The paper reviewed here is ‘The Operating Framework for the NHS in England 2010/2011’ and freely available here.
There is a foreword by David Nicholson, CBE. Here Nicholson describes the period 2010/2011 as a year of growth in the NHS and refers to a further document which outlines the plan for the next 5 years in the NHS. He emphasises a need for innovation, prevention, quality and productivity. Amongst other issues, he discusses the need for integration and ‘risk management across systems’. In reference to the latter he states that risk is a ‘zero sum game’ with risk remaining even when it is transferred within the system. In the context of risk management he also notes that all NHS organisations will need to be registered with the Care Quality Commission next year to assure specified standards are met. The intention to deliver more services closer to home at the end of the next 5 years is stated. The integration of both services and organisations in some instances is also discussed.
The next section places the operational framework in context. Thus the budget is discussed, the ‘need to generate …from existing resources’, the importance of focusing on preserving the workforce, the need for clinical leadership and the benefits of the national care service for social care delivery. Chapter 2 is about priorities. They identify three tiers within the NHS Vital Signs and also the National priorities. Of interest here is a section on health and wellbeing (particularly interesting in view of the article reviewed here) there is a reference to New Horizons and the emphasis on early identification of mental illness. In this section, it is also stated that
‘All NHS organisations must play their full part in supporting health research….all providers of NHS care will want to continue to increase their level of participation and performance in hosting research funded by non-commercial and commercial research funders. As part of that, in their Quality Accounts we propose that NHS providers shoud include the number of patients recruited to clinical research‘
They also emphasise the role of Strategic Health Authorities with regards to clinical research and in engaging with ‘the work of the new NHS Life Sciences Delivery Board on the uptake of innovation in medicines and medical technologies’.
The third chapter deals with system levers and enablers. The financial framework is discussed here as is the Quality Framework. Indeed I found the diagram of the quality framework was quite helpful in gaining a rapid overview of the structure. There is also a description of the NHS Performance Framework where it is noted that
‘Mental health trusts: from April 2010 – to include a limited set of additional indicators on organisational governance‘
The final part of this chapter is on informatics where it is noted that
‘Ambitious and innovative approaches to digital technology should underpin the delivery of strategic business and service objectives…Digital technologies will connect all parts of the service together, by enabling access to health services through a wider range of communication channels‘
The last chapter is on planning and includes a discussion of issues such as ‘performance monitoring and assessment’, working in partnership with other organisations (e.g in crime reduction) as well as a timetable for action by Strategic Health Authorities. At various points in the document there are also references to the introduction of patient choice in the NHS constitution.
In conclusion, this 56 page document contains a lot of information which is of interest to various audiences and there is an emphasis in places on detailed financial outlines. There were a few references to mental health services as well as a validation of the importance of research in the NHS and a key role for informatics.
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