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Overview

Commissioning and Contracting in Wales EHESP, Rennes Wednesday 11 th March 2009 Dr Jenny Harries Local Director of Public Health Monmouthshire Local Health Board. Overview. ‘Who, What and Where’ of commissioning in Wales How it works in practice – chronic conditions

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Overview

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  1. Commissioning and Contracting in WalesEHESP, RennesWednesday 11th March 2009Dr Jenny HarriesLocal Director of Public HealthMonmouthshire Local Health Board

  2. Overview • ‘Who, What and Where’ of commissioning in Wales • How it works in practice – chronic conditions 3. Stroke project in Wales

  3. What is commissioning? A function applying to third party payers Organisations or individuals Responsibility for spending resource allocated for healthcare Act on behalf of taxpayers or insured Aim: to meet health objectives of the health system, insurance organisation or patient

  4. Do we mean the same thing? Strategic commissioning V Commissioning v Contracting

  5. What is commissioning? Purchase is the process of buying or funding services in response to demand or usage Commissioning is the set of linked activities required to assess the health care needs of a population, specify the services required to meet those needs with a strategic framework, secure those services, monitor and evaluate the outcomes. (Woodin J, 2006) Procurementis the process of identifying a supplier and may involve competitive tendering, Competitive quotation, single sourcing. It may also involve Stimulating the market through Awareness raising & education Contractingis the technical process of selecting a provider, negotiating and agreeing the terms of a contract for services and ongoing management of the contract including payment, monitoring, variations

  6. Where do we commission?

  7. U K Govt Which organisations commission for health in Wales? Specialised Commissioning (HCW) Welsh Assembly Government: DHSS ££££££ Hospital Trusts Local Health Board x 22 Local Authority X 1 Police force S 31 Local Health Board x 22 Local Health Board x 22 Local Health Board x 22 Local Authority x 2 Voluntary organisations REGIONAL COMMISSIONING Primary care: GPs & Dentists STATUTORY & VOLUNTARY PARTNERSHIPS Local Authority x 3….

  8. Diverging Policy Context • England: Shifting the Balance of Power 2002 Commissioning a Patient Led NHS 2005 World Class Commissioning 2007 • Policy and strategic context in Wales Wanless Reports Designed for Life 2005 One Wales 2007 Fulfilled Lives, Supportive Communities 2007 • NHS Wales Reorganisation October 2009

  9. Prioritisation National: Annual Operating Framework – efficiency driven Local: Local Delivery Plans Partnership strategies eg Children & Young People’s plans • No explicit prioritisation criteria • Overriding of NICE • Strong support for lobbyist groups

  10. Chronic Conditions Commissioning

  11. The Welsh Chronic Conditions Model

  12. Commissioning the Care Pathway– Primary prevention Welsh Assembly: Stop Smoking Wales (NPHS provider); GP Exercise referral (LA provider) Local Authority: Sports provision Local Health Board: GP contract Pharmacy contract

  13. Commissioning the Care Pathway– Secondary prevention Welsh Assembly: GP Directed enhanced service LHBs: Expert patient programme GP contract GP Locally enhanced service ‘Secondary’ care intermediate care teams Pharmacy contract Voluntary sector LAs: Care & repair

  14. Commissioning the Care Pathway–Primary care • GP contract - monitoring - dataflows - relationships - QoF reliability – gaming • Dental contract

  15. Commissioning the Care Pathway–Secondary care Welsh Assembly • Direct investment LHBs • Strategic Longterm Agreements (SLA) • Consortium purchasing [Lead negotiation agreements] • Contracts historic, cost block/activity

  16. Commissioning the Care Pathway–Specialised commissioning Health Commission Wales = executive agency of Welsh Assembly Govt Individual - direct payments - personal budgets Paying for Care in Wales (2009) LHB - Individual patient commissioning panels - Cross border referrals Choice versus demand

  17. Assessing Commissioning Capacity & Effectiveness Outcomes • Annual Operating Framework • Quality Outcomes Framework (QoF) • Services External Review • LHB – Healthcare Standards • LA – Care and Social Services Inspectorate Wales (CSSIW) • Eg Adult Care Information Network -”Information for effective commissioning and planning”

  18. Problems & Positives • Lack of levers – tariffs/PbR • Skills – LA & LHBs; service specifications • Structure eg HCW • Population size & patient flows • Ethical framework for commissioning - individual choice not population health • Partnerships & Governance - for pooled budgets - for partnerships 7. Central strategy v local implementation • Prioritisation framework • Legal framework eg pharmacy sites • Timely resource distribution • Information – financial, activity and outcomes

  19. Strategic Planning in the future in Wales • New process for specialised commissioning • Clinical leadership & engagement • New initiatives: Value Wales • Unclear where commissioning decisions will be made • Loss of contact between health & community commissioners eg LA • Useful transferable private sector models on resource-based strategy

  20. Thank you Jenny.Harries@nphs.wales.nhs.uk

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