Commissioning Cycles – World Class and BetterAlcohol Improvement Programme5th Early Implementer National ConferenceBirmingham 1st December 2009

To boldly go …

Galactic-class and beyond …

The World Class Commissioning Cycle Cycle or spiral? Making it real ….

…. and a shameless bit of opportunism …

Assess needs

Assess needs

Review current service

provision

Review current service

provisionDecide

prioritiesDecide

priorities

Strategic planning

Design serviceDesign service

Shape structure of

supply

Shape structure of

supply

Specify outcomes &procure services

Manage demand

and ensure appropriate access to

care

Manage demand

and ensure appropriate access to

care

Clinical decision making

Clinical decision making

Managing performance

(quality, performance,

outcomes)

Managing performance

(quality, performance,

outcomes)

Managing demand and performance

Commissioning Spiral

upward spiral is achievable

downward spiral can be avoided

analysing

planning

executing

reviewing

Relationship of commissioning

Strategic Operational Individual

commissioning for the future whilst supporting the here and now

local enablement of the here and now, with an eye to future supply and demand

meeting immediate needs to optimise function in the here and now

(leading and influencing behaviours; facilitating relationships across

all the sectors)

(creating viable local market conditions)

(getting it right for one person aggregates up into getting

it right for all)

Commissioning levels

Multi-level commissioning

Strategic

Operational

Individual

>

>

>

<

<

<

Self directed support, individual budgets and care management

Locality based commissioning and brokerage; support to individual

commissioning

Local authority area wide and regional level joint

commissioning

Strategic Planning

• Assess needs• Review Current Provision• Decide Priorities

Multi-sourced data Credible, cogent detail Understanding local markets Working with the data Collaborating with partners / stakeholders Deciding priorities Disseminating commissioning intentions Planning action

Market Review & Market Dynamics

Demand

Supplier Relationships

JSNA

State-provided

Self-funded

Self-managed

Brokered

Open dialogue

Provider signalling

Shared plans

Shared risk

Planned disinvestment

Micro-markets

Additional provider support

The market

What range

How many

How much

How flexible

How viable

Where sited

What reputation

What quality

What price

Specify Outcomes & Procure Services

• Design Service• Shape and Structure of Supply

Organic and consensual Reflecting local needs Meeting local expectation Getting desired outcomes Stakeholder involvement

in design Market intelligence Influencing supply Market intervention De-commissioning Disinvestment strategies

An opinion …

“There is limited experience in influencing local care markets either by an individual authority/ PCT or collaboratively across (statutory commissioning) authorities. Even where there is an appreciation of its importance, there is often a lack of capacity to spend adequate time engaging productively with providers in planning to transform health and social care services. Discussions may take place with larger providers but often commissioners make little attempt to engage with the range of smaller providers who may be important innovators, particularly for specific ‘niche’ communities’ needs”.

[Kings Fund response to Transforming Adult Social Care]

The Commissioner’s Scope?

What is the scope of the commissioner to influence local markets? Purchasing power? Budgets (growing or contracting)? Market Share?

And what about the effects of … Self-managed Support/personal budgets? External factors – e.g. regulation? Local/national/global economic health? … or … focused too much on price ?

Commissioning Preoccupations

Individual outcomes

Personalisation (PPF/TASC)

Innovation

Quality

Price/Cost

Managing Demand & Performance

• Manage Demand and Ensure Access• Clinical Decision - making• Managing Performance

It’s not ‘Open All Hours’ Targeted / segmented Using planning data Developing forecasting techniques Driving quality Utilising resources Contract compliance Financial regularities Continuous improvement in quality and outcomes

Bench-marking performance

World-Class performers Google ? BBC ? Tesco ? Anytownshire PCT ??

In whose judgement? Based on what results ? To what end ?

Getting it Right First Time – or not

It’s tough scaling the ladders …

… and you might have to slide down

an awful lot of snakes

… Oh! And the Opportunism

An alcohol harm reduction tool Establishing a sense of ‘readiness’ On-line self assessment

strategic planning local programme review and the implementation of the HICs

… ideas welcome!

Thank you for your kind attentionJanet Crampton 07540 503030www.2020commissioning.co.uk