World Class Commissioning a Guide for Professionals

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Commissioning Supportfor London

Mental HealthWorld Class Commissioning.A quick guide for mental health professionals

August 2009


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Mental Health World Class Commissioning.A quick guide for mental health professionals2

Engagement in commissioning involvesunderstanding and applying:

thepolicyandstrategiccontextofMentalHealthWorld Class Commissioning ( WCC)

howtoinuenceWCCandthedecisionsmadebycommissionersinyourlocality

thepublichealthandevidencebaseforWCCdrivers.

Engaging in commissioning requires the mentalhealth proessional, clinician and practitioner to:

focusontherelationshipsyouhavewithcommissioningcolleaguesandhowtocommunicateclinicalchallenges

understandhow,whenandwheretheabovetwiththecommissioningdecision-makingprocess.


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Mental Health World Class Commissioning.A quick guide for mental health professionals4


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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 2009 05

Foreword 03

Who is the guide or? 06

Why read it? 06

What does it cover? 07

Understanding mental health policy 08

Commissioning or mental health 12

World Class Commissioning 13

What are the World Class Commissioning competencies? 14

Why does World Class Commissioning matter to the mental health proessional? 15

The commissioning cycle stage by stage 16

Working better together 21

Useul links 23

Reerences 24

Acknowledgements 25

Contents


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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200906

The guide is or clinicians and other mental

health proessionals working along the

mental health care pathway who would

like to learn more about the principles o

World Class Commissioning (WCC) and how

they could be involved in improving services

or users. Mental health commissioning is

relevant to many dierent stakeholders:

people who use services, people who deliverservices, those who monitor perormance

and eectiveness, and the wider public.

This guide has three objectives:

1 awareness to highlight the challenges

aced by commissioners, clinicians, and

other proessionals who are working to

implement strategic commissioning at

local level

2 knowledge to improve understanding

o the commissioning process

3 application to describe how mental

health proessionals can get involved

in commissioning, and how

commissioning colleagues can benet

rom the involvement o mental

health proessionals.

Mental health proessionals have an

important role to play in infuencing

commissioning decisions.

The purpose o this guide is to describe

the basics o WCC and encourage mental

health proessionals to get involved in the

commissioning agenda and work with the

health and social care commissioners intheir area.

The guide explains how mental health

proessionals can:

inuence decisions in partnership

with commissioners

understand the political and perormance-

related incentives that guide the work o

commissioners

improve services, and

build on opportunities to improve

outcomes and quality.

Who is theguide for?

Whyreadit?


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The guide starts with an overview o current

mental health policies, setting the context

or the World Class Commissioning agenda.

It goes on to:

explain what World Class Commissioning

is, and what it demands of those

responsible for commissioning

health services explain the commissioning cycle whereby

commissioners arrive at their decisions

about what services to commission

explain why and how mental health

professionals can and should get involved

in the commissioning process

suggest some prompts that highlight

what professionals can bring to the

commissioning process

explore barriers to professional

involvement in commissioning, and

suggest ways in which professionals

and commissioners can work together

to improve mental health services.

What doesitcover?


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Mental Health World Class Commissioning

operates within the context o a number o

key national policies and guidance.

National Service Framework for MentalHealth (Department o Health, 1999)

The National Service Framework (NSF) for

Mental Health (Department o Health,

1999) prioritised mental health as one othree key health issues requiring investment

and development, alongside coronary

heart disease and cancer. It set out seven

standards, with milestones or achieving

set objectives within its ten-year liespan,

within a national template o evidence-

based services or working age adults with

which local mental health services were

required to comply. These services, covering

mental health promotion, primary mentalhealth care, services or people with severe

mental illness, services or carers, and

interventions to prevent suicide, were to

be provided seamlessly between agencies

and available around the clock. A review

o the implementation o the National

Service Framework, published in 2004,

ound that mental health services had been

successully reshaped according to the NSF,

but there remained areas requiring urther

improvement specically, inpatient care,

services or people with dual diagnosis, social

exclusion o people with mental health

problems, services or ethnic minorities, and

access to psychological therapies.

New Horizons

A new Department o Health strategy, New

Horizons, will replace the NSF towards the

end o 2009. New Horizons is expected

to give more weight than the NSFto theimportance o promoting whole-population

mental health and well-being across the

liespan, while supporting continued

improvement o specialist services or people

with severe and enduring mental health

problems. It will also address the inequalities

that dierent groups in society experience,

both in access to services and in levels o

mental health. It will guide a programme o

action or mental health services rom 2010

and bring together agreed principles andpriorities under one banner, aligning them

with High Quality Care for All(the Darzi

report, see below) and other government

health and social care policies, such as

Putting People First(see page 9).

At the time o going to press, New Horizons

is out or consultation until 15th October

2009. For urther inormation please

go directly to the Department o Health

wesbite: www.dh.gov.uk/en/Healthcare/

Mentalhealth/NewHorizons/index.htm

Delivering Race Equality: an action planfor reform (Department o Health, 2005)

The Delivering Race Equalityaction plan was

published in 2005. It draws on the report

into the death o David Rocky Bennett in

a medium secure unit in Norwich in 1998,

and a growing body o evidence that people

rom black and minority ethnic groups are

disproportionately detained in psychiatric

units, have a poorer experience o mental

health services than their white British

counterparts, and are more likely to be

subject to compulsory treatment. Delivering

Race Equalitysets out a ve year action

plan or achieving equality and tackling

discrimination in mental health services or

all BME people, including people o Irish and

Mediterranean origin and east Europeanmigrants. The action plan comprises three

main building blocks:

Understanding mentalhealthpolicy
http://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htmhttp://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htmhttp://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htmhttp://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htm


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moreappropriateandresponsiveservices

communityengagement,viacommunity

development workers based in every PCT

betterinformation,includinganew

annual census o mental health patients.

Our Health, Our Care, Our Say:anew direction for community services

(Department o Health, 2006)This document emerged rom an

extensive consultation with the public and

proessionals. It builds on Choosing Health,

the public health White Paper (Department

o Health, 2004), which identied the

improvement o mental well-being as a

priority or health and social care services.

Our Health, Our Care, Our Saysets out how

NHS and social care services should work

together to provide more individualised

health and social care services that better

meet peoples needs and are available closer

to their homes. It states that health andsocial care services should be more fexible

and more personalised to meet the health

and social care needs o individuals, and

should give patients and service users more

control over the treatment they receive.

It gives GPs, primary care trusts and local

authorities more say in how best to plan and

commission services or local communities,

outlines the need or a shit in resources

towards preventive services, and encouragesgreater partnership between statutory

health and social services and the third sector.

Commissioning Framework or Health andWell-being (Department o Health, 2007)

This provides a ramework and practical

suggestions, including resources and

sources or tools, or commissioning or

health and well-being rom 2008/09. It

sets out a number o objectives to help

people stay healthy and independent

and to build stronger communities. These

include giving people choice about care

services, delivering services close to home,

and tackling health inequalities.

Putting People First(Department o Health, 2007)

Putting People Firstis jointly endorsed by

all government departments and many

o the lead voluntary sector organisations

concerned with adult social care. It outlines

the governments vision or a personalised

adult social care system that is designed to

maximise peoples independence, choice

and control over their own lives and care.

Its proposals include a rst stop shop to

provide a universal inormation, advice and

advocacy service or people needing social

care services, and their carers, irrespective

o their eligibility or public unding.

It introduces the Joint Strategic Needs

Assessment, to be conducted together

by NHS providers, local authorities and

PCTs, and combined with other local

needs assessments (i.e. housing) to orm a

Sustainable Community Strategy or the

area. It sets out how these agencies can

identiy and agree, with other stakeholder

organisations, how best to meet local

priority needs, and which agency will do

so, through Local Area Agreements. It alsointroduces personalised budgets or all those

eligible or state-unded social care services.

social care servicesshould be more fexibleand more personalised


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The Local Government and PublicInvolvement in Health Act 2007 (HMSO, 2007)

This Act enacts the 2006 Local Government

White Paper. Among its provisions directly

relating to health and social care, it replaces

the Patient and Public Involvement Forums

(PPIFs) with Local Involvement Networks

(LINks), to provide the patient and public

voice in the planning and delivery o local

health and social care services (PPIFs related

only to health services), and claries and

strengthens the existing duty on NHS bodies

to involve and consult patients and the

public in the planning and provision o

services. It places a specic duty on local

authorities to undertake Joint Strategic

Needs Assessments and to consult with their

local communities. It also requires PCTs, local

authorities and other relevant bodies to co-

operate with each other in the development

and agreement o Local Area Agreements,

which are also given statutory status.

Cross-cutting prioritiesIn addition, the government has identied

a number o key, cross-cutting priorities to

which all public services are expected to

contribute. In mental health and social care,

the most relevant are:

personalisation

socialinclusion.

Personalisation

Personalisation embodies the governments

aim to put people rst in public service

delivery. The stated aim is that people should

be able to live their own lives as they wish,

and should receive high quality, sae health

and social care services that support theirown goals and promote their independence,

well-being, and dignity.

This approach is set out in Putting People

First, which states that every person who

receives support, whether provided by

statutory services or sel-unded, will have

choice and control over the shape o that

support in all care settings. Direct payments

and individual budgets are seen as the

means to deliver this aspiration.

Social exclusion

Social exclusion in relation to adults with

mental health problems is documented

in the Mental Health and Social Exclusion

report, published in 2004 by the Oce o

the Deputy Prime Minister. This highlighted

the lack o employment opportunities,

poverty, poor housing, social isolation,

stigma and exclusion rom community

services experienced by people with severemental health problems.

Government action to tackle social exclusion

is set out in the Public Service Agreement

(PSA) 16 (see overlea or an explanation

o PSAs). PSA 16 ocuses specically on the

needs o our client groups who are seen as

particularly vulnerable to poor lie outcomes

and multiple orms o disadvantage:

youngpeopleleavingcare offendersunderprobationsupervision

peoplereceivingsecondarymental

health services

peoplewithmoderatetosevere

learning disabilities.

PSA 16 has two key aims: to increase the

numbers o people in these groups living

in settled accommodation, and to increase

employment, education and training ratesin these groups. Government departments

signed up to achieving these aims include


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the Department or Work and Pensions,

the Department o Communities and Local

Government, the Ministry o Justice, the

Department o Health, the Department

or Innovation, Universities and Skills, and

the Department or Children, Schools and

Families. This partnership approach will

be refected at local authority and health

service commissioning and delivery level.

Policy into practicePublic Service Agreements (PSAs)

The strategic ramework governing the

delivery o all government policy is provided

by the Comprehensive Spending Review

(CSR) and Public Service Agreements. The

aim is to ensure the relevant government

(national and local) departments work

together to address areas o priority publicservice need, and that public spending

and perormance at local level is careully

monitored to ensure quality o service

provision and value or money.

The CSR sets out the governments public

spending plans. PSAs provide the perormance

management ramework whereby the

government sets out the outcomes expected

to be delivered by public services at nationaland corresponding local levels.

PSAs or the current period (2008/09

2010/11) are set out in the Comprehensive

Spending Review 2007. The PSAs are

grouped under ve main headings:

helppeopleandbusinessescomethroughthe

downturn sooner and stronger, supporting

long-term economic growth and prosperity

fairnessandopportunityforall abetterqualityoflife

strongercommunities

amoresecure,fairandenvironmentally

sustainable world.

Those with specic relevance or mental

health and social care are:

Fairnessandopportunityforall

Address the disadvantage that

individuals experience because o their

gender, race, disability, age, sexual

orientation, religion or belie

Increase the proportion o

socially excluded adults in settled

accommodation and employment,

education or training.

Abetterqualityoflife

Promote better health and

well-being or all

Ensure better care or all.

Each PSA is underpinned by a single delivery

agreement shared across all government

departments concerned. Delivery

agreements are expected to be developed

in consultation with NHS trusts and other

agencies who will be delivering the services,

and with rontline workers.

At local level PSAs are refected in Local Area

Agreements (LAAs) and Local Public ServiceAgreements (LPSAs). Local Area Agreements

may cover one or more local authority

area and set out goals, agreed with all

participating agencies, or service delivery

across a range o public services.

Local Public Service Agreements provide a

ramework through which local authorities

and other local organisations agree targets

or service delivery and improvement withcentral government, and are nancially

rewarded or achieving these targets.


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Commissioning is the process whereby PCTs

and local authorities translate the aspirations

and needs o their local populations into

services that:

deliverthebestpossiblehealthand

well-being outcomes

reduceinequalitiesandpromoteequality

providethebestpossiblehealthandlocal

authority provision

achievethebestuseofavailableresources

Put simply, commissioning is the cyclical

process o planning, developing, monitoring

and reviewing health and social care services.

The role o the mental healthcommissioner

The mental health commissioner is the

executive ocer within a PCT responsible

or taking a lead on assessing local

mental health needs, reviewing service

provision, developing strategic plans

and commissioning services and service

development or the population served

by the PCT, the local authority, and third

sector organisations.

It is important to remember that

commissioners do not work in isolation.PCTs will have a number o commissioners

with lead responsibility or each o the

health specialisms.

Commissioningfor mental health


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World Class Commissioning (WCC) was

launched by the Department o Health in

2008. It is an ambitious programme, based

on best practice in the UK and other health

systems around the world, to transorm the

way in which PCTs ull their commissioning

unction. Its aim is to help PCTs deliver better

services that are more closely matched to

local needs, resulting in better quality ocare, improved health and well-being and

a reduction in health inequalities across the

community.

WCC does this by creating a ramework

through which PCTs can ocus on improving

the health o local people.

There are our key elements to the World

Class Commissioning ramework. Vision - To achieve world class excellence

in delivering health improvement

through commissioning.

Assurance system - To develop

appropriate rameworks or implementing

world class commissioning and ensuring

improved health outcomes.

Competencies - To dene the knowledge,

skills, behaviours and characteristicscommissioners will need to reach world

class status.

Support and development - To develop

tools or commissioners to deliver

improvements, either by sharing

services and costs across localities,

remodelling and expanding internal

resources, or buying in external expertise.

Outcome-based commissioning

Outcome-based commissioning ocuses

not on activities and processes but on

results. It represents a shit away rom

previous practice whereby commissioning

was based on providers meeting contractual

requirements through outputs such as

the number o hours or type o service

to be provided. Outcome-based

commissioning means that providers will

have to demonstrate how their services

will achieve real and tangible benets or

the local population.

The task or commissioners is to dene

what systems and services need to be

in place in order to meet the outcomes

required or their local populations and then

support providers to improve services that

are not working towards those outcomes.

Improvements may be in:

clinicalandcareoutcomes

healthoutcomes

communityoutcomes

World ClassCommissioning


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What are the World ClassCommissioning competencies?

14

There are 11 competencies (or sets o

skills) in which commissioners and PCTs are

expected to demonstrate their prociency.

Below are listed the WCC competencies

with most relevance to mental health

proessionals, and a brie explanation o

what they mean in practice.

Leading the continuous and meaningul

engagement o all clinicians to inorm

strategy and drive quality, service design

and use o resources.

Commissioners are explicitly required to

involve and draw on the knowledge and

experience of frontline practitioners when

researching and making decisions about

commissioning services.

Proactively seeking and building

continuous and meaningul engagement

with the public and patients, to shape

services and improve health.

Commissioners are explicitly required to

consult with and involve service users and

the wider public in reaching their decisions

about local needs and how best to meetthem.

Stimulating the market to meet demand

and secure required clinical and health

and well-being outcomes.

Commissioners are expected to encourage

innovation and look beyond their usual

providers when inviting tenders from

organisations to run services.

Promoting and speciying continuous

improvements in quality and outcomes

through clinical and provider innovation

and confguration.

Commissioners are expected to promote

and support innovative approaches

to clinical care and treatment and the

organisation o services to deliver betterquality and improved outcomes.

The ull list o WCC competencies

can be ound at: www.dh.gov.uk/en/

Managingyourorganisation/Commissioning/

Worldclasscommissioning/Competencies/

index.htm
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htm


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WhydoesWorldClassCommissioningmatter to mental health professionals?

Proessional leadership and involvement

should be an integral part o the

commissioning process. Mental health

proessionals and clinicians work with

their local communities and know about

local needs and shortalls in service

provision. Their knowledge is o paramount

importance or inorming strategic plans and

decision-making during commissioning.

Mental health proessionals and clinicians

are well placed to draw attention to and

advise on issues relating to quality and

eectiveness o services. They can also

oer valuable insights on the eectiveness

o care pathways and the points at which

early interventions can be most successully

implemented.

Clinicians have animportant role toplay in assessinglocal needs and

shaping priorities(World Class Commissioning: vision.

Department o Health, 2007)

Barriers to proessional involvementin World Class Commissioning

There are a number o reasons why

proessionals may not be currently

suciently involved in the commissioning

process. These include pressure on timerom their work commitments, incomplete

understanding o the commissioning process

and its relevance to their clinical and

proessional practice, and concerns that their

contributions may not be valued.

Increased proessional involvement in

strategic planning and service design

is a critical component o World Class

Commissioning and essential in ensuring

clinical excellence.


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Thecommissioningcycle

16

The commissioning cycle is the annual

process by which commissioners are

expected to deliver improved health and

well-being outcomes.

It describes the continuous process whereby

commissioners collect, analyse and use data

to make decisions about spending and

service development. The commissioningcycle also helps commissioners think about

the strategic plans they need to produce,

and when.

Understanding the eight stages o the

commissioning cycle is central to the

successul infuencing o commissioning

decisions. Mental health proessionals

are well-placed to provide important

inormation at a number o points in thecycle. Ultimately, proessional involvement

helps to ensure that commissioning

decisions and resource allocation meet

the needs o people with mental illness,

address actors that negatively aect

mental health, and support well-being.

In addition, the commissioning cycle includes

the development, review and approval o

three urther key plans.

1 The Strategic Commissioning Plan (SCP)

is produced by every PCT and establishes

its direction and priorities or at least the

next ve years. It is developed every three

years and updated annually. The CSP

should be available on your PCTs website.

2 The Operating Plan sets out how the PCT

plans to achieve the health outcomes and

nancial goals set out in the Strategic

Commissioning Plan (SCP). It includes

targets, nancial and activity schedules

and action plans. It is developed annually.

3 The Organisational Development Plan

describes the organisational capabilities

needed to deliver the Strategic

Commissioning Plan, and any capability

gaps and how they will be lled. It is

developed every three years and updated

annually. PCT boards are required to work

with local stakeholders (these include

mental health proessionals) to ensure

these plans are comprehensive and joined

up with local delivery.

PCTs are expected to work with local

stakeholders to ensure these plans are

comprehensive and integrated into local

delivery plans.

The role o the Strategic HealthAuthority (SHA)

Strategic Health Authorities (SHAs)

have a regulatory role in that it is their

responsibility to ensure that all threeplans contain nancially sound options

that are regularly reviewed and lead to

signicant improvements in the health

o local populations.


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The commissioning cycle stage by stage

This section describes the WCC cycle in more detail, and oers suggestions about where and

how mental health proessionals, clinicians and practitioners can maximise their impact at

each stage.

The diagram below explains the commissioning cycle. It is just one example: approaches may

dier rom area to area.

1 Assessing needs

Understandingthehealthcareneedsof the PCT population

Stakeholderengagement Engagingclinicalchampionsand

serviceleaders

2 Reviewing services and

gap analysis

Reviewingservicescurrentlyprovided Deningthegapsorover-provision

3 Risk management

Understandingthekeyhealth

and health care risks Decidingonastrategytomanage risks

4 Deciding priorities

Robustevidencebase Costcomparisons Prioritisingareasforpurchase

5 Strategic planning

Collatingallinformationinoneplan(CSP)

Settingactionpointsfordelivery

including: localcoreobjectives SHAandDHpriorities

8 Managing provider perormance

Managingproviderperformanceandsustainingquality

Monitoringagainstcontractsandkeyperformanceindicators

7 Provider development

Carepathwayre-designanddemand management

Supportingproviderimprovementsorintroducingnewproviders

Supportingprovidersindecommis-sioningofservicesasappropriate

6 Contract implementation

Implementingstrategicplans

throughcontractingwithproviders Allcontractscommissionedto demonstrate clear anddenedoutcomes


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Step 1 Assessing Needs

Commissioners need to build an accurate

picture o the health and health care needs

o the local population. The PCTs website

should include details o the standards,

reviews and commissioning plans o which

mental health proessionals, clinicians and

practitioners need to be aware. The PCTs

annual review will show how well it is

perorming in its commissioning unction

against the WCC ramework. Every PCTs

progress and development needs are assessed

through an annual assurance check.

3 Check your local PCT website or a copyo the World Class Commissioning Report

2009 that gives an outline o your PCTs

progress to date and details or supporting

strategic plans or improving health andwell-being within the local community.

Step 2 Reviewing services and gap analysis

Based on the known needs o each area

within their remit, commissioners need to

review existing services and the extent to

which the services they commission meet

those needs, and identiy any areas o

over-provision or gaps. All PCTs and local

authorities are required by law to produce aJoint Strategic Needs Assessment (JSNA). This

provides the evidence base or the health

and well-being o the local population,

including health, mental health, housing,

education, deprivation levels, economic

activity etc, which will allow decision makers

to identiy areas o need, and how these are

likely to change in the uture. By drawing

together these needs in a single document,

the JSNA enables local agencies to worktogether and co-ordinate planning to ensure

their services meet current and uture needs.

3 Have you seen your local Joint StrategicNeeds Assessment (JSNA)? Ask or a copy

rom your mental health commissioner. Does

it match your understanding o the health

needs o the communities with which you

work? Are there areas o need that the

needs assessment has missed?

Step 3 Risk management

Commissioners need to identiy the main

health and health care risks (ie. unexpected

need or a particular service, an ageing

population that may need services in the

uture) anticipated in their local area, and

contribute to a strategy that addresses and

mitigates those risks.

3 Through your work, identiy anysignicant health and health care risks,

both current and looking ahead to the

uture. What evidence do you have or their

existence and what potential solutions can

you suggest to commissioners?

Step 4 Deciding priorities

Based on sound evidence and an ethical

ramework, commissioners need to be ableto advise the PCT on the current health and

health care priorities in their area.


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3 Is the evidence base comprehensive?Does it include the data and inormation

you have collected rom your services how

people access your services and the levels

o uptake? Are you aware o planned

investment/disinvestments plans that may

aect your service next year? Do you know

how mental health commissioning plans mayaect your service in the next 12 months? Is

the local Strategic Commissioning Plan (SCP)

inormed by the expertise o the people

working in your service and the data you

have collected?

Responsibility or some mental health

commissioning is being transerred

rom PCTs to general practitioners (GPs)

and other senior primary care clinicians

through a process known as practice-based

commissioning.

3 Are local practice-based commissionersaware o your service? How can your

specialist input improve their knowledge

o local health needs and the decisions

they make? Do they have plans or uture

investment/disinvestment that may aect

your service?

Step 5 Strategic options

By collating the evidence into a single

Strategic Commissioning Plan,

commissioners are able to take a strategic

view on immediate, medium and long

term commissioning objectives. The SCP

also takes into account national and

regional perormance indicators and

outcomes required by the SHA and the

Department o Health.

3 Read the Strategic Commissioning Planor your area. Do the priorities outlined

match your own views o the areas in most

need o service development? Do you have

the inormation necessary to infuence the

detail and delivery o the SCPs objectives?

Do you have a good understanding o the

local and national perormance drivers thatmay aect the way you deliver and monitor

the eectiveness o your service? Ask your

commissioner or a list o national and

regional priorities that are relevant to

your service and or guidance on how

you may be asked to meet perormance

indicators or targets.

Step 6 Contract implementation

Commissioners then translate their strategicplans into contracts, setting out value or

money, clinical and service use outcomes,

service models and perormance monitoring.

These ensure that the PCT is meeting its

obligations to procure high quality services

that achieve health improvements or all

sections o the community.

3 Do you have a good understanding o

the contract arrangements or your service?Are you aware o the new contracting

arrangements proposed in the standard


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mental health contract guidance issued by

the Department o Health? The Department

o Health has published two new standard

contracts that will be used by primary care

trusts (PCTs) to contract health and care

services with any provider rom April 2009.

There is one or general community based

services and another or specialist mental

health/learning disability or substancemisuse services. The contracts contain

standard legal terms that cannot be changed

and a service specication template or

completion at a local level or each service.

For urther details, visit: www.dh.gov.uk/en/


Systemmanagement/DH_085048

Step 7 Provider development

In addition, PCTs have a responsibility to

support and resource providers to improve

and develop their services and sta, and to

encourage new providers to develop new

and innovative service options.

3What are the outcomes expected romyou individually and rom your service as

a whole? How can you contribute to these

outcomes in your work, and how can you

best demonstrate tangibly that you aredoing so?

Step 8 Managing provider perormance

Commissioners are required to monitor

and manage the perormance o the

providers they commission. How providers

report on their perormance should be set

out in the contract, together with any key

perormance indicators that may have been

set by the SHA.

3 Have you seen the perormance returnsor your service or been involved in service

monitoring visits? Knowing what your

service specication says and what your

service is expected to deliver are important

as it will help you understand the strategic

process whereby your service

is commissioned and monitored.

Ask your local commissioner to add you to

their circulation list or any consultations.

You need all this inormation to inuence

commissioning decisions in your locality.
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048


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Workingbetter together

The introduction o World Class

Commissioning requires new competencies

or commissioners and proessionals involved

in the planning and procurement o mental

health services. These changing roles have

an impact on the commissioner-provider

relationship, resulting in a dierent dynamic

and new ways o working. As commissioners

consolidate the WCC competencies and theirrole develops, so too must the knowledge

and skill base o those who work with them.

World Class Commissioning requires

commissioners and proessionals to work

constructively and positively together. So

3Build a dialogue and share yourperspective

Develop a good working relationship withyour commissioners. Establishing regular

dialogue will help them understand and

appreciate the challenges proessionals ace,

and ensure your perspectives contribute

useully to strategic planning, quality o care

and service development. Your knowledge is

crucial to the commissioning process.

3Establish a shared evidence-base

The main ocus o commissioning is onmonitoring quality o care, identiying unmet

needs and improving outcomes. Establishing

a common set o measures to evaluate these

will acilitate decision making about service

improvements and innovation. Clinicians are

in a unique position to collect the necessary

data (through audits, clinical eectiveness

targets and the use o national guidance rom

the National Institute or Health and Clinical

Excellence (NICE)) to inorm commissioningdecisions. For more inormation on NICE

guidance, visit: www.nice.org.uk

Ask yoursel

Whatskillsandexpertisecan

I contribute towards each o the

commissioning cycle stages?

WhatdoIwantcommissionerstoknowabout local services and local needs beore

they make commissioning decisions?

WhatevidencehaveI/colleaguescollected

that could be used to argue or and

inorm the development o new services?

WhatknowledgeordatadoIholdon

local care pathways and current use o

resources?
http://www.nice.org.uk/http://www.nice.org.uk/


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The example below shows how proessional input can help drive strategic service improvement.

Invest to save

Proessional engagement in the quality and cost agenda

In line with the World Class Commissioning expectation on commissioners to review

and update established practices and care pathways, Sutton and Merton PCT, the

London Borough o Sutton and South West London and St Georges Mental Health

Trust are working with local proessionals to develop care pathways that are

responsive to current need, reduce costs and improve service delivery.

Commissioners have established an Invest to Save project to review all residential,

nursing and orensic care placements to ensure they meet WCC standards and use

evidence based practice and the recovery model.

The project is based on the premise that identiying savings and nancial

eciencies in the commissioning process must be accompanied by an equal ocus

on the quality and outcomes o services.

Commissioners work with residential and nursing providers to set clear targets

or quality and perormance so that they are better inormed about progress or

each patient/client.

Proessionals are given opportunity to comment on the most appropriate

pathway or users and any challenges they encounter when co-ordinating care

across agencies.

Monthly review meetings between commissioners and trust managers aim tomake continuous improvement in both the management o placements and

the commissioning requirements underpinning them.

Proactively seeking to involve and engage providers in the commissioning process

and giving proessionals an opportunity to exert real infuence over the direction

o change o services and to comment on the care pathway leads to improvements

in services, enhances the patients experience, boosts sta morale, and helps to

achieve national policy objectives.

For urther inormation contact [email protected]
mailto:[email protected]:[email protected]


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Useful links

World Class Commissioning

www.dh.gov.uk/en/


Worldclasscommissioning/index.htm

Standard mental health contract

www.dh.gov.uk/en/

Managingyourorganisation/Commissioning/Systemmanagement/DH_085048

NICE clinical guidance

www.nice.org.uk

JSNA toolkit

www.nmhdu.org.uk

Commissioning and procurement the

mental health road map or commissionerswww.pasa.nhs.uk/PASAWeb/PCTzone/

mentalhealthservices/

Outcomes compendium: helping you select

the right tools or best mental health care

practice in your feld

www.dh.gov.uk/en/Publicationsandstatistics/

Publications/PublicationsPolicyAndGuidance/

DH_093316

Public Health Observatories

www.apho.org.uk

Readers are advised that all of the above links were

correct at the time of going to press. If you have problems

accessing the documents through the direct links detailed

above, they should be readily located via a search from

the relevant sites home page.
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.nice.org.uk/http://www.nmhdu.org.uk/http://www.pasa.nhs.uk/PASAWeb/PCTzone/mentalhealthservices/http://www.pasa.nhs.uk/PASAWeb/PCTzone/mentalhealthservices/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.apho.org.uk/http://www.apho.org.uk/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.pasa.nhs.uk/PASAWeb/PCTzone/mentalhealthservices/http://www.nmhdu.org.uk/http://www.nice.org.uk/http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm


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References

24

Department o Health (1999)National service ramework or mentalhealth. London: Department o Health.

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598

Department o Health (2004)

The national service ramework or mentalhealth fve years on.London: Department o Health.


Department o Health (2005)Delivering race equality in mental health care:an action plan or reorm inside and outsideservices. London: Department o Health.


Department o Health (2006)Our health, our care, our say: a newdirection or community services.London: Department o Health.

www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882

Department o Health (2007)Commissioning ramework or health andwell-being. London: Department o Health.


Department o Health (2007)Putting people frst: a shared vision andcommitment to the transormation o adultsocial care. London: Department o Health


Department o Health (2007)World class commissioning: vision.London: Department o Health


Department o Health (2008)Department o Health strategic ramework.London: Department o Health.


Department o Health (2008)High quality care or all: NHS next stagereview fnal report (the Darzi report).London: Department o Health.


HMSO (2007)The Local Government and PublicInvolvement in Health Act 2007.London: HMSO.

www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1

HM Treasury (2007)2007 pre-budget report and comprehensivespending review: meeting the aspirations othe British people. London: HM Treasury.

www.hm-treasury.gov.uk/pbr_csr07_index.htm

Social Exclusion Unit (2004)Mental health and social exclusion. London:Ofce o the Deputy Prime Minister.

www.socialinclusion.org.uk/publications/SEU.pd
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1http://www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1http://www.hm-treasury.gov.uk/pbr_csr07_index.htmhttp://www.socialinclusion.org.uk/publications/SEU.pdfhttp://www.socialinclusion.org.uk/publications/SEU.pdfhttp://www.hm-treasury.gov.uk/pbr_csr07_index.htmhttp://www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598


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Acknowledgements

The National Mental Health Development

Unit and Commissioning Support for

London would like to express their thanks

to the members of the London Clinical and

Professional Engagement Advisory Group

(CPAG), who generously gave their time

and expertise to inform this guide.

Thomas Barnes Honorary consultant, WestLondon Mental Health Trust/Proessor o

Clinical Psychiatry, Imperial College, London

Jed Boardman Senior Policy Adviser,

Sainsbury Centre or Mental Health

Deborah Colvin GP, City & Hackney PCT

Sophia Frangou Head o Section,

neurobiology o psychosis, and Sub-Dean,

Institute O Psychiatry/Honorary ConsultantPsychiatrist, South London and Maudsley

NHS Foundation Trust

Catherine Gamble Nurse Specialist,

South West London and St Georges

Mental Health Trust

Claire Helman Director o New Initiatives,

Together: Working or Well-being

Sian Rees Senior Policy Advisor, MentalHealth, Department o Health

Bernadette Simpson Personalisation Lead,

Department o Health

Linda Seymour Head o Policy, Sainsbury

Centre or Mental Health

Geraldine Strathdee Clinical Adviser,

Healthcare or London

Yvonne Stoddart National Acute Care

Programme Lead, National Mental Health

Development Unit

Angela Yphantides Mental Health Project

Lead, Healthcare or London

Catherine Jackson Report Editor

Particular thanks are due to Claire Helman

rom Together and the CAPITAL Project

Western Locality Group.

Project Team

Jim Symington Chair

Louise Howell Programme Consultant

Nicholas Cohen Administrator


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Comments and eedback

We value your eedback on this guide. Please

let us know i you ound it helpul.

I you are a mental health proessional with

examples o good practice in engagement

with your local commissioners and are happy

to share these with others, please send your

comments/examples to:

Louise Howell

National Mental Health Development Unit

Wellington House (Room 306)

133-155 Waterloo Road

London SE1 8UG

Email: [email protected]

About the National Mental Health

Delivery Unit

The National Mental Health Development

Unit (NMHDU) is the agency charged by the

Department o Health with supporting the

implementation o mental health policy in

England in collaboration with the NHS, local

authorities and other major stakeholders.

The national mental health commissioning

programme (MHCP) exists to support

the development o innovative and

ground-breaking concepts in mental

health commissioning. It aims to support

commissioner development through

collaboration, inormation exchange

and partnerships with national and

local agencies. The programme is one

o six NMHDU work areas and has been

commissioned through the Department

o Health to aid the achievement o

World Class Commissioning (WCC) inMental Health.

For urther inormation on the NMHDU

Mental Health Commissioning Programme,

please visit www.nmhdu.org.uk

About Commissioning Supportor London

Commissioning Support or London (CSL)

was launched on 1 April 2009. The London

Development Centre (LDC), where work on

this guidance began, became one o the

ounding members o this new pan-London

agency. CSL brings together several London

organisations, including NHS Londons

commissioning support unction, Healthcare

or London and the London Health

Observatory to provide support to Londons

31 PCTs to enable them to strengthen

their perormance against the World Class

Commissioning requirements.

The CSL Mental Health Commissioning

Programme addresses issues specic to

mental health commissioning in London

by working directly with commissioners

and partner agencies. The programme

aims to aid the achievement o World Class

Commissioning, through the development

o knowledge, learning and tools or

mental health commissioners by acilitatingthe sharing o good practice, interpreting

Department o Health and other relevant

policy guidance and the production o tools

and products that respond to their needs

and priorities.
mailto:[email protected]://www.nmhdu.org.uk/http://www.nmhdu.org.uk/mailto:[email protected]


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CommissioningSupport or London,

18th FloorPortlandHouse

StagPlaceLondonSW1E7RS

Telephoneswitchboard:

020 8433 6868

www.csl.nhs.uk

Designedbywww.Design-Culture.co.uk
http://www.csl.nhs.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.csl.nhs.uk/


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Commissioning Supportfor London

Documents

World Class Commissioning a Guide for Professionals