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Getting to grips with the commissioning cycle - working with cycles, processes and potential to innovate
Ali Jan Haider
DHEZ Presentation – 30th June 2016
‘what is commissioning?’
Question
“Commissioning is the cycle of assessing theneeds of people in an area, designing andthen achieving appropriate outcomes. Theservice may be delivered by the public,private or civil society sectors”.
Question
“Commissioning is the process of specifying,securing and monitoring services to meetpeople’s needs at a strategic level. Thisapplies to all services, whether they areprovided by the local authority, NHS, otherpublic agencies, or by the private andvoluntary sectors.”Institute of Public Care Commissioning Framework
Contracting and Purchasing
PurchasingPurchasing The process of acquiring
goods, works or services from (usually)
external providers/suppliers and managing these
through to the end of contract.
ContractingContractingThe process of negotiating and
agreeing the terms of a contract for services,
and on-going management of the contract including
payment and monitoring.
Why do we need to transform how we Commission?
10 years of increased spend
Increase in demand
25% to 40% budget cuts
Rising public expectation
6September 2011
THE BIG PICTURE(If you think its bad now …)
A call to action (2013)
BRADFORD DISTRICT CCG FINANCIAL PLAN
WHERE WE SPENT OUR MONEY IN 2013/14
TOTAL SPEND IN 2013/14 WAS £400.1MBREAK-EVEN
2013/14 IN YEAR RESOURCES AVAILABLE WAS £400.1M
£228.7M
£18.4M
£35.6M£14.5M
£6.2M£2.9M
£53.4M
£40.4M
Total ServicesAcute Services
Continuing Care Services
Mental Health Services
Other Programme Services
Running Costs
Primary Care Out of Hours
Primary Care Prescribing
Primary & Community
Who commissions what in health?
• 3 Clinical Commissioning Groups (CCGs)– Bradford City (BCCCG)– Bradford Districts (BDCCG) – Airedale, Wharfedale & Craven (AWCCCG)
• CCGs are: NHS bodies, membership organisations, clinically led; plan and buy healthcare services for local people
• Public Health (transferred to the Local Authority in April 2013)
• NHS England
CCGs NHSE Public Health
emergency and urgent care (including: A&E, ambulance and out of hours services)
community health services
maternity services planned hospital care rehabilitation services healthcare services for
people with mental health conditions or learning disabilities
continuing healthcare
• primary medical care• community pharmacy• dental services• NHS sight tests • specialised services and high security psychiatric services• prison health and services for military personnel• some public health services
• sexual health services• the Healthy Child programme• local programmes to promote activity, healthy eating and weight management• drug and alcohol misuse services• stop smoking services• local programme to prevent accidents or reduce deaths, for example, winter planning
DH Commissioning Model
IPC model for joint strategic commissioning & purchasing
11
Task
Grit Commissioners
Bradford expects a tough winter 16/17 and a very heavy downfall of snow; You have been tasked with commissioning grit for 16/17 for the whole of Bradford District:
•How do you work out how much grit would be needed?•Which areas would you prioritise for gritting?•How would you ensure good value for money?•Why is quality and safety important?•How do you promote self-care and prevention?
Question
How does the commissioning cycle bring health and well-being to life?
THE BIG PICTURE Mission impossible?
• Prevent people from dying early• Enhance the quality of life for people with
long term conditions• Help people recover following episodes of ill
health or following injury• Improve patient experience• Improve patient safety• Reduce health inequalities
THE BIG PICTUREGreat expectations!
• A health service – not just an illness service• Give patients greater control over their health• Harness transformational technologies• Exploit potential for transparent data• Move away from ‘one-size fits all’ model of care• Unlock healthcare as a key source of economic
growth
THE BIG PICTUREThe Wizard of Oz
• If I only had a brain– Integration of health and social care• We must make real connections
• If I only had a heart– Care closer to home• Locally delivered, culturally sensitive services
• If I only had courage– Self care• We have to let go so that the people (aka ‘patients’)
become the experts (or at the very least – make shared decisions!)