Understanding the new Commissioning Landscape Thoughts for future planning Dr Nick Harding

1. Understanding the new Commissioning Landscape Thoughts for future planning Dr Nick Harding BSc MFMLM FRCGP DRCOG DOccMedPGDip(Cardiology) February 2012 Botanical Gardens

2. An introduction We are passionate about improving healthcare for the people of Sandwell and West Birmingham. Our vision is for transforming services to ensure excellence for everyone and in everything we do. We will not be a PCT in new clothing – this is a different kind of organisation that is firmly ground in its membership, relationships and local knowledge. We will be using local and clinical knowledge for change and improvement in health for our patients. Clinical Engagement Event - February 2012

3. Numbers of the day… 350 257 97 152 50 10 4 539 000 000 Clinical Engagement Event - February 2012 3

4. Our health needs • SWBH commissioning area is 530,560 patients • Heart of Birmingham ranked 10th most deprived Local Authority in England with 68% BME population • Sandwell ranked 12th most deprived Local Authority in England with approx 20% BME population • Health challenges against rising costs and demands for healthcare • Absolute commitment to improving quality of care Health without boundaries - November 2011 4

5. The journey Clinical Engagement Event - February 2012

6. Our CCG Clinical Engagement Event - February 2012

7. CCG Area covered Clinical Engagement Event - February 2012

8. Deputy Chair (TBA) Interim Chair (Currently Chair of HealthWorks) Board Secretary Chair and Vice Chair of Black Country Chair and Vice Chair of HealthWorks Lay Advisors Secondary care consultant Finance Lead Consortia Development: Non-voting members Nurse Representative Finance Lead Birmingham Lay Advisor Birmingham Director of Commissioning Birmingham Chair and Vice Chair of ICOF Chair and Vice Chair of Pioneers 4 Health Public Health Representative Finance Lead Black Country Lay Advisor Black Country Director of Commissioning Black Country Chair and Vice Chair of Sandwell Health Alliance Our Interim Structure Clinical Engagement Event - February 2012

9. Main SWBCCG Board Finance & Performance Sub-Committee Quality & Safety Sub-Committee Strategic Commissioning & Redesign Sub-Committee Remit: To have on-going responsibility for the affordability of the local healthcare system, and to receive monthly monitoring reports. This group will highlight concerns to the Board. Remit: To regularly review providers to ensure that services are safe, and that outcomes are monitored. Remit: To consider service provision and ensure that services are commissioned for shorter pathways, better value for money, and that provision is appropriate and adequate. Our structure Clinical Engagement Event - February 2012

10. Local Commissioning Groups • Develop Clinical Pathways (local or on behalf of SWBCCG) • Primary Care Quality inc. Medicines Management • Membership • QIPP delivery Engagement Primary Care demand management • Commission local services • Patient Participation Groups / Local Patient Networks • Engage with Local Authority structures at local level • Develop Commissioning Priorities & feedback problems with Providers. Delivery through membership • Clinical Commissioning Group • CCG Authorisation • Patient & Public Consultation on major service changes • Large-scale patient & public engagement events • Commission, Contract & Performance • Primary care strategy inc. Medicines Management • Manage: SWBH, Dudley Group*, BCHC, BCH*, BWH*, BSMHT, ROH**may be led by one CCG on behalf of others • QIPP Plan / Strategy & Performance monitoring • Commissioning Business Plan • Organisational Development • Health & Wellbeing Board • Emergency Planning (inc. Winter Planning) • Interface with PCT Clusters / NHS Commissioning Board • Secure information required for intelligent commissioning. Chair and Vice Chair of Black Country Chair and Vice Chair of HealthWorks Chair and Vice Chair of ICOF Chair and Vice Chair of Pioneers 4 Health Chair and Vice Chair of Sandwell Health Alliance Sandwell and West Birmingham Clinical Commissioning Group Clinical Engagement Event - February 2012

11. Our Role • By April 2012 - shadow form as a CCG in readiness for 2013. • We want to: • Be clear on the health needs of our population and how we are going to improve their health • Get the balance right between local and strategic decisions • Show real clinical leadership and development across the health economy • Do this new role in the most effective way we can • Create a clinical commissioning group that leads by example • Be effective in communications within our organisations and the people we serve • Be ready to lead and manage the NHS as a system by April 2013. Clinical Engagement Event - February 2012

12. New NHS Parliament Department of Health Key: Accountability Monitor CQC NHS Commissioning Board Funding Licensing Partnership SWBCCG 2° and 3° Providers Contracts Birmingham HealthWatch Sandwell HealthWatch Patients & Public Clinical Engagement Event - February 2012

13. Estimating the Size of the Challenge - CommissionersA Conceptual Model • The scale of the financial challenge has been estimated by applying demand pressure forecasts by service line and price pressure forecasts to current levels of spend. Cost pressures associated with the planned transfer of funds from NHS allocations to social care are also included. • By 20014/15, there will be a recurrent cost pressure of £2.4bn (£1.3bn demand pressure, £1.0bn price pressure and £100m social care transfer). 44% of this will be offset through increases in commissioner allocations, leaving a residual recurrent cost pressure of £1.35bn in 2014/15. Clinical Engagement Event - February 2012

14. Clinical Engagement Event - February 2012

15. Beds Days by Admission Method and Age Group Birmingham Providers 2009/10

16. Secondary care delivering specialist services Better primary care delivering more services Improved patient experience And releasing savings Areas we can target Doing exactly what we should be doing Clinical Engagement Event - February 2012

17. Doing the right things right Improving quality Different place Increase efficiency Stop doing things Decrease dependency Different provision Keeping local and clinical engagement at the centre of how we deliver – a grass roots approach Clinical Engagement Event - February 2012

18. Our ambition as a CCG • Improve patient experience and quality of care • Improve health for our population • Working towards delegation/authorisation in 2012-13 • Continue to build on good work done so far (RCRH) • Remain committed to the build of the new hospital and working in partnership • Through continuous improvement, create rewarding experience for clinicians wherever they are Clinical Engagement Event - February 2012

19. Getting the best out of services - diabetes Patients - regular follow up - easy physical access - close to home CCG - Patients managed safely - Upstream interventions - Value for money • SWBH • Managed care • - Professional opinion • - Costs covered Clinical Engagement Event - February 2012 19

20. Over to you Clinical Engagement Event - February 2012