Towards informed and innovative

commissioningCommissioning Workshop

for Library & Knowledge Services October 2013

sue.lacey-bryant@nhs.net

1. Commissioning defined2. Context3. Evidence-based commissioning4. Understanding the customer5. Best value6. How can librarians evolve to meet the need?

Sue Lacey Bryant

The library as a platform for change

• Health is a knowledge- based industry• Health is a people based industry• What more can librarians do to help?• “What more can I do to help?”

Sue Lacey Bryant

1. Commissioning defined

“the process of allocating public resources to achieve the greatest gains in health within a

defined population”

Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/

Sue Lacey Bryant

Shift in approach to commissioning 20th Century

• Hospital centred• Challenges met by growth

• Clinician-centred• Benefits of treatment• Quality improvement • Focus on individual • Patient compliance; public &

patient engagement • High carbon usage

21stCentury• Care closer to home• Transformation; innovation;

whole system; redesign

• Patient-centred• Prevention; risk stratification • Reduce waste; increase value• Population perspective• Patient as co-producer

• Low carbon usage

Sue Lacey Bryant

2. Context: key facts

The NHS in England:• Deals with over ? patients every 36 hours• Serves ? people• Employs ? staff• Budget of ? £ Billion• Av. CCG is commissioning care for ? people; • Av. CCG has been allocated ? £m in 2013-14Life expectancy rising Infant mortality falling

Sue Lacey Bryant

Key facts

The NHS in England:• Deals with over 1m patients every 36 hours• Serves 53m people• Employs 1.35m staff• Budget of £95.6 billion• Av. CCG is commissioning care for 226,000 people; • Av. CCG has been allocated c £300m in 2013-14Life expectancy rising Infant mortality falling

Sue Lacey Bryant

Sue Lacey Bryant

19 CSUs; 105 CCGs; 27 Area Teams

Where in the world are we?

• NHS ranked 2ndafter Holland• 2nd patient equality & safety• Scored highly on access

• Best system in terms of efficiency, effective care and cost-related problems

2010 : NHS cost £2,021 per

person in UK - less than half than the £4,926 per head in US

• 2nd to last for 'long, healthy, productive lives‘

• Bottom for life expectancy of patients at age 60

22.5 yrs vs 24.6 in Australia

• Much higher death rates from conditions amenable to medical care.

In 2003 rates were 25% - 50% higher than Canada and Australia

Sue Lacey Bryant

Platform for change

• Harsh financial climate: find £20 billion efficiency savings by 2015

• Berwick report: give patients quality care

every time

Sue Lacey Bryant

Pressures

• Unprecedented demand

• Ageing population– more complex health needs– Increasing demand

• Patient involvement– No decision about me without me

Sue Lacey Bryant

Priorities

• Stemming the increase in emergency admissions

• Service reconfiguration; making the shift from hospital to community care; seamless care

• Addressing inappropriate variations in clinical practice; clinical safety and quality

• Improving Public Health; reducing inequalities

Sue Lacey Bryant

Primary care at the helm

• GPs manage the lion’s share of NHS medical work

• High level of patient confidence and satisfaction

• One year's care by a GP costs c1/10th of a day in hospital

• CCGs responsible for £65 billion of the £95b commissioning budget

• Increasing choice and service integration

Sue Lacey Bryant

3. Evidence-based commissioning

“the process of allocating public resources to achieve the greatest gains in health within a defined

population”

Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/

Sue Lacey Bryant

Sue Lacey Bryant

Evidence based commissioning

Redesigning services in the NHS can be an incredibly complex task, with differential demands for information and evidence originating from the nature of the task itself

Emerging research suggests that, for redesigning and commissioning or recommissioning services, equal attention may need to be paid to both clinical and non-clinical evidence.

Emmanouil Gkeredakis & ClaudiaRoginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011

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A plurality of evidence

HSJ 26 May 2011 p23-25

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Top Tips for gathering evidence

• Consider the different forms of evidence needed for different tasks

• Value plurality of evidence (from authoritative bodies & local knowledge)

• Be proactive• Ask advice from people who have already

tackled the challenge

Derived from Emmanouil Gkeredakis; Claudia Roginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011

Sue Lacey Bryant

Pressing need for innovation

“We need to radically transform the way we deliver services. Innovation is the only way we can meet these challenges”

“Put simply, we must make innovation a priority. We know that the NHS can spread new ideas at pace and scale when it puts its mind to it, and we need to do more of this.”

“ Innovation ... needs to be replicable – and replicated – across similar settings. So innovation is as much about applying an idea, service or product in a new context, or in a new organisation, as it is about creating something entirely new. Copying is good.”Sue Lacey Bryant

The value of library and knowledge services to QIPP

David Nicholson. HSJ. 10 Sept 2009

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“What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making. We need to look at how information links together to get a holistic picture of the situation.”

Dr Shahid Ali, GP and Clinical Lead, Patients and Intelligence Directorate, NCB

4. Understanding the customer

Information services & products for commissioners

Sue Lacey Bryant

What do commissioners ask?

• How have others done it?• Data on outcomes?• Benchmarking• Data and models to support development of

specifications• Key performance indicators?• Summaries

Sue Lacey Bryant

Examples - Evidence searches• Impacting on hospital use (re)admission, Outpatient Dept,

A&E, community care• GPs in A&E departments• Has anyone charged for DNAs?• Outcomes of MSK services• Service specifications inc. Community cardiology, MSK,

Urgent Care• What self care tools will we need to support our new MSK

Clinical Assessment & Triage services?• Predictive modelling tools • Return on Investment in telehealth/telecare• Why are our antenatal admissions so high?• Self management, decision aids• Outcomes based contracting

Sue Lacey Bryant

“Anne carried out three targeted data searches for me to support the CCG’s three Local Priorities in its Integrated Commissioning Plan (ICP). Rather than merely searching for relevant articles, Anne reflected on the problem areas, searched for evidence of a range of successful interventions achieved elsewhere and provided a new measurable solutions for the CCG to adopt. This saved me time in developing the ICP and added real value and a new angle of approach.”

Tim Deeprose: Interim Director of Commissioning, NHS Milton Keynes CCG, July 2013

Sue Lacey Bryant

What sources do commissioners value?Survey n=300

Very/quite important • Local public health

intelligence • Expert advice• Examples of best practice• Local policies• Guidelines• Government pubns• Benchmarking• Cost effectiveness

Not important/did not use• General published

literature• Professional association

guidance• Management studies• Academic research• Management consultants

Sue Lacey Bryant

HSJ 26 May 2011 p23-25

5. Best value

Benefits – Cost

Sue Lacey Bryant

Core offer into CCGs & CSUs?Generic/At scale offer

• Horizon scanning• Tailored and targeted dissemination of evidence, by

stakeholder group• Concise summaries of key policy documents • Intranet/web knowledge zone

• Aligned with the strategic objectives of the organisation

Sue Lacey Bryant

Core offer into CCGs & CSUs?

Specialised services – for individuals ; for teams

• Investigative research and enquiry service covering clinical & cost effectiveness; best practice”; models of service

• Producing Easily read, synthesised reports ie. retrieve, select, appraise, summarise• SDI to key personnel - by profile • Supporting pathway review & service redesign • Information skills training

Sue Lacey Bryant

Targeted alerting services • Client focus; ensuring insights into CCG agenda• national policy drivers• transforming pathways• QIPP challenge; financial balance• supporting service redesign; models of delivery• promoting best evidence• promoting tools and resources• sharing best practice to drive innovation and enable

transformation

Sue Lacey Bryant

A bang for the buck

• Work to strengths: what are we really good at? • Collaborate to improve products & services? • Efficiency: at-scale delivery of back office• Understand which functions can routinely be

delivered remotely? Which require engagement?• Use strengths in networking to enhance impact• Help to overcome silo mentalities• Raise our expectations; demonstrate impact• Quality = clarity and standards Reflect on service specifications and KPIs

Sue Lacey Bryant

What does good look like?Performance area KPI Performance

scoreTimeliness Search reports to be delivered by…

Availability & Responsiveness

Routine queries to be dealt within….

Priority queries to be dealt with within …

Client Satisfaction Use baseline client survey to develop

Value for Money Incorporate planned efficiency of back office functions into delivery of service

Quality. Q - Is this the sum of the parts? Impact?

Meeting clearly defined standards

Delivery of added value

Sue Lacey Bryant

Benefits• Benefits:

o Cost effective;o Time effective o Expertise in sourcing, selecting, summarisingo Knowledge of resourceso Rapid response optiono Build a knowledge resource

• High quality service to support both strategy & operations• Scale up across the potential customer base

Sue Lacey Bryant

Criteria by which to assess CSS

Alignment: demonstrable commitment to achieving CCG objectives inc. high quality care Responsive: to the individual priorities of our CCG and the population on behalf of which we commission Agile: flexibility to support changing demands on CCG

Cost effective: value for money; added value

Innovation: sharing best practice; ‘lift & shift’ where practical

Business focus: robust arrangements to support multiple clients

Sue Lacey Bryant

Actions speak louder than words

3 actions from this session inc. the presentation and your group discussion

1.

2.

3.

Sue Lacey Bryant

6. How can health librarians evolve to meet the need?

Source: A visualização da imagem anterior desperta para a leitura do artigo: "Evolving Web, evolving librarian" de Amy and Robert Favini

balcaodebiblioteca.blogspot.com

Sue Lacey Bryant

Enhancing the role of librarians

Role enhancement involves expanding a group of workers' skills so they can assume a wider and higher range of responsibilities through innovative and non-traditional roles

Sue Lacey Bryant

Positioning librarians as catalysts for improvement

• Aligning with NHS priorities• Bringing research, education and practice

closer together• Spreading innovation• Multidisciplinary working• Changing skill mix: role substitution, role enlargement & enhancement

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“Libraries will get you through times of no money better than money will get you through

times of no libraries”

Anne Herbert, writer. b1952

Towards informed and innovative commissioning

Sue Lacey Bryant