice nursing since Transforming Community Services to identify where good models of commissioning practice for this exist. Nurse commissioners can contribute to this review by contacting Stacey Mccan.

Confidential Inquiry into the deaths of people with learning disabilities (CIPOLD)

CIPOLD recognises the significant role and value of nursing in health services for those with learning disabilities and reviews care received prior to a death in hospital to support and improve achievement of high quality care. Inquiries identify contributory errors and provide evidence of good practice on avoiding premature death.

Good Practice in Learning Disability Nursing

The UK steering group for Strengthening The Commitment: The Report of the UK Modernising Learning Disabilities Nursing Review are collecting examples of good practice in learning disability nursing, demonstrating how health and social care organisations are meeting the 17 recommendations of the Review. Ministers are due to receive a progress report on the implementation of the review in the Autumn. To contribute please complete this form.

£150,000 dementia prize fund launched

Frontline health and care professionals are being invited to bid for a share of the £150,000 NHS Innovation Challenge Prize for Dementia. The competition is open to anyone working in dementia care including GPs, specialist nurses, social workers, support workers, charities and patient support groups.

£260 million technology fund to make the NHS safer

The Secretary of State for Health, Professor Sir Bruce Keogh and I have launched a £260 million Technology Fund to enable doctors and nurses to access better information about patients and provide safer care. The fund will be available to NHS providers, supporting the rapid progression from paper-based systems for patient notes and prescriptions to integrated electronic care records and the development of e-prescribing and e-referral systems.

Heatwave plan for England 2013 published

The Heatwave plan for England 2013 has been published as a joint document between NHS England, Public Health England and other partner agencies. The plan’s purpose is to enhance resilience in the event of a heatwave and to describe the actions which can be taken to protect and improve health before and during such an event.

NHS Improving Quality – driving improvements

NHS Improving Quality has published a strategic intent document which includes details of the improvement programmes it is focussing on. NHS Improving Quality improve health outcomes across England by providing improvement and change expertise, building on the success of previous NHS improvement programmes. Professionals from all disciplines who would like to share their suggestions for improving quality should get in touch.

Issue of Healthcare Professional Alert Notices

NHS England has written to NHS Trust Medical Directors, Area Team Medical Directors and Regional Medical and Nursing Directors setting out interim arrangements for issuing Healthcare Professional Alert Notices. In the letter, the Secretary of State has directed the National Health Service Litigation Authority to operate the Healthcare Professional Alert Notices (HPAN) system from 1 April 2013. NHS organisations who wish to request the issue of an Alert Notice should notify the National Clinical Assessment Service (NCAS), part of the NHS LA.

New disability benefit: PIP

Personal Independence Payment (PIP) has replaced Disability Living Allowance (DLA) for people aged 16-64 on 8 April 2013. This means they can make new claims to PIP but not for DLA. The Department for Work and Pensions will start inviting existing DLA claimants to claim PIP from October 2013.  However, most existing claimants won’t be affected before October 2015

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Professor Sir Bruce Keogh’s Urgent and Emergency Care Review was announced in January this year. Its aim is to develop a national framework to build a safe, more efficient system, 24 hours a day, seven days a week.

Those using and working in the NHS have from 17 June to 11 August to feedback on an evidence base for change and emerging principles that will guide the Review, also published today.

The terms of reference, evidence base and emerging principles, along with details on how to contribute and get your views heard, are all on the NHS England website.

This Review is just one part of a national approach to improving the way NHS services are delivered so that patients get high quality care from an NHS that is efficient now and secure for future generations.

Professor Sir Bruce Keogh, National Medical Director for NHS England, said:

“The Urgent and Emergency Care Review has provided us with an excellent opportunity to improve the way we offer care between our hospitals, primary and community care and social services.

“We have seen clear improvement in A&E performance across the country coming into the summer, but the issues will not just simply go away.

“Over the past few months, we have been building an evidence base of guidance, reports and data to inform our review – and it is clear that the way we currently deliver urgent and emergency care needs to change.

“A compelling case for change can only be built on evidence and, while not always comfortable reading, it is the only way to have a truly honest discussion. We must keep pace with medical progress and make sure everyone has the best chance of receiving the most appropriate care.

“We now need to hear your views on our work so far, and what you want from your local health services to ensure high quality and safe care in the right place and at the right time for those who need it.”

The Review Steering Group is chaired by Professor Keith Willett, National Director for Domain Three: Acute Episodes of Care, with representation from professional bodies, a patient and public organisation, providers and commissioning organisations.

Professor Keith Willett, National Director for Acute Episodes of Care for NHS England, said:

“At its heart, this review is about bringing together the expertise from across the health and care system to determine how best to organise emergency care in future.

“We know that A&E is the pinch point of the health and care system and that staff are working very hard to provide the care they know the public need.

“To relieve the pressure and design a system that is sustainable and fit to meet future challenges, we need as many patients, doctors, nurses and NHS colleagues as possible to get involved.”

The Urgent and Emergency Care Review will develop a national framework and associated guidance for clinical commissioning groups in 2015/16 to help them commission consistent, high quality urgent and emergency care services across the country within the resources available.

For the short term, NHS England has already announced plans to strengthen performance in urgent and emergency care across the country to help hospital A&E departments meet demand and tackle waiting time pressures.

Please note that comments submitted on this page will not be added to the review.  To take part in the review, please complete our questionnaire.

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The document begins by setting out the role that risk stratification can play in managing the health of a population. It then explains how risk stratification arrangements in England were affected by the implementation of the Health and Social Care Act 2012 and the re-organisation of the NHS on 1 April 2013. There follows a consideration of how risk stratification may be conducted lawfully and where to obtain further information about the information governance of risk stratification. The appendices set out (a) a range of options that CCGs can use to conduct risk stratification legally; (b) a detailed description of the law relating to risk stratification; (c) frequently asked questions on the information governance arrangements; (d) a list of items excluded from disclosure; and (e) a glossary of terms.

NHS England recognises that the issues around this area are complex and we will develop additional supporting materials in the coming weeks. The document will be kept under review and contains links to further information. Any enquiries should be directed to England.RiskStratificationIG@nhs.net.

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NHS England reaction to independent reconfiguration panel report on the proposed changes to children’s heart surgery

NHS England has promised to lead a rethink of plans to improve children’s heart surgery in England following publication of an independent report on the Safe and Sustainable Review. The review was the first national assessment of care quality for children born with a serious heart condition. An extensive consultation exercise attracted approximately 75,000 responses

NHS 111 is steadily improving

The latest data published on the performance of NHS 111 in April 2013 showed the service is steadily improving and is highly rated by those who use it – 92 per cent were very or fairly satisfied with their NHS 111 experience.

Roadmap for improved patient e-Referral system

NHS England has announced its vision for an improved electronic patient referral service for the NHS.  The vision for change will build on the existing Choose and Book system. This is part of NHS England’s commitment to making all referrals electronic and the NHS paperless by 2018.  The announcement kicked off an initial five-month consultation period with healthcare professionals, with further consultations planned with patients.

Interim specifications for specialised commissioning

NHS England has published the interim specifications it has adopted for the commissioning of specialised services. The new service specifications, along with clinical commissioning policies, were the subject of a short, public consultation which ran from mid-December 2012 to February 2013. Feedback received during consultation informed the new specifications.

Funded development opportunities available to all healthcare staff

The leadership academy provide development programmes for people at every level of leadership responsibility, from all backgrounds and experience levels. If you are looking to develop your knowledge, skills, expertise, attitudes and behaviours then our programmes are for you. Applications close Sunday 30 June.

Policy news

‘Longer Lives’ reveals avoidable local death rates

The Health Secretary has announced a new website ‘Longer Lives’ developed by Public Health England, providing easy access to data on how local areas are performing on premature deaths from the five major killers – cancer, stroke, heart, lung and liver disease. It aims to drive awareness and boost council action to tackle public health problems. Further data will be rolled out providing clear accessible information on how health services are performing.

NBOMe and Benzofury groups of ‘legal highs’ to be banned

On 10 June, the Government made the NBOMe and Benzofury groups of ‘legal highs’ illegal for up to 12 months under a Temporary Class Drug Order, while independent experts, the Advisory Council on the Misuse of Drugs, assess whether they should be permanently controlled. The Council’s report contains further information, including the pharmacology and toxicology of these drugs.

Part 1 of information about 2013/14 flu immunisation programme is announced

This letter about the flu immunisation programme for winter 2013/14 outlines the second phase of increases for take up of the flu jab. Last year the NHS was asked to plan a three year trajectory to increase flu immunisation and this year health professionals will be asked to reach or exceed a 75% take up in over 65s and at risk groups.

Publications

Securing Excellence in Commissioning Sexual Assault Services published

This document and accompanying letter from Ann Sutton, Director of Commissioning (Corporate) outlines how sexual assault service commissioning arrangements will improve outcomes for patients whilst reducing inconsistency and duplication in the system. NHS England will work together with police forces and local authorities to provide an integrated service.

Economic Evaluation – Electronic Palliative Care Coordination System

The Electronic Palliative Care Coordination System provides a shared locality record for health and social care professionals. It allows rapid access across care boundaries, to key information about an individual approaching the end of life, including their expressed care preferences, putting more control in the individuals’ hands.

National training survey results published

The results of the General Medical Council’s 2013 national training survey which helps local education providers such as hospitals and general practices improve their training are now available. A record 97.7% of doctors in training shared their views, and overall trainees are satisfied with their training experience despite concerns about long hours and handover arrangements before and after night duty.

Conferences and events

Responding to Francis – regional events

The Department of Health, in partnership with NHS England, are holding five events to discuss the response to the Francis Report. These events bring together insight from local conversations and national work to develop and implement a system-wide response to Francis.

Electronic Prescribing in Hospitals, Wednesday 3 July 2013, Manchester

With an opening presentation from Dr Masood Nazir Clinical Informatics Advisor, NHS England, this conference looks at moving forward with Electronic Prescribing and Medicines Administration (EPMA) in a hospital setting as part of becoming paperless. A 20% discount is available.

Commissioning for outcomes and transformational change, 16 July, London

Bob Ricketts, director of commissioning support, strategy and market development for NHS England will outline the vision for service transformation. Speakers and case studies will provide insight as to how to commission services to deliver genuine transformation, and how providers can drive forward this agenda.

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• The Tariff Engagement Document, with key information  on the 2014/15 National Tariff
• Proposals for local payment variations; and
• Proposals for enforcement of the tariff by Monitor and the NHS Trust Development Authority.

There are three questionnaires asking for views particularly on:

• Our approach to setting prices for 2014/15
• Our approach to assessing the impact of the proposed changes to the National Tariff
• Our approach to applying the rules and permitted variations from the 2013/14 Tariff to the 2014/15 Tariff
• Our proposed method for agreeing local modifications
• Our approach to enforcing the National Tariff
• Pricing for adult mental health services
• The proposed structure for the 2014/15 National Tariff Document.

Your responses will help to shape the National Tariff Document which will be published later this year.

You can access the three documents here.

Please use the questionnaires to send us your feedback  by 5pm on Tuesday 9 July 2013.

There will also be additional opportunities to share your views on this important area over the coming weeks – a list of events is available here.

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‘Towards commissioning excellence: a strategy for commissioning support services’  sets out the building blocks for developing a vibrant market that enables Clinical Commissioning Groups (CCGs) and other commissioners to choose from best-in-class providers from the public, voluntary and independent sector.

• Towards commissioning excellence: a strategy for commissioning support services

An effective market will bring strong incentives for commissioning support providers to be responsive to their customers’ needs, to develop innovative services that enable CCGs to drive improvements in patient services and provide value for money.

Rosamond Roughton, NHS England’s National Director for Commissioning Development, said: “The NHS needs to rapidly evolve so we have a system which is equipped to meet the demands of modern healthcare.

“If commissioning is to deliver better value for money and better quality and outcomes for patients, it must be taken to a new level – clinically led, professional and streamlined.

“This means being capable of securing quality today whilst leading the transformation of services for tomorrow. Commissioners will not be able to achieve this on their own. It’s important that CCGs retain their clinical focus, and are lean and agile organisations supported by excellent at scale and affordable commissioning support services.

“Commissioning Support Units (CSUs) are already making a difference around the country. For example, in the North of England, the CSU, as a member of the Northern CCG Forum, has mapped out common commissioning priorities to support collaboration across a number of services. It has also developed a business intelligence system to ensure commissioning decisions are underpinned by a strong evidence base. It is this kind of pragmatic and considered approach that this strategy will build on and develop.

“Truly transformational change won’t happen by accident and there needs to be a real understanding of support needs, where to access the best services to meet this need and to help stimulate the market to ensure this is achieved. This strategy is taking the first practical steps towards making this a reality and I am delighted to announce its launch today.”

There are three key elements to the strategy:

1. Enabling CCGs to exercise informed choice of how they source their commissioning support and from whom.  The first step towards this is the launch of a new ’choice app’ for CCGs which is being demonstrated at the Commissioning Show in London today (12 June).

2. Building a strong cohort of excellent commissioning support providers. NHS Commissioning Support Units (CSUs) are currently the mainstay of commissioning support. NHS England is committed to investing in their development, encouraging and enabling partnership working and collaboration, and assuring their development with the aim of CSUs being autonomous by no later than 2016.

To strengthen collaboration between NHS CSUs and the voluntary sector, a partnership agreement has just been signed between the Association of Chief Executives of Voluntary Organisations (ACEVO) and CSUs so that CCGs benefit from a wider range of support.

Rosamond Roughton added, “Voluntary organisations have a wealth of experience and expertise and this strategy recognises the need to work more closely together. I am delighted that the CSU network and ACEVO have signed a partnership agreement to stimulate closer working and sharing expertise. This will enable CSUs to strengthen their offer to CCGs in areas such as patient involvement, needs assessment and service redesign”

Sir Stephen Bubb, Chief Executive of the Association of Chief Executives of Voluntary Organisations (ACEVO), said: “It is essential that the voluntary and public sectors work together to share their knowledge, experience and expertise. The voluntary sector has a vital role to play in supporting commissioners to shape services around the needs and priorities of service users. Consequently I am delighted that we are able to announce this partnership agreement with the CSU Network, which demonstrates our joint commitment to working closely together to deliver the best services we can.”

A similar partnership arrangement, between CSUs and NHS Improving Quality (NHSIQ) has also been put in place to drive forward the development of transformational support for commissioners.

• NHS CSUs and NHS Improving Quality
• NHS CSUs and the Association of Chief Executives of Voluntary Organisations (ACEVO)

3. Ensuring the establishment of simple, efficient procurement mechanisms which enable fair and open competition.  Alongside the strategy, NHS England has also published a procurement guide which explains the process commissioners need to follow should they wish to choose an alternative commissioning support provider. In addition, to ensure the NHS adopts the best approach to procurement, NHS England has also today launched an engagement exercise with  key stakeholders on proposed options to support CCGs and others to procure commissioning support simply and effectively, for example through new framework agreements.

• Your choice of commissioning support services guide
• Engagement document to explore how best to support CCGs in buying commissioning support

In the autumn, NHS England will publish an update on the progress made across the key building blocks of the strategy along with the second stage of  the strategy to describe  the process and next steps for giving NHS CSUs full autonomy.

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Working with the police, crime commissioners, local authorities and public health and community safety groups, NHS England will support commissioners in delivering services that secure the best help for vulnerable sex crime victims.

Recent British Crime Surveys reveal how health and victim support workers face a massive undertaking:

• 42,976 most serious sexual assaults were recorded by the police in England and Wales in 2011/12. Most serious sexual offences comprise rape, sexual assault or sexual activity with children.
• Of people aged 16-59 years surveyed in 2010/11, one in five women (19 per cent) and one in 5000 men (2 per cent) had experienced sexual violence or attempted sexual violence.
• Only 11 per cent of rapes are reported to the police and 45 per cent of rape victims tell no-one about what they have suffered.

Kate Davies OBE, NHS England’s Head of Public Health, Armed Forces and their Families and Health & Justice explained: “Whoever you are, or wherever you are, NHS England is dedicated to ensuring that, as a victim, you will get safe, confidential and high quality support, health care and forensic examinations from a local Sexual Assault Referral Centre.

“We are working to improve and develop high quality provision on a 24 hour basis, 365 days of the year.”

NHS England’s new way of helping sex crime victims has been developed with, among others, the Department of Health, the Youth and Criminal Justice System, local NHS Offender Health Teams, as well as with the Home Office, the National Offender Management Service and Sexual Assault Referral Centres (SARCs).

There are 45 SARCs across England, Scotland and Wales, linked to police forces. The commissioning of SARCs is implemented across England with funding from the NHS, police, local authorities and the voluntary sector.

The new framework will drive up local improvements in the quality of services, improve the outcomes of the victims of sex assault and rape, as well as reducing health inequalities.

The plan will be delivered by four NHS England regional teams, supported by nine areas teams and London.

They will work within a national framework, aimed at driving up standards of care, reducing inconsistency and take duplication out of the system – thereby saving money.

As it launched its plans entitled ‘Securing Excellence in Commissioning Sexual Assault Services for People Who Experience Sexual Violence’, Director of Commissioning (Corporate) Ann Sutton explained: “This is a vital step forward in giving much needed and improved support across the entire country for the victims of sexual assault and rape.

“Many victims suffer long term health issues as a result of the crimes they have been subjected to. This plan will ensure better joined-up thinking among the various agencies who offer vital support.”

ACPO’s spokesman on rape, Martin Hewitt, Deputy Assistant Commissioner Specialist Crime and Operations for the Metropolitan Police, said: “ACPO welcomes the publication of this important document which will support the commissioning of a vital service to victims. The police service looks forward to engaging with NHS Commissioners and other key partners across the country to ensure that our victims receive the best possible service, consistently through the country.”

The needs of victims include dealing with the physical consequences of sexual violence or rape, a risk of pregnancy in five per cent of cases, the contraction of sexually transmitted infections and HIV and, for all victims, longer-term health issues such as increased rates of chronic illnesses, poor health and increased use of medical services.

The psychological consequences are linked to profound long-term health issues, with one-third of rape victims developing post-traumatic stress disorder, relationship problems, mental illness and longer-term psychological needs.

There is also increased risk of suicide for abused children when they reach their mid-twenties.

Supporting documents: Securing excellence in commissioning sexual assault services for people who experience sexual violence

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The new service specifications, along with clinical commissioning policies, were the subject of a short, public consultation which ran from mid-December 2012 to February 2013. NHS England received more than 3,500 responses from individual patients, carers, patient groups, and clinicians which detailed how the proposals could be further developed to reflect the needs of patients. Feedback received during consultation informed the new specifications.

Also being published are the existing national service specifications (mainly covering highly specialised services). Whilst the new specifications are interim until 1 October 2013, the existing national specifications were adopted from 1 April 2013 and were not subject to consultation.

NHS England will now, through its 74 Clinical Reference Groups (CRGs), continue to work with patients, carers and patient groups in the further development of the services specifications for use in 2014/15. Patient and carer members have already been recruited to the CRGs, and will work with clinical and commissioner colleagues, contributing their valued insights and experience to the CRGs’ work programmes. In addition to this, more than 1,000 people have registered with the CRG stakeholder programme, which will enable CRGs to share work with, and collect views and opinions from, a wide range of individuals and organisations with an interest in specialised services.

NHS England will also continue to develop and strengthen patient and carer engagement in the governance of specialised commissioning which will be developed at the Programme of Care, Portfolio and Clinical Priorities Advisory Group levels, ensuring that the patient voice contributes to the drawing up of recommendations and decision-making in specialised commissioning; and NHS England continues to develop its model for engagement in specialised commissioning, which involves patient and carer representatives in its design.

Whilst all of this work continues, NHS England has adopted the specifications in their draft form. Reports detailing the findings from the consultation, and how they have been used to develop the draft documents, will be published on the NHS England website later this year.

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Professor Sir Bruce Keogh, Medical Director for NHS England said:

“We welcome the review and NHS England will now study its recommendations in full to learn from them.  We will institute a new process that recognises the very strong case for redesigning services to meet the demands of the future whilst addressing the legitimate concerns in our local communities.”

The Safe and Sustainable Review assessed nationally, for the first time, the quality of care given to children born with a serious heart condition. An extensive consultation exercise attracted some 75,000 responses

Professor Huon Gray, National Clinical Director for Cardiac Care for NHS England said:

“We want to acknowledge the huge effort and commitment of all involved.  We are pleased the Independent Reconfiguration Panel’s (IRP) endorsed the case for children’s heart surgery and interventional cardiology to be provided only by well-resourced, specialist teams providing round the clock cover, and the use of national standards for commissioning the pathway of care.

“But the Independent Reconfiguration Panel has also raised some really important issues, which mean we cannot implement change immediately.  This is matter of regret for everyone who wants to improve care for children today.”

Dr Jacqueline Cornish, National Clinical Director for Children and Young People for NHS England said:

“It is essential that all those involved can learn lessons from the Safe and Sustainable Review and work purposefully and quickly together to find a new way forward in the shortest possible timescale.  If we are not able to make progress swiftly, children will be the losers.

“As of April, NHS England is the new national commissioner of these services so it is our responsibility to lead the process on behalf of children and their families.

“We want to build consensus on the way forward, working with all those affected.

“So we will take the time to listen before coming up with a new proposition, working with patients, clinicians and the providers of services.  We intend to announce a new way forward in the autumn, with plans for implementation within 12 months.

Prior to receiving the IRP Report, it was important to keep options open. In order to meet legal deadlines, NHS England sought leave to appeal against the previous high court judgement on the Safe and Sustainable Review. It is now asking the Court’s permission to withdraw the appeal.

For further information, please e-mail the NHS England media team. 

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