Policy Context The Commissioning Challenge

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Policy ContextThe Commissioning Challenge

• Anthony Kealy
• Head of Commissioning Policy

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The NHS is changing because the world is changing
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There has been unprecedented investment
By 2008 NHS investment will have trebled, but
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Weve established a comprehensive reform
programme
Money following the patients, (transactional
reforms)
Better care Better patient experience Better
value for money
More diverse providers, with more freedom to
innovate (supply-side reforms)
Choice Commissioning (demand-side reforms)
System management reforms Safety,quality,
equity, value for money
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There have been tangible improvements
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Failure of Commissioning

• NHS has commissioned for well over a decade,
  but
• Command control delivery model has
  consistently reinforced the provider line
• Commissioners have lacked robust levers
• Not all available levers have been used
• Inadequate regulatory regime bail out
• Low investment in developing commissioners
• Highly variable fragmented practice
• Lack of legitimacy (linked to voice patient
  /public engagement)
• Very limited range of providers

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Re-launching Commissioning

• Vision direction set out in
• The Commissioning Framework (July 2006)
• Practice-Based Commissioning Guidance (November)
• NHS Contract hospitals (December)
• Care and Resource Utilisation demand management
  (December)
• Commissioning Framework for Health Well-being
  (March - consultation)

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The commissioning framework

• Main Themes
• Greater clinical engagement
• More community engagement
• Better information to support commissioning
• New incentives and contracts
• Securing the cash limit
• Developing capacity and capability

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Policy Review Building on Progress public
services

• The vision is to create self-improving
  institutions of public service, independent of
  centralised state control, drawing on the best of
  public, private and voluntary provision.
• These institutions must be free to develop in the
  way they need to, responsive to the needs of
  citizens, and with a flexible workforce able to
  innovate and change. Out of this vision will come
  a new concept of modern public services one
  built around the user of the service.

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Policy Review Building on Progress public
services

• This means
• Empowering citizens to shape services around them
• Opening up the supply side so the greatest
  possible diversity is encouraged .. Use
  contestability and incentives to drive innovation
  and improvement
• Empowering public servants to achieve more
  breaking down the barriers between professions,
  creating new roles
• Reaching out to the most excluded
• Creating a new partnership between the state and
  the people

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A new focus on health well-being
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The Commissioning Framework for Health and
Well-being
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Aims
1. A shift towards services that are personal,
sensitive to the needs of the individual and
focused on maintaining independence.

• A reorientation towards promoting health and
  well-being, and proactive prevention of ill
  health.

3. A stronger focus on commissioning for
outcomes, across health and local government,
working together to reduce health inequalities
promote equality
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Eight steps to more effective commissioning

• Putting people at the centre of commissioning
• Understanding the needs of populations and
  individuals
• Sharing and using information more effectively
• Assuring high quality providers for all services
• Recognising the interdependence of work, health
  and well-being
• Developing incentives for commissioning for
  health and well-being
• Making it happen local accountability
• Making it happen capability and leadership

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What will it mean?

• Less top-down direction
• Greater diversity in service provision
• More responsive services
• Greater accountability and transparency
• Impact on health inequalities