Reverse CommissioningAn Effective Process to Engage

BME CommunitiesDr Vivienne Lyfar-Cissé MBA

Transitional Lead

NHS BME Network

Background

• 2004Launch of Brighton BME Network

• 2007Launch of South East Coast (SEC) BME Network

• 2008SEC Race Equality Service Review

Background contd:-

• 2009Inaugural BME Conference

• 2010Launch of NHS BME Network Conference

• 20111st Anniversary Conference

NHS BME Network

Vision

“to be an independent and effective voicefor BME staff, patients, service users and carers to ensure the NHS delivers on its statutory duties regarding race equality”

What is Commissioning?

Several Definitions:• The act of committing finite resources to

evidence based interventions particularly, but not limited to the health and social sectors with the aim of improving health, reducing inequalities and enhancing patient experience

• The process of specifying, securing and monitoring services to meet the individuals’ needs at a strategic level

The Commissioning Process

The Commissioning Process is driven by

and/or dependent on the need to:

• Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements

• Prioritise investment according to local needs, service requirements and the values of the NHS

• Work collaboratively with community partners to commission services that optimise health gains and reductions in health inequalities

• Proactively seek and build continuous and meaningful engagement with the public and patients to shape services and improve health

1. Assessing needs: through a systematic process, understanding of the health and healthcare needs of the PCTs resident population.

Commissioning Cycle

2. Reviewing services and gap analysis: reviewing the services currently provided and based on the needs, defining gaps (or over provision).

Commissioning Cycle

3. Deciding priorities: given a list of desirable actions using available evidence of cost effectiveness and based on a robust and defensible ethnical framework, prioritise areas for purchase

Commissioning Cycle

4. Risk management: understanding the key health and health care risks facing the PCT and deciding on a strategy to manage it

Commissioning Cycle

5. Strategic options: bring together all the available information into a single strategic commissioning plan that outlines how the PCTs will deliver its core objectives (including those of the SHA and DH)

Commissioning Cycle

6. Contract implementation: put those strategic plans into action through contracting

Commissioning Cycle

7. Provider development (including care pathway re-design and demand management): support provider improvements or introduce new providers to deliver the services required (including setting up demand management systems and designing new care pathways). This includes supporting providers in decommissioning of services where appropriate.

Commissioning Cycle

8. Management provider performance:monitor and manage the performance of providers against their contracts, especially against KPIs.

Commissioning Cycle

QuestionWhy Reverse Commissioning?

AnswerThe commissioning process has (in the main) failed to identify the health needs and effectively engage our BME communities. Consequently, ethnic health inequalities remains a major problem for BME people.

Ethnic Health Inequalities

General Statements

1. The incidence of CHD and diabetes is higher than average in ethnic minority groups

2. Asians are more likely than others to have worse reported health and also have long-term illness

3. Ethnic differentials in the incidence of mental health are well reported

4. Generally people from ethnic minorities have lower levels of satisfaction with health services

5. Etc Etc Etc

Ethnic Health Inequalities

Mental Health - Count me in census 2010

Since the inception of the Delivering Race Equality

Programme in 2005 three of the twelve goals have not

altered materially as follows:

• Admission rates remain higher than average among some minority ethnic groups, especially Black and White./Black Mixed groups for whom rates were two or more times higher than average in 2010 (six times higher than average for the other Black group). In contrast admission rates have consistently been lower than average among the Indian and Chinese groups and about average in the Pakistani and Bangladeshi groups

• Detention rates have almost consistently being higher than average among the Black, White/Black Caribbean Mixed and Other White groups. The rates for being placed on a CTO were higher among the South Asian and Black groups.

• Although there have been annual fluctuations in seclusion rates, they have been higher than average for the Black White/Black Mixed and Other White groups, in at least three of the six censuses

Reverse CommissioningFlagship Project

Brighton and Sussex University Hospitals NHS Trust

Eastern Road, Brighton, BN2 5BE

Dr Vivienne Lyfar-Cissé MBA

Associate Director of Development

NHS SocialCare

PublicHealth

New Structure of the NHS

Department of Health (including public health England) – Overall responsibility for health,

public health and social care policy

Service delivery

Accountability to patients, service users and the public (underpinned by the regulators and Healthwatch England)

NHSCommissioning

Board

Pu

blic h

ealth

delivery

Department for Communities and Local Government

Local authorities(including health and

wellbeing boards)

Subject to Parliamentary scrutiny

LocalCommissioning

Group

NHS Commissioning Board

Remit to commission services to meet the needs of local communitiesand resources allocated accordingly

Remit to commission services to meet the needs of local communitiesand resources allocated accordingly

Remit to commission services to meet the needs of local communitiesand resources allocated accordingly

Lack of evidencex

Remit to commission services to meet the needs of local communitiesand resources allocated accordingly

Lack of evidencex

Health Professionals

Engage

Educate

Enlighten

Enhance service delivery

BME Communities

Enable

Expert

Empower

Enhance patient experience

EstablishReverse Commissioning Group

4 Es Model

Remit to commission services to meet the needs of local communitiesand resources allocated accordingly

Lack of evidencex

Remit to commission services to meet the needs of local communitiesand resources allocated accordingly

Lack of evidencex

Health improvement

Ethnic health equalities

Health promotion

Does the Evidence Exist???

Generally

• Ethnic monitoring has been a legal requirement for many years

Specifically (Mental Health)

• Mental Health Minimum Data Set (MHMDS) –the statutory data set submitted by the providers of specialist mental health services in England to the National Mental Health Development Unit (NMHDU). The data provided covers information concerning the following:

• Individual patients

• Services provided to those admitted to hospital

• Community Treatment Orders

• The Outcome of Care

Inpatient Data

 

Total Number of Patients = 775

Total Number of BME Patients = 61

14.8%

21.3%

1.6%

6.6%13.1%

29.5%

13.1%

Ethnicity of BME Inpatients - %

Black

Asian

Chinese

Mixed

White Irish

White Other

Other BME

Diabetes Department

Outpatient Data

 

Total Number of Patients = 7526

Total Number of BME Patients = 976

12.8%

32.8%

0.9%

6.8%6.4%

31.4%

9.0%

Ethnicity of BME Outpatients - %

Black

Asian

Chinese

Mixed

White Irish

White Other

Other BME

Diabetes Department cont’d

Percentage of Inpatient and Outpatient Data compared

Ethnic Group Percent Inpatients Percent of Outpatients

Black 14.8 12.8

Asian 21.3 32.8

Chinese 1.6 0.9

Mixed 6.6 6.8

White Irish 13.1 6.4

White Other 29.5 31.4

Any Other Ethnic Group 13.1 9.0

Total 100.0 100.0

Diabetes Department cont’d

The NHS Outcomes Framework 2011/12

The focus of the Framework is on health improvement and its purpose is threefold:

• To provide a national level overview of how well the NHS is performing, wherever possible in an international context

• To provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board; and

• To act as a catalyst for driving quality improvement and outcome measurement throughout the NHS encouraging change in culture and behaviour, including a renewed focus on tackling inequalities in outcomes.

The NHS Outcomes Framework 2011/12

1 NHS Outcomes FrameworkDomain 1

Preventing people from dying

prematurely

Domain 2Enhancing quality of life for people with

long-term conditions

Domain 3Helping people to

recover from episodes of ill health

or following injury

Domain 4Ensuring that people

have a positive experience of care

Domain 5Treating and caring for people in a safe environment and

protecting them from avoidable harm

Duty of quality

Duty of quality

Du

ty o

f q

ua

lity

Du

ty o

f qu

ality

NICE Quality Standards(building a library of approx 150 over 5 years)

2

CommissioningOutcomesFramework

3

CommissioningGuidance

4 Provide payment mechanismsStandardcontracttariff CQUIN QOF

5

Commissioning/ContractingNHS Commissioning Board – certain specialist services and primary care

GP consortia – all other healthcare services

6

Page 42-The NHS Outcomes Framework 2011/12

“The Department of Health has made tackling health inequalities a priority and it is also under a legal obligation to promote equality across the equality strands protected in the Equality Act 2010. There is therefore both a legal requirement and a principle in designing the NHS Outcomes Framework that its induction will not cause any group to be disadvantaged. We have used the equalities and inequalities breakdowns to assess data availability in order to monitor this commitment. Date collection is more complete for some of the strands than others; for example, there is better coverage (questions are asked as standard and patients provide the information) for age and gender than for religion or belief and sexual orientation”.

Our question - What about ethnicity?

What is Reverse Commissioning?

Reverse Commissioning is an effective process to engage BME communities to ensure their health needs are addressed by the NHS

Why Reverse Commissioning?

Reverse Commissioning is necessary because the existing commissioning process has failed to

(i) identify the needs of BME communities

(ii) effectively engage with BME communities and

(iii) reduce/eliminate ethnic health inequalities.

How Does Reverse Commissioning Work?

Reverse Commissioning works by:

• Using existing data and evidence to identify the needs of BME communities

• By recognising that Health Professionals needs to be educated and trained to enhance service delivery

• Recognising that BME communities need to be empowered to engage with Health Professionals

• Recognising there is a need to establish lasting partnerships between health professionals and BME service users to effect change

• Using information gained from these partnerships to influence commissioning by Local Clinical Commissioning groups.

Summary cont’d:What are the Desired Outcomes of Reverse Commissioning?

The desired outcomes of reverse commissioning are as follows:

• Clinical services that meet the needs of BME communities• Enhanced BME patient experience• Enlightened health professionals • Enhanced clinical service delivery to BME people• Reduction in ethnic health inequalities• Health improvement for BME communities• Health promotion programmes directed at BME communities• Effective and lasting partnerships between health professionals and BME services users to effect change

Conclusion

Effective commissioning to meet the needs of BME communities is possible if we apply the correct process

Discussion How can we best deliver on the 4Es model?

Health Professionals

Engage

Educate

Enlighten

Enhance service delivery

BME Communities

Enable

Expert

Empower

Enhance patient experience

4 Es Model

The Big Move1st Anniversary Conference

Date: Friday 16 September 2011

Time: 09.30-16.30 Hours

Venue: London Hilton Park Lane

Thank you