World Class Commissioning

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World Class Commissioning
Alistair Blane Assistant Director of
Commissioning Strategy Development NHS East
Midlands 21 May 08
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What is commissioning?
Commissioning is using the available resources
to achieve the best outcomes by securing the best
possible health and care services for local
people
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A co-production
SHAs
PCTs
Local authorities
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VISION AND COMPETENCIES
ASSURANCE SYSTEM
SUPPORT AND DEVELOPMENT MODEL
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Adding life to yearsand years to life
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Health Profile of England 2007
Infant mortality England, EU countries and
selected averages, latest data (2004), ranked
Rate per 1,000 Live births
Denmark, Italy 2001 Belgium - 1997
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Health Profile of England 2007
Mortality Selected smoking related causes, for
2001
Standardised death rate (SDR) per 100,000
population
Selected EU-15 members
145.2
EU weighted averages
EU-15 (member countries before 2004)
United Kingdom
Standardised death rate (SDR) per 100,000
population
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Gynaecological cancers
Skin Urological cancers
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Commonwealth Fund Mirror, mirror on the wall
2003 data - Source Calculated by
Commonwealth Fund based on the Commonwealth Fund
2004 International Health Policy Survey, the
Commonwealth Fund 2005 International Health
Policy Survey of Sicker Adults, the 2006
Commonwealth Fund International Health Policy
Survey of Primary Care Physicians, and the
Commonwealth Fund Commission on a High
Performance Health System National Scorecard.
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Vision

• Better health and well being for all
• People stay healthier for longer adding life
  to years.
• People live longer and health inequalities are
  dramatically reduced and years to life
• Better care for all
• Services are of the best clinical quality and
  evidence based
• People exercise choice and control over the
  services that they access so they become more
  personalised.
• Better value for all
• Informed investment decisions
• PCTs work across organisational boundaries to
  maximise effective care.

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Competencies
1. Locally lead the NHS
7. Stimulate the market
8. Promote improvement and innovation
2. Work with community partners
9. Secure procurement skills
3. Engage with public and patients
10. Manage the local health system
4. Collaborate with clinicians
5. Manage knowledge and assess needs
11. Make sound financial investments
6. Prioritise investment
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A commissioner assurance system
Measures quality in health care and ability to
deliver key health outcomes and services
Assessment against three domains
NHS Input
NHS Input
Review of board controls and processes, strategy,
and long term financial controls
Measures whether the organisation possesses the
competencies associated with world class
commissioning
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There are three components of commissioning
assurance

• Focus on improvement

• Focus on improvement

• Maintain standards

Nature
Level 4
Rate of improvement
Rating
Level 1
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Vital Signs
PBCs drive innovation to deliver
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Competencies
Competencies have set baseline, with improvements
on up to world class. All PCTs to reach baseline
by 2009 on a journey towards world class
Baseline
World class
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Competency 4 Lead continuous and meaningful
engagement of all clinicians to informstrategy
and drive quality, service design and resource
utilisation
Clinicians are best placed to advise and lead on
issues relating to clinical quality and
effectiveness. They are the local care pathway
experts who work closely with local people
understanding clinical needs. PCTs should ensure
that through the involvement of clinicians in
strategic planning and service design, services
commissioned build on the current evidence base,
maximise local care pathways and utilise
resources effectively. Professional Executive
Committees (PECs) have a crucial role to play in
building and strengthening clinical leadership in
the strategic commissioning process. Practice
based commissioning (PBC) is the key methodology
for this and should be maximised to drive
innovative and transformational change.
Evidence
Level 4
Level 2
Level 3
Level 1
a

• Number of PBC proposals approved and live
• Number of clinical reviews in past year with
  results that were implemented

• PCT can identify several non-PEC clinicians that
  have made substantive contributions to PCT
  strategy, planning and policy development
• Clinicians are regularly present and actively
  participate in PEC meetings
• PCT seeks views of broad clinical group

• PCT engagement also includes other
  representatives e.g., consortia reps, local
  social care, and allied health practitioners
• All engagement groups actively drive PCT planning
  and service development
• Clinical engagement supports ongoing improvement
  of patient outcomes

• PCT engagement includes clinicians that represent
  all healthcare and well-being delivery methods
• Active clinical leadership across PCT agenda
• Facilitate links between primary and secondary
  care clinicians to support commissioning

• Does not meet Level 2 requirements

• Clinical engagement
• Dissemination of information to
• support clinical decision making
• 3. Reputation as leader of clinical
• engagement

Clinical engagement
c

• PBC governance
• Feedback from 360 survey
• Staff survey

• Key stakeholdersstrongly agree that the PCT
  pro-actively engages clinicians to inform and
  drive strategy, service design and resource
  utilization

• Key stakeholders slightly agree that the PCT
  pro-actively engages clinicians to inform and
  drive strategy, service design and resource
  utilization

• Key stakeholders agree that the PCT pro-actively
  engages clinicians to inform and drive strategy,
  service design and resource utilization

• Does not meet Level 2 requirements

Reputation as leader of clinical engagement
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Assurance process

• Self assessment
• 360
• Metrics
• Panel review
• Panel report
• Potential for improvement

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Incentives and interventions driven by ratings

• Those improving faster than the national average
  should be rewarded
• Those that have lost growth relative to the
  national average should be addressed

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Example PCT data pack content benchmarking of
programme budgets
EXAMPLE
Analysis/data sources
Example outputs

• For each PCT and SHA, McKinsey will prepare a
  benchmarking pack incorporating analysis on
  programme budgeting data such as
• Spend per weighted population and per disease
  registered population across conditions
• PCT spending compared to their public health
  needs and outcomes
• Reports on PCT spending priorities, comparisons
  of proportion of total spend across categories

Source McKinsey
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Recruitment of a high quality panel critical to
the success of the panel review days
Recruitment approach
Description
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• Executive Director from an International
  organisation or another industry

• Agreed participation from Kaiser Permanente
  medical group

Independent Expert
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• Director of Adult Services or Director of
  Childrens Services

• Recruited through linking with the SHAs local
  CSIP and local government networks
• Participants will need to be nominated

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• PBC consortia lead or Medical Director

• This will vary by SHA
• For many panels we would expect to have no costs
  incurred

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• Requirement of the SHA, the participation of the
  Director of Commissioning should be maximised

• Director from the Local SHA

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• PCT Chief Executive from another health economy

• Utilise NHS PCT confederation and PCT networks
• Participants will need to be nominated

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Support and development
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Support and Development Progress so far

• 2-day event in December to discuss support and
  development needs
• Group comprising the NHS Institute, NHS
  Confederation, PCTs, SHAs and DH developed more
  detailed proposals
• Discussion with SHAs and subsequent agreement
  that
• the majority of support and development would be
  managed at a local level
• a small aspect of development would benefit from
  a nationally consistent approach
• DH asked by the SHAs to commission a national PCT
  support programme on board development

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Next steps

• NHS Next Stage Review published
• First cut strategic plans autumn 08
• Second cut strategic plans winter 08
• Clinicians highly involved
• Formal assessment of PCTs published 09/10

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How is this different from current commissioning
approaches?

• Compelling vision
• One integrated system designed as a co-production
  with the NHS
• Industrial approach
• Tough assurance system to direct development
• Innovation
• Clinical involvement and partnership approach at
  heart
• Strategic long term

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What will success look like?

• Vibrant, effective partnerships
• Population actively engaged
• Clear local priorities and long term strategy, to
  tackle local health issues
• Innovative practice based commissioners working
  to an agreed PCT wide strategy . . . But leaving
  room for very local initiatives
• People are staying healthier for longer
• People are living longer
• The inequalities gap is narrowing