Reverse Commissioning An Effective Process to Engage BME Communities

1. Reverse CommissioningAn Effective Process to Engage BME Communities Dr Vivienne Lyfar-Cissé MBA Transitional Lead NHS BME Network

2. Background • 2004 Launch of Brighton BME Network • 2007 Launch of South East Coast (SEC) BME Network • 2008 SEC Race Equality Service Review

6. Background contd:- • 2009 Inaugural BME Conference • 2010 Launch of NHS BME Network Conference • 2011 1st Anniversary Conference

7. NHS BME Network Vision “to be an independent and effective voicefor BME staff, patients, service users and carers to ensure the NHS delivers on its statutory duties regarding race equality”

8. What is Commissioning? Several Definitions: • The act of committing finite resources to evidence based interventions particularly, but not limited to the health and social sectors with the aim of improving health, reducing inequalities and enhancing patient experience • The process of specifying, securing and monitoring services to meet the individuals’ needs at a strategic level

9. The Commissioning Process The Commissioning Process is driven by and/or dependent on the need to: • Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements • Prioritise investment accordingto local needs, service requirements and the values of the NHS

10. Work collaborativelywith community partners to commission services that optimise health gains and reductions in health inequalities • Proactively seek and build continuous and meaningful engagementwith the public and patients to shape services and improve health

11. Commissioning Cycle 1. Assessing needs:through a systematic process, understanding of the health and healthcare needs of the PCTs resident population.

12. Commissioning Cycle 2. Reviewing services and gap analysis:reviewing the services currently provided and based on the needs, defining gaps (or over provision).

13. Commissioning Cycle 3. Deciding priorities:given a list of desirable actions using available evidence of cost effectiveness and based on a robust and defensible ethnical framework, prioritise areas for purchase

14. Commissioning Cycle 4. Risk management:understanding the key health and health care risks facing the PCT and deciding on a strategy to manage it

15. Commissioning Cycle 5. Strategic options:bring together all the available information into a single strategic commissioning plan that outlines how the PCTs will deliver its core objectives (including those of the SHA and DH)

16. Commissioning Cycle 6. Contract implementation:put those strategic plans into action through contracting

17. Commissioning Cycle 7. Provider development (including care pathway re-design and demand management):support provider improvements or introduce new providers to deliver the services required (including setting up demand management systems and designing new care pathways). This includes supporting providers in decommissioning of services where appropriate.

18. Commissioning Cycle 8. Management provider performance:monitor and manage the performance of providers against their contracts, especially against KPIs.

19. Question Why Reverse Commissioning? Answer The commissioning process has (in the main) failed to identify the health needs and effectively engage our BME communities. Consequently, ethnic health inequalities remains a major problem for BME people.

20. Ethnic Health Inequalities General Statements 1. The incidence of CHD and diabetes is higher than average in ethnic minority groups 2. Asians are more likely than others to have worse reported health and also have long-term illness 3. Ethnic differentials in the incidence of mental health are well reported 4. Generally people from ethnic minorities have lower levels of satisfaction with health services 5. Etc Etc Etc

21. Ethnic Health Inequalities Mental Health - Count me in census 2010 Since the inception of the Delivering Race Equality Programme in 2005 three of the twelve goals have not altered materially as follows:

22. Admission rates remain higher than average among some minority ethnic groups, especially Black and White./Black Mixed groups for whom rates were two or more times higher than average in 2010 (six times higher than average for the other Black group). In contrast admission rates have consistently been lower than average among the Indian and Chinese groups and about average in the Pakistani and Bangladeshi groups

23. Detention rates have almost consistently being higher than average among the Black, White/Black Caribbean Mixed and Other White groups. The rates for being placed on a CTO were higher among the South Asian and Black groups. • Although there have been annual fluctuations in seclusion rates, they have been higher than average for the Black White/Black Mixed and Other White groups, in at least three of the six censuses

24. Reverse CommissioningFlagship Project Brighton and Sussex University Hospitals NHS Trust Eastern Road, Brighton, BN2 5BE Dr Vivienne Lyfar-Cissé MBA Associate Director of Development

25. New Structure of the NHS Department for Communities and Local Government NHS PublicHealth SocialCare Public health delivery Department of Health (including public health England) – Overall responsibility for health, public health and social care policy NHSCommissioningBoard Local authorities(including health and wellbeing boards) LocalCommissioningGroup Service delivery Accountability to patients, service users and the public (underpinned by the regulators and Healthwatch England) Subject to Parliamentary scrutiny

26. NHS Commissioning Board

27. Remit to commission services to meet the needs of local communities and resources allocated accordingly

28. Remit to commission services to meet the needs of local communities and resources allocated accordingly

29. Remit to commission services to meet the needs of local communities and resources allocated accordingly x Lack of evidence

30. Remit to commission services to meet the needs of local communities and resources allocated accordingly x Lack of evidence

31. Health Professionals Engage Educate Enlighten Enhance service delivery BME Communities Enable Expert Empower Enhance patient experience 4 Es Model EstablishReverse Commissioning Group

32. Remit to commission services to meet the needs of local communities and resources allocated accordingly x Lack of evidence

33. Remit to commission services to meet the needs of local communities and resources allocated accordingly Health promotion Ethnic health equalities Health improvement x Lack of evidence

35. Does the Evidence Exist??? Generally • Ethnic monitoring has been a legal requirement for many years

36. Specifically (Mental Health) • Mental Health Minimum Data Set (MHMDS) –the statutory data set submitted by the providers of specialist mental health services in England to the National Mental Health Development Unit (NMHDU). The data provided covers information concerning the following:

37. Individual patients • Services provided to those admitted to hospital • Community Treatment Orders • The Outcome of Care

38. Diabetes Department Inpatient Data Total Number of Patients = 775 Total Number of BME Patients = 61

39. Diabetes Department cont’d Outpatient Data Total Number of Patients = 7526 Total Number of BME Patients = 976

40. Diabetes Department cont’d Percentage of Inpatient and Outpatient Data compared

41. The NHS Outcomes Framework 2011/12 The focus of the Framework is on health improvement and its purpose is threefold: • To provide a national level overview of how well the NHS is performing, wherever possible in an international context • To provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board; and • To act as a catalyst for driving quality improvement and outcome measurement throughout the NHS encouraging change in culture and behaviour, including a renewed focus on tackling inequalities in outcomes.

42. Duty of quality 1 NHS Outcomes Framework 2 NICE Quality Standards(building a library of approx 150 over 5 years) Duty of quality Duty of quality 3 4 5 CommissioningOutcomesFramework CommissioningGuidance Provide payment mechanisms tariff Standardcontract CQUIN QOF 6 Commissioning/ContractingNHS Commissioning Board – certain specialist services and primary careGP consortia – all other healthcare services Duty of quality The NHS Outcomes Framework 2011/12 Domain 1Preventing people from dying prematurely Domain 2Enhancing quality of life for people with long-term conditions Domain 3Helping people to recover from episodes of ill health or following injury Domain 4Ensuring that people have a positive experience of care Domain 5Treating and caring for people in a safe environment and protecting them from avoidable harm

43. Page 42-The NHS Outcomes Framework 2011/12 “The Department of Health has made tackling health inequalities a priority and it is also under a legal obligation to promote equality across the equality strands protected in the Equality Act 2010. There is therefore both a legal requirement and a principle in designing the NHS Outcomes Framework that its induction will not cause any group to be disadvantaged. We have used the equalities and inequalities breakdowns to assess data availability in order to monitor this commitment. Date collection is more complete for some of the strands than others; for example, there is better coverage (questions are asked as standard and patients provide the information) for age and gender than for religion or belief and sexual orientation”. Our question - What about ethnicity?

44. What is Reverse Commissioning? Reverse Commissioning is an effective process to engage BME communities to ensure their health needs are addressed by the NHS

45. Why Reverse Commissioning? Reverse Commissioning is necessary because the existing commissioning process has failed to (i) identify the needs of BME communities (ii) effectively engage with BME communities and (iii) reduce/eliminate ethnic health inequalities.

46. How Does Reverse Commissioning Work? Reverse Commissioning works by: • Using existing data and evidence to identify the needs of BME communities • By recognising that Health Professionals needs to be educated and trained to enhance service delivery • Recognising that BME communities need to be empowered to engage with Health Professionals • Recognising there is a need to establish lasting partnerships between health professionals and BME service users to effect change • Using information gained from these partnerships to influence commissioning by Local Clinical Commissioning groups.

47. Summary cont’d:What are the Desired Outcomes of Reverse Commissioning? The desired outcomes of reverse commissioning are as follows: • Clinical services that meet the needs of BME communities • Enhanced BME patient experience • Enlightened health professionals • Enhanced clinical service delivery to BME people • Reduction in ethnic health inequalities • Health improvement for BME communities • Health promotion programmes directed at BME communities • Effective and lasting partnerships between health professionals and BME services users to effect change

48. Conclusion Effective commissioning to meet the needs of BME communities is possible if we apply the correct process

49. Health Professionals Engage Educate Enlighten Enhance service delivery BME Communities Enable Expert Empower Enhance patient experience Discussion How can we best deliver on the 4Es model? 4 Es Model

50. The Big Move1st Anniversary Conference Date: Friday 16 September 2011 Time: 09.30-16.30 Hours Venue: London Hilton Park Lane