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Armed Forces Health Commissioning Arrangements
Melanie Iredale
Head of Armed Forces Commissioning
Tuesday 11th November 2014
Armed Forces Commissioning• Cement the “No disadvantage”
requirement as specified in Armed Forces Covenant and Government’s Mandate to the NHS
• A single, national body commissioning for the serving armed forces with one set of commissioning policies
• Build commissioning capability in the new system so as to credibly build networks and relationships
• Standard operating procedures for Armed Forces personnel in development
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Health and Wellbeing Boards, AFNs, Community Covenant and partnerships
NHS England - Armed Forces Health
NHS England Board
NHS England Operations Directorate
NHS England Operations Directorate
Area Teams – x 3Area Teams – x 3
Armed Forces Commissioning Interface between MOD and Providers(Securing Excellence – Military Health)
CCGs - Veterans, Families, Reservists, Armed Forces Networks
lead
Armed Forces Commissioning
Veterans’ and families commissioning Transition management
Veterans, reservists and families
Veterans’ and families commissioning Transition management
Veterans, reservists and families
Reservists, Veterans’ & Families Commissioning
Design Principles :Retain: Knowledge, expertise, capability, continuity, skillsets, credibilityEnsure: Momentum, partnerships, linkages, AFNs, practical configuration and delivery
CCGsCCGs
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Armed Forces commissioning responsibilities
Serving Armed Forces in England
Serving Armed Forces overseas
Armed Forces Families registered with DMS med centres in England
Armed Forces Families registered with DMS med centres overseas
Armed Forces Families registered with NHS GP Practices
Reservists while mobilised i
Veterans (inc. reservists when not mobilised)
Primary CareDMS ii DMS DMS DMS NHS England
DMS&NHS England iv
NHS England
Community Mental Health DMS DMS NHS England DMS CCGs DMS CCGs
Secondary acute & community care NHS England
DMS&NHS England iv
NHS EnglandDMS&NHS England iv
CCGsDMS&NHS England iv
CCGs iii
MOD Enhanced pathways DMS DMS N/A N/A N/A DMS N/A
i - Reservists have access to DMS care whilst mobilisedii - Serving personnel can access local GPs on an emergency basis if needing to access care whilst away from the military addressiii - The NHS England will commission specialised services for veterans, e.g. limb prostheses, iv - While overseas, serving personnel and families can access DMS-commissioned healthcare where such provision exists, or may be provided with non-DMS healthcare by local Host Nation or other contracted arrangements, or have right of return for NHS England-commissioned NHS care in England4
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NHS England
COO
NHS North
Comm Mgr – James Carter
Asst Hd Military
Andy Bacon
DoC (Corporate)Ann Sutton
CCGs - Link to JSNA and H&Wb Bds
Armed Forces
Networks
N Yorks &Humber AT
N Yorks &Humber AT
Hd of Spec AF Melanie IredaleHd of Spec AF Melanie Iredale
Comm Mgr –North
Jim Khambatta
Comm Mgr –North
Jim Khambatta
DoC Julie Warren
DoC Julie Warren
NHS Mildands NHS South
Bath, Swindon & Wilts AT
Bath, Swindon & Wilts AT
Hd of Spec AF Jenny Kirby
Hd of Spec AF Jenny Kirby
Comm Mgr -South
Sharon Greaves/Karen
Beckett
Comm Mgr -South
Sharon Greaves/Karen
Beckett
DoC Debra Elliott
DoC Debra Elliott
Notts & Derbs AT
Notts & Derbs AT
Hd of Spec AFAlison TreadgoldHd of Spec AF
Alison Treadgold
Comm Mgr -Mids
Ann Berry
Comm Mgr -Mids
Ann Berry
DoC Vicky Taylor
DoC Vicky Taylor
Hd PH, Armed Forces and
OffenderKate Davies
DoCJulie Higgins
DoCCatherine O’Connell
DoCSue Davies
NHS London
DoCSimon Weldon
AF Network Lead/Transition
Richard Swarbrick
Head of Public Health, Armed
Forces and Offender Health Commissioning
Alison Frater
Kenny Gibson
Wayne KirkhamNational Lead
National Veteran Mental Health
Network
Armed Forces commissioning responsibilities: Structures post-April 2013
NHS England Internal
Oversight & Assurance structures
Operations & Delivery structures
External Assurance Groups
Armed Forces Governance Structure
Clinical Priorities
Advisory Group
Clinical Priorities
Advisory Group
Internal Delivery Groups (Armed Forces)
AFCRGAF
CRG
Armed Forces Partnership
Board
Armed Forces Partnership
Board
External Partnership
Groups
Health Partnership
Working Group
Health Partnership
Working Group
Defence Recovery Steering
Group
Defence Recovery Steering
Group
DMS/NHS England Joint
Commissioning Group
DMS/NHS England Joint
Commissioning Group
Veterans Mental Health Network
Veterans Mental Health Network
AF JointCommissioning Task & Finish
Groups
AF JointCommissioning Task & Finish
Groups
Screening & Immunisations Delivery Group
Screening & Immunisations Delivery Group
Patient & Public Voice Forum
Patient & Public Voice Forum
Armed Forces Networks
Armed Forces Networks
ETMETM
Directly Commissioned
Services Committee
Directly Commissioned
Services Committee
Armed Forces Oversight
Group
Armed Forces Oversight
Group
Operations SMT
Operations SMT
NHS England Board NHS England Board
CRG sub-groups as required
CRG sub-groups as required
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DH Future Roles• Policy
• Governmental and inter departmental business
• 2 Murrison Reports
• Mental Health Provision:
• Veterans MH Network
• Big White Wall
• Prosthetics:
• National Funding of Veterans Prosthetics
• Improved Disablement Support Centres
• Veterans Information Service
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MoD/Joint Medical Command
Joint Medical Command
• MoD (Chief of Defence Personnel) deliver (support):• Tri-service welfare and recovery• Chain of Command looks after/owns service
personnel under their command (Single Service or TriService)
• Transition• Recovery
• MoD (Joint Medical Command) still commission/provide (supporting) healthcare:
• Operational Care• Primary Care• Rehabilitation• Community Mental Health • Inpatient Mental Health (NHS Provided)
n.b. note supporting/supported tension that we understand8
Obligations
• “The NHS and its public sector partners need to work together to help one another to achieve their objectives. …. This includes, in particular, demonstrating progress against the Government’s priorities of: upholding the Government’s obligations under the Armed Forces Covenant;
• The Covenant says:• The Armed Forces Community should enjoy the same standard of, and access to,
healthcare as that received by any other UK citizen in the area they live.
• Personnel injured on operations should be treated in conditions which recognise service
needs
• For family members, primary healthcare may be provided by the MOD in some cases (eg
when accompanying Service personnel posted overseas). And … should retain their relative
position on any NHS waiting list, if moved around the UK due to the Service person being
posted.
• Veterans … should receive priority treatment where it relates to a condition which relates
to .. their service, subject to clinical need
• Those injured in service should be cared for in a way which reflects the Nation’s moral
obligation …with professionals who have an understanding of Armed Forces culture9
NHS England
• England (not whilst Overseas), or Devolved Administrations
• Direct Commissioning:
• Post Operational Health Care (non-recovery)
• Community Care
• Hospital Care (also for MH not in main contract)
• Specialist IVF
• IVF on Moves
• Indirect Commissioning:
• CCG Assurance
• DMS – NHS IM&T Connectivity
• NHS England Other: Dental, “Specialised”, Offenders, Immunization, Vaccination and Screening
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Armed Forces Networks• All Local Stakeholders:
• Regional Armed Forces Structures
• PRUs
• Local NHS – Commissioners and providers
• Local Authorities
• Charities
• Veterans Organisations
• Currently 9 in England mapped closely to Brigade structure
NHS
Charities Armed Forces
Local Authorities
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Planned Improvements• Continuity of Care
• Pathway redesign (especially roles of
1ry/2ry)
• Improved Choice
• Recording and Performance monitoring of quality
• Referrer Involvement
• Patient and Carer involvement
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Issues
• Very poor data:
• £15M or £170M?
• Philosophical Differences:
• “The Armed Forces Community is entitled to appropriate recognition for the
unique Service which it has given, and continues to give, to the Nation, and the unlimited liability which the Service person assumes” AF Covenant
• “Only clinical features taken into account: The NHS CB must make decisions fairly about funding treatments and not on the basis of age, sex, sexuality, race, religion, lifestyle, occupation, family status (including responsibility for caring for others) social position, financial status etc. unless these directly affect the expected clinical benefit that an individual will derive from a treatment” NHS England Interim Standard Operating Procedures
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So what does this mean for CCG’s• Involvement in Armed Forces Networks
• New North East, Yorkshire & Humber AFN
• CCG stewardship
• Rotating chair
• Multi-agency representation
• Veteran’s Awareness
• Identification at practice level
• RCGP e-learning tool
• Staff training
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Continued …..• Veteran Mental Health Services
• Outreach services
• Big White Wall
• Combat Stress residential
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Thank you!
http://www.england.nhs.uk/resources/resources-armed/
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