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S116: Commissioning for outcomes
EXPO: Pop-up university session
Paul & John
Tuesday 4th March 2014
Room 1
Who are we?
Dr Paul Husselbee
(Clinical lead, NHS
Southend CCG)
Dr Paul Husselbee
(Clinical lead, NHS
Southend CCG)
John Stewart
(Director Outcomes
Framework, NHS
England)
John Stewart
(Director Outcomes
Framework, NHS
England)
Co Chairs: NHS CA Quality Working GroupCo Chairs: NHS CA Quality Working Group
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‘Come together’ in the next hour
Ensuring high
quality care for all
– now and for future
generations
Ensuring high
quality care for all
– now and for future
generations
Outcomes-
based approach
Outcomes-
based approach
Your input! Insights,
challenges, ideas…
Your input! Insights,
challenges, ideas…
1
2
1. Commissioners 1. Commissioners
2. Providers 2. Providers
3. Community & Vol. sector3. Community & Vol. sector
Who do we
have in the
room today ?
4. Patient / Public (inc rep bodies)4. Patient / Public (inc rep bodies)
5. Private sector5. Private sector
6. Other6. Other
OUR SURVEY SAYS…
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Your role for the next hour: sit in Paul’s seat and ‘Drive
my car’
‘Imagine’ you are now a chair of ‘anytown’ ccg…
Older demographic
High prevalence of LTCs
Higher levels of deprivation
A CCG economy…A CCG economy… …forecast to go bust over next 5 years …forecast to go bust over next 5 years
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…you lead a CCG board planning meeting: ‘Help!’
It starts badly…It starts badly… …and gets worse!…and gets worse!
Local providers have each written
to the CCG requiring more funding
to keep their services going
‘Save our local hospital’
campaigners storm the meeting
…start again with a free ‘ticket to ride’
So what are you
going to do now?!!!
We will return to
this scenario later!
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Good commissioners tell us to always keep it simple: What are you trying to achieve?
‘We can work it out’
1. More doctors & nurses1. More doctors & nurses
2. A magic pill that solves all 2. A magic pill that solves all
3. Clinically effective care3. Clinically effective care
What do the public really
want from their NHS?
(You can vote for two)
4. A hospital within 10miles4. A hospital within 10miles
5. A safe and positive experience5. A safe and positive experience
6. Their money back6. Their money back
OUR SURVEY SAYS…
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‘Please Please me’: High quality care for all
Prevents
premature mortality
Prevents
premature mortality
Enhances your
Quality of lifeEnhances your
Quality of life
Helps you recoverfollowing ill health or
injury
Helps you recoverfollowing ill health or
injury
Provides a positive
Experience as
possible
Provides a positive
Experience as
possible
Safe: protects
you from avoidable
harm
Safe: protects
you from avoidable
harm
Person-centred carePerson-centred care
1. Run out of money1. Run out of money
2. Ageing population 2. Ageing population
3. Lack of personal responsibility3. Lack of personal responsibility
What’s the biggest
challenge facing the NHS
over the next 5 years?
(Vote for only one)
4. Decline of public trust in NHS4. Decline of public trust in NHS
5. Politicians / media5. Politicians / media
6. Others?….6. Others?….
OUR SURVEY SAYS…
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A real challenge ‘when I’m 64’ (+1)
Increasing demand
on resources
Increasing demand
on resources
Tight fiscal
environment
Tight fiscal
environment
Rising public
expectations
Rising public
expectations
View from the 211 Clinical
Commissioning Groups
View from the 211 Clinical
Commissioning Groups
Not just the ‘money (that’s what I want)’
Incremental changeIncremental change Transformational changeTransformational change
Can we deliver better for less through…Can we deliver better for less through…
‘We want a better diabetes service’: shift
resources to this priority
‘We want a better diabetes service’: shift
resources to this priority
‘We want to enhance quality of life for people
with LTC’: open up resources for this priority
‘We want to enhance quality of life for people
with LTC’: open up resources for this priority
Hospital
introduces new
consultant led
service
GPs introduce
targeted testing
A better diabetes service for the
public
Personal
budgets to
spend on own
care
Enhanced quality of life for people
with LTCs
Lead providers
partner with
local services to
provide whole
care solutions
Local
communities
co-designing &
co-producing
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Ok, so what can we all learn from good commissioners?
‘How do you do it?’
OUR SURVEY SAYS…
1. Being clear about the goal1. Being clear about the goal
2. Being results-driven 2. Being results-driven
3. Able to think long term3. Able to think long term
What makes a good
commissioner?
(You can vote for more
than one)
4. Brings all the key players together4. Brings all the key players together
5. Open to new ideas & innovation5. Open to new ideas & innovation
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Be clear: ‘Shout!’ for the patientcommission more OUTPUTS?commission more OUTPUTS? commission better OUTCOMES?commission better OUTCOMES?
Drugs available on the NHS
Number of hip operations
Number of acute hospital
beds
Reduce waiting times
Number of trained doctors
and nurses
Preventing premature mortality
Enhancing quality of life for those
with LTC
Helping people to recover quickly
Ensuring patients experience of
care is as positive as possible
Ensuring patients care is as safe
and risk free as possible
OR
Focus on results: Patients ‘glad all over’
An outcomes-based approach means
focusing less on what is done for patients,
and more on the results of what is done
An outcomes-based approach means
focusing less on what is done for patients,
and more on the results of what is done
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Be ambitious: For the future, not ‘yesterday’
An outcomes-based approach
means setting challenging and
stretching goals to achieve for our
patients over the medium – longer
term
An outcomes-based approach
means setting challenging and
stretching goals to achieve for our
patients over the medium – longer
term
Be strategic: ‘Hello Goodbye’
An outcomes-based
approach means getting the
right people working
together focused on meeting
the needs of the patient,
regardless of traditional
organisational boundaries
An outcomes-based
approach means getting the
right people working
together focused on meeting
the needs of the patient,
regardless of traditional
organisational boundaries
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Think innovative: ‘The Hippy Hippy Shake’
An outcomes-based approach means being
open to new ideas, new innovations and new
ways of delivering better outcomes for patients
An outcomes-based approach means being
open to new ideas, new innovations and new
ways of delivering better outcomes for patients
‘Hey jude’, can you now bring an outcomes based approach in
your planning meeting?
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‘Let it be’ that we return to our scenario then…
So what are you
going to do now?!!!
…’I wanna hold your hand’ and plan for the future
Be clear Focus on results Be ambitious Be strategic Think innovative
Are you
interested in
outputs or
outcomes?
What does high
quality care look
and feel like for
the public?
Where do you
want to get to
over the medium
to longer term?
Who do we need
to work with to
achieve
improvements?
How can we
challenge the
status quo and
be open to new
ideas?
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1. Prevents premature mortality1. Prevents premature mortality
2. Enhances quality of life2. Enhances quality of life
3. Recovery from ill health or injury3. Recovery from ill health or injury
We now have the outcomes, but
where do you want to allocate
your money …you decide!
(Vote for your number 1 priority)
4. Positive patient experience 4. Positive patient experience
5. Patient safety5. Patient safety
The ‘Penny lane’ round…
‘Got to get you into my life’
How are we putting
commissioning for outcomes and high quality care at the
heart of the new commissioning system?
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OUR SURVEY SAYS…
1. YES1. YES
2. NO2. NO
3. NOT SURE3. NOT SURE
Are you are aware of the ‘ask’ in
the NHS planning guidance for
all 211 CCGs, together with their
area teams to set 5 year
ambitions to improve outcomes?
The planning guidance has now set out our clear commitment to an outcomes based approach –
‘revolution’?
For the first time, commissioners are being asked to plan on a five
year trajectory, to enable the NHS to capitalise on opportunities for
transformational change and improvement
All 211 CCGs, together with their NHS England Area teams, are being
asked to jointly set levels of ambition against seven overarching
outcome measures. The seven outcome measures are deliberately
broad so as to drive improvement for all CCG local populations.
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Preventing people from dying prematurely
(‘Run for your life’)
Enhancing quality of life for people with Long Term Conditions
Helping people to recover from episodes of ill health or following
injury
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and
protecting them from avoidable harm
1: Securing additional years of life for the people of England
with treatable mental and physical health conditions
2: Improving the health related quality of life of the 15
million+ people with one or more long-term condition,
including mental health conditions
3: Reducing the amount of time people spend avoidably in
hospital through better and more integrated care in the
community, outside of hospital.
4: Increasing the proportion of older people living
independently at home following discharge from hospital
5: Increasing the number of people having a positive
experience of hospital care
6: Increasing the number of people with mental and
physical health conditions having a positive experience of
care outside hospital, in general practice and in the
community
7: Making significant progress towards eliminating
avoidable deaths in our hospitals caused by problems in
care
Further information & ‘thank you girl’
Visit: http://www.england.nhs.uk/ourwork/sop/plan-sup-tools/
The NHS Commissioning Assembly Quality Working Group have produced a short
‘how to’ guide for local commissioners on setting 5-year ambitions to improve
outcomes
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For Discussion…
1. Reflections from those currently setting 5-year outcome ambitions
2. The biggest barriers to an Outcomes-based approach
3. How can NHS England / the Quality Working Group support local
commissioners to tackle these barriers