World Class Commissioning: opportunities for the sector

1. World Class Commissioning: opportunities for the sector Liz Matthews NHS North West

2. Unsustainable increase in hospital based activity • Over the last 3 years – all hospital admissions in North West up by 10%. • Emergency admissions up by 19% • Rise in emergency admissions is faster than in the rest of England (gap is getting wider). • More recently, the acute sector 2008/09 delivered more than they were contracted to by PCTs by almost 5% - this meant ~40,000 ‘extra’ episodes than had been contracted for. This is referred to as ‘over-performance’ of the contract.

3. First exercise • In pairs, imagine you are in a lift in a tall building. Each take 1 minute to introduce yourself, explain what your organisation does and the key thing you are looking for • Change round when you hear me clap three times

4. Transformational change needed • Given financial climate, we cannot sustain this activity growth • Need to consider working very differently • In positioning our strategic approach to sustainability, we need to consider the risk of divergence between different organisations • Any win: lose scenario represents a lose: lose in reality for the people of the North West • The only possible quadrant for us to pursue is win: win • This will require a systems approach and we will fail if we consider isolated organisational solutions • Given the context, a laissez faire approach will not result in the win: win position.

5. Building blocks for future success • Improving health • Improving quality • Increasing productivity

6. Short pay back times for improving health • Seasonal flu vaccination • Over half of non-elective admissions for influenza are aged over 65 • Vaccination can reduce admissions by > 50%. • 75% uptake in 08/09. • Hypertension • Identified and well controlled hypertension - > 35% reduction in stroke, 50% in heart failure and 16% in coronary events. • NHS NW achieved 98.7% of available QOF points, BUT on average we haven’t diagnosed 58% of cases of hypertension in the North West. • Falls prevention • Can reduce admissions in high risk groups by >20%

7. Quality, innovation, productivity and prevention • Lord Darzi’s ‘High Quality Health For All’ published in 2008 set out quality as the organising principle for healthcare • We are all capable of producing quality services and we all deserve them • Be a yardstick of quality. Some people aren't used to an environment where excellence is expected.’ Steve Jobs American computer engineer

8. Quality, innovation, productivity and prevention • Innovation: identifying, adapting, adopting, spreading and sharing best practice • Productivity: getting more value, increasing efficiency

9. Exercise 2 • Take a few moments to write down or think about something your organisation has done that demonstrates either improvement in quality, introduction of something innovative, increase productivity or emphasis on prevention • In pairs, take five minutes each to share it. When you hear me clap three times switch over

10. What Do We Mean By Commissioning?

11. Definition of commissioning • “Commissioning is the process of specifying, securing and monitoring services to meet people’s needs at a strategic level • This applies to all services, whether they are provided by the local authority, NHS, other public agencies, or by the private and voluntary sectors.”

12. Health Market Analysis Service Reviews JSNA Strategic Commissioning Plan Commissioning Strategy for Community Services • Plans For: • Market Development • Strategic Sourcing • Contestability, Competition and Procurement • Option Appraisal The commissioning cycle

13. Assessing needs • First important PCT document: Joint Strategic Needs Assessment (JSNA) • Jointly produced by PCT and Local Authority • Live document – refreshed regularly as new information comes on stream • Outlines the needs of the population, where health inequalities exist • Uses present facts and information that can then be modelled to project future issues • You can contribute your knowledge of your group E.G. needs of those you serve • Current gaps include in depth knowledge of disability, new migrants

14. Commissioning Strategic Plan • Second important PCT document: Commissioning Strategic Plan (CSP) • Sets out vision, goals, initiatives, health outcomes improvements • Example of vision: • We will support people to live longer, healthier lives and commission high quality health services that represent value for money

15. Examples of goals • Improve the health outcomes for children • Improve the health outcomes for older people • Improve access to planned care and reduce hospital admission • Develop local integrated services that provide care in the most appropriate setting • Support long term condition prevention and management • Promote positive mental health for all people • Improve care models for respiratory diseases and diabetes • Reduce cancer mortality, CVD mortality

16. Examples of improvements in health outcomes • Reduce number of obese children in year 6 • Increase our early detection of dementia to get on care pathway • Reduce the number of hospital admissions related to alcohol consumption and mental health • Reduce lung cancer death rates • Reduce heart disease death rates • Reduce the proportion of people on incapacity benefit due to Mental Health problems • Increase the number people stopping smoking

17. Initiatives • Initiatives are sets of activities and approaches introduced in order to move the needles on the outcomes dials Initiaitives are described in Commissioning Strategic Plans • Can you play a part in the initiatives chosen?

18. Most popular initiatives in the North West

19. Advantages of using care pathway approach • Meaningful for patients, users and carers • Meaningful for clinicians and care givers • Promotes identification of leverage points • Promotes identification, adoption and adaption of innovation and best practice • Confirms responsibility and supports supply chain analysis

20. Meaningful for patients, users and carers • Meaningfully describing events, journeys, continuum of life much more than organisational structures • Real and virtual communities of common interest to share knowledge, experience from patient perspective • Refine the general to reshape to meet personal specific needs – see PACE in Healthier Horizons • Supports patient facilitators e.g. patient advocates, patient trackers – prevention support, decision support, communication with providers support • Encourages partnerships with meaning – co-production, patient based design, patient experience measures, PROMS – drive up quality

21. Meaningful for clinicians and care givers • Expertise built around collective intelligence, repository based on front line workers every day knowledge and experience gained through working with patients • Encourages networks, across and between organisations, interagency and multi disciplinary • Encourages partnerships with meaning: co production, based round networks and communities of common interest • Supports Clinical Leadership and empowerment

22. World Class Commissioning 2008 first year of WCC, competencies which include • Being visible leaders who listen to local people • Building trust and legitimacy by engaging with patients, partners and clinicians • Using local knowledge and intelligence to prioritise investments • Managing the market and promoting choice in patient care • Care pathway redesign to improve health outcomes and patient experience • Agreeing and managing performance of contracts

23. Thank you • Liz Matthews 0161 625 7144 • Liz.matthews@northwest.nhs.uk