Why Co-commissioning?Mike Edmondson(Public Health Commissioning Manager)

West Yorkshire Area Team / 3rd March 2014

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Section 7a Agreement

An agreement under Section 7a of the NHS Act 2006, as amended by the Health and Social Care Act 2012, created a new set of responsibilities for the delivery of public health services. In England, although the local leadership for improving and protecting the public’s health will sit with local government, the reforms provide specific roles for the National Health Service England (NHS England) and Public Heath England (PHE) for the Commissioning of certain public health services as part of the wider system design to drive improvements in population health.

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Direct commissioning responsibilities

NHS England (West Yorkshire) has direct commissioning responsibility for the provision of high quality, consistent and value for money public health screening and immunisation services, as set out in the Section 7a agreement between the DH and NHS England, specifically:

• Cancer screening (bowel, breast and cervical)

• Non-cancer screening (AAA and Diabetic Eye)

• Immunisation

• Health Visiting / Family Nurse Partnership

• Antenatal/Newborn screening & immunisation

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Commissioning Intentions 2014/15 – three commissioning challenges ahead

1. Full national implementation of commissioning in accordance with the service specifications by 31 March 2015, including antenatal and newborn screening.

2. Implementation of Flu vaccination to school aged children

3. Implementation of OPDR in Diabetic Eye Screening Programme

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Challenges

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Antenatal/Newborn screening, most of which will be paid for as part of the Maternity Pathway Payment (MPP)

• MPP is funded by CCGs, but CCG’s have limited commissioning responsibility

• NHS England has commissioning responsibility for 8 antenatal/newborn screening & immunisation programmes• Compliance with national service specifications

• Quality assurance

• Double payments

• Implementation of new schemes (eg BCG for high risk)

NHS England and CCGs should work closely together to ensure that this change does

not cause any adverse implications and issues are dealt with to ensure patients are

supported and have full access to services (Who pays for Screening and Immunisation

within the Maternity Pathway Payment? (January 2014)

Challenges

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Implementation of Flu vaccination to school aged children • School Nursing in West Yorkshire is commissioned by Local Authorities

• School age immunisations in West Yorkshire are commissioned by NHS England (West Yorkshire) – diverse provision

• Funding for school nursing transferred to LA

• Strategic alignment – diverse commissioning intentions, strategic intent, outcomes and objectives• What happens if/when LA want to re-procure school nursing??• Funding re-alignment

Challenges

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Implementation of OPDR in Diabetic Eye Screening Programmes (DESP)• National initiative to reduce pressure in CCG-commissioned Hospital Eye

Services (HES)

• Resulting increase in ‘surveillance’ in NHS England-commissioned DESP

• Cost pressure

• Funding re-alignment

• Quality assurance

• Incident management

Necessary next steps…..

Co-commission, in order to:

• Understand commissioning responsibilities and intentions of all stakeholder organisations

• Understand outputs and outcomes of all stakeholder organisations

• Consider and agree shared objectives, outputs and outcomes

• Agree joint governance arrangements and processes

• Share valuable but limited resources

• Consider integration and co-commissioning when developing 2-year Operational and 5-year Strategic plans

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Outcomes and ambitionsFive Outcome Domains

1 Prevent people from dying prematurely

2 Improved quality of life for people with long term conditions

3 Quick recovery from episodes of ill-health or injury

4 Improved patient experience

5 Improved patient safety

Seven Ambitions

A Securing additional years of life for people with treatable conditions

B Improving health related quality of life for people with one or more long term condition

C Reducing the amount of time people spend avoidably in hospital and integrating care in the community

D Increasing the proportion of older people who live independently at home

E Increasing the number of people who have a positive experience of hospital care

F Increasing the number of people who have a positive experience of care outside of hospital

G Making significant progress towards eliminating avoidable deaths in hospital

Six Patterns of Service

i Citizen engagement in all aspect of service design and change

ii Wider primary care, provided at scale

iii A modern model of integrated care

iv Access to high quality urgent and emergency care

v A step-change in the productivity of elective care

vi Specialised services concentrated in centres of excellence

Four Essential Elements Access – convenience and NHS Constitution commitments Quality – response to Francis and Berwick, Patient safety, Compassion in Practice, Staff satisfaction, seven-day working, safeguarding

Innovation - Value for Money – financial resilience, effectiveness & efficiency, improved procurement

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