Sharon Haggerty

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Sharon Haggerty

• Head of Adult Services
• County Durham Darlington PCTs

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Commissioning Specialist Care
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What is Commissioning?

• Commissioning is the means to secure the best
  value for local people.
• It is the process of translating needs and
  aspirations, into services for users which
• Deliver the best possible health and well-being
  outcomes, including promoting equality
• Provide the best possible health and social care
  provision
• Achieve this within the best use of available
  resources.

DOH (2007) World Class Commissioning
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Level of Commissioning
Individual
Locality
Regional
Community
National
Specialist Commissioning
Self Directed
PbC
PCT
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Vision

• Better health and wellbeing for all
• People stay healthier for longer
• People live longer, and health inequalities are
  reduced
• Better care for all
• Evidence based
• Best clinical quality
• Choice and control over services you choose
• Better value for all
• Informed investment decisions
• PCTs work across organisational boundaries to
  maximise patient care

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December, 2004
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• In some types of services, there may be a range
  of providers
• In other areas, no obvious alternative providers
  may exist
• We must consider how to develop a wider variety
  of local services and models of provision in
  response to patients needs

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January 2009
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The crux of it!
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Contestability

• Contestability theory was developed in the early
  1980s by the American economist Will Baumol, who
  recognised that monopoly providers do not need to
  be exposed to actual competition in order act
  competitively, but only the threat of
  competition.
• Contestability is not a synonym for competition
  but rather refers to a situation where a provider
  faces a credible threat of competition

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• Commissioners will be actively seeking new and
  innovative ways to improve new services with a
  range of providers
• Where PCTs continue to manage services,
  decision-making on commissioning and on provision
  will be separated in order to enhance
  contestability.

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What do we know?

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What do we need to know?
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How will NHS Providers survive and grow?
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Have a hook?
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• Proportion of people with long term conditions
  supported to be independent and in control of
  their condition
• Number of emergency bed days per head of
  population

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Assess Local Needs

• Give a complete picture of the populations
  involved and how needs differ
• Identify specific communities with particularly
  poor health, such as travellers, migrant workers,
  people with learning disabilities, those living
  in disadvantaged areas or demographic groups
• Give a clear view of unmet needs
• Enable comprehensive benchmarking of health needs
  against comparable populations.

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Mapping Existing Service

• How are services currently being provided by us?
• Benchmarks
• Other similar services
• NSFs, NICE, Core Standards
• Are there any gaps in service?
• Can we fill the gap?
• If so how
• At what cost

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Provide Evidence

• Capacity
• Quality
• Access and responsiveness
• Patient choice
• Value for money

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Identify What Needs To Change

• Misalignments between those segments of the
  population that have the highest health needs and
  the existing pattern of investment in services
• Areas that have poor access to services or
  widespread patient dissatisfaction
• Communities that have limited choice, either in
  terms of providers or in the nature of services
  available
• Providers that are falling short on quality
  standards

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Concentrate your efforts on those who can
influence?
Power/Interest Grid
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Also consider

• Who has the heart?

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• Who has the courage?

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• Who has the brain?

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• Dont be afraid to take a big step if one is
  indicated. You cant cross a chasm in two small
  jumps!
• David Lloyd George 1863-1945 British Prime
  Minister

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• Enthusiasm is followed by disappointment and even
  depression, and then by renewed enthusiasm.
• Murray Gell-Mann

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Summary

• If I can do it , anyone can
• No idea is a stupid idea
• Disappointment is a given
• Enthusiasm is your best tool
• And.

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• You don't have to be a "person of influence" to
  be influential.
• Scott Adams

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Thank You

• sharon.haggerty_at_nhs.net