World Class Commissioning

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World Class Commissioning

• Developing Contestability Choice For The
  Benefit of the Rotherham Healthcare Community A
  Case Study On The Rotherham Health Centre

• Presented by Mark Leyshon Duncan Smales
• Email mark_at_sarlleyshon.com and
  duncan.smales_at_rotherhampct.nhs.uk

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Agenda

• Overview of PCT
• Strategic Objectives
• A Simple Process
• Options Appraisal
• Managing The Complexity
• Procurement Process
• Learning From The Rotherham Case
• Going Forward
• Procurement
• Questions Case Discussion ( Any General
  Project / Procurement Questions)

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NHS Rotherham (PCT)

• Overview of the PCT

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NHS Rotherham

• Part of Yorkshire and Humber SHA
• NHS Rotherham is coterminus with the Rotherham
  Metropolitan Borough area
• Serves a diverse community of circa 250,000
  people
• Metropolitan with high level of deprivation
• Central area in the top 10 of deprived electoral
  wards nationally
• Higher than average black and minority ethnic
  residents (over 10)
• Secondary services predominantly delivered by
  local FT provider

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Corporate Values
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Strategic Objectives

• The Problem Specifying What Needs To Be Achieved

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Strategic Issues Facing The PCT

• Ageing healthcare building carrying out primary
  care services (Doncaster Gate)
• Cost circa 11 million to renovate bring up to
  modern day standards
• Services offered limited in primary care
  (traditional services)
• Equity of access in a diverse population still
  presented issues to the PCT
• Virtual monopolistic position of key providers
  limiting choice with little contestability
• Leverage limited for PCT due to virtual
  monopolistic market position

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Strategic Objectives

• Identify alternative delivery vehicles models
  within the existing cost structure
• Address equity of access issues in the region by
  ensuring there is a simple and convenient point
  of access to a wide range of primary care and
  urgent care services, primarily determined by
  clinical need not by patient demand
• Ensure the patients are assessed and treated by
  the right professional with access to the right
  interventions first time.
• Reduce unnecessary emergency admissions to
  hospital by developing responsive alternative
  services in the community and ensuring
  professionals can easily access them.

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Strategic Objectives (Cont)

• Integration of services to maximize appropriate
  responses in the most efficient pathway
• Empower patients to take control and
  responsibility for their own health and well
  being through selfcare and self-management.
• Links back into the wider primary care and health
  and social care system with patients referred on
  to other services as necessary through agreed
  clinical pathways
• Create real choice for the population of
  Rotherham
• Test the market encourage contestability in the
  region (tender stage through performance
  measurement)

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A Simple Process

• In a Complex World

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A Simple Process!
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If You Are Not Juggling Complexity
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Options Appraisal

• Out of Adversity Comes Great Things

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Strategic Options

• Do nothing
• Renovate the old building
• Build a new Polyclinic Centre in the centre of
  the region
• Providing existing services
• Expand the primary care services offered
• Offer real choice by introducing current
  secondary services alongside additional primary
  care
• Contract with the existing secondary

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Rationale Underpinning Decision

• Was a cost neutral option
• Offered a brand new state of the art polyclinic
  in the heart of the region with good transport
  links
• Opportunity to provide a mixed economy within the
  region within the polyclinic (internal provider
  third sector)
• Increases contestability performance benchmarks
  between providers for services to be procured
• Greater leverage / opportunity for future change
• Chance to offer real choice in the healthcare
  region

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Managing The Complexity

• Breaking Into Manageable Chunks

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Separated Procurement(s) Into Manageable /
Related Elements

• The Polyclinic building
• Maintained some services with incumbent (PCT
  Provider)
• Batched some services
• GP Services
• Urgent Care (WiC, OOH, Fast Response, Call
  Handling)
• Sourced separately specialist services
• Diagnostics
• Pharmacy

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Rationale For Separation

• Construction leasing of the centre in
  particular was a specialist activity
• Based on perceived optimum size to generate
  economies of scale the right interest
• Focused on plurality expertise by grouping
  services based on market segmentation /
  specialism (e.g. too large may have restricted
  bidders to just two or three bidders who had
  loose capabilities across all requirements or
  forced collaboration in an embryonic market that
  may not have been ready)
• Allowed contracts to be aligned as start and
  finish dates where not consistent

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Assembling Internal Capability

• Ensured that project lead had high degree of
  experience, strong leadership, was both driven
  very focused on end game (but sensibly so)
• Recognised that internal capability did not exist
  in totality due to embryonic nature of
  contestable market in the NHS so secured external
  support for
• Quantity surveying project management
• Procurement
• Legal
• Used PCT expertise alongside external support to
  cross fertilise knowledge (reduces longer term
  reliance on third party support)

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Procurement Process

• Tendering The Services

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Generated Clearly Defined Spec - Objectives
Role Of Providers

• Got it right at the start investing significant
  time expertise on the required outcomes how
  these would be stringently measured
• Didnt press Go until they really were ready
• Very clear on what they expected in bids
  subsequently from the provider(s)

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Procurement Process

• Even though the clinical services were Residual
  Service B still followed OJEU Procurement
  Directive principles
• Always ensured process was fair, transparent and
  open to all
• Evaluation stages reflected this of course the
  interest of patients tax payers compromised
  on this for no one
• Ensured that the process was robust had a clear
  audit trail to avoid disruption through challenge
• Risk management appropriate contingencies were
  part of the project procurement process

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Left No Doubt About The Outcomes Expected

• Comprehensive performance management structure
  with predominantly clear quantifiable targets
  (with risk reward element)

Please note Extract only
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Clear, Detailed, Cross Functional Auditable
Evaluation Process

• Transparent collective scoring approach to
  ensure fair, balanced, organisational buy in

Please note Summary score only
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Auditable Evaluation Process (Cont)

• Case law now that detailed criteria must also be
  shown

Please note Extract only
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Learning From The Rotherham Case

• Increasing The Chances of Success

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Some of The Key Success Factors

• Strong leadership got on with it didnt shy
  away from difficult or uncomfortable decisions /
  situations
• Identified the risks, minimised them throughout
  the process had clear steps for dealing with
  risks that couldnt be totally minimised when
  they happen
• Project Team was always supported / backed had
  a fundamental belief in what they were seeking to
  achieve why for the patient population of
  Rotherham
• Team werent afraid to pull things apart that
  worked

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Some Of The Key Success Factors (Cont)

• Avoided groupthink encouraged debate
  challenge to gain optimum decisions
• However team decisive in agreeing, or
  disagreeing, whether in part or whole to avoid
  ongoing deliberation / stall
• Project team had the necessary authority remit
  to get the job done without unreasonable delay to
  feedback / gain approval from bureaucratic
  committee(s)
• Involved all relevant functions in debate
  concept build but didnt allow individuals to
  highjack, slow, or take process off course

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Going Forward

• Whats Next For NHS Rotherham

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(No Transcript)
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Not A Time To Be Sitting Back The Polyclinic

• Need to get people providers working seamlessly
• Strong communication to build awareness,
  confidence, get patients to use centre when
  appropriate
• KPIs fully integrated in Providers systems
  deployment PCT using these to manage by
  exception
• Full roll out of the audit regimes
• Strong contract management to ensure the
  Providers deliver what they are contracted to
• No point spending hours on a tender contract
  you wont ensure they adhere to

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Not A Time To Be Sitting Back Procurement

• Important to balance drive to improve against
  consolidating what has been done so far
• Dont bite off more than you can chew
  consolidate, build success impetus
• Use new pathways as a benchmark leverage for
  change in other agreements / providers
• Recognise communicate positively early
  successes
• Identify the next opportunities
• Where can the next significant improvemenst be
  made
• What leverage does the PCT have now how can it
  be used to realise future gains (e.g. VFM,
  patient outcomes, patient experience, etc)

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Longer Term A Fully Integrated Procurement
Strategy?
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Procurement

• Some Simple Rules Advice

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Get It Wrong It Does Cost

• If you have missed key elements of information
  off an advert, tender document, etc that is key
  to the process, you may have to step back in
  order to correct and avoid challenge
• Adding something later always seems to cost that
  little bit more than it probably would have been
  if it had been included in the competitive part
  of the process!
• Quality in generally equals quality out
• But you cant make a silk a purse out of a sows
  ear if it isnt clearly defined, dont expect
  the bidder to be any better informed

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Good Relationships Have OnlyWinners

• With competitive tensions underpinning the
  success
• Create tensions to drive sustainment

• Understand market competitors

• Dont subsidise poor performers if they dont
  deliver take contestable action

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Summary / Some Tips

• Dont be afraid to flex a little muscle at the
  right times
• Always have options contingencies
• Know more about the service market than they do
• Work out their hand (e.g. cost synthesis,
  resource analysis)
• Providers, whether they are third sector or NHS,
  or you own PCT Provider are neither friend or foe
• Dont allow yourself to be backed in to a corner
  or be allowed to be bullied by your providers
• Stretch Providers with quantifiable KPI targets
  hold them to account if they arent met or
  exceeded.

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Questions Case Discussion

• And Any Other Procurement, Polyclinic, or Project
  Management Questions

• Presented by Mark Leyshon Duncan Smales
• Email mark_at_sarlleyshon.com and
  duncan.smales_at_rotherhampct.nhs.uk
• SARL Leyshon Tel [phone]