From painting by numbers to creative expression

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From painting by numbers to creative expression
- moving commissioning to a new era
Nigel Walker National Lead Commissioning Care
Services Improvement Partnership
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Contradictory messages dont help
The developing agenda...
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The developing agenda...
A developing agenda...

• Strong and Prosperous Communities
• Our Health, Our Care, Our Say Making it Happen
• New Outcomes Framework Performance of Adult
  Social Care
• Relentless Optimism Commissioning for
  personalised Services
• Options for Excellence Social Care Workforce
  Planning
• Third Sector initiatives
• Health Care Commissioning Framework
• NHS Operating Framework 2007/08
• State of Social Care in England 2005-06
• Commissioning Framework for Health and Wellbeing
  (March 07)

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Drivers for Change Strong and Prosperous
Communities

• Local Involvement Networks (LINKs)
• Community Call for Action
• Co-ordinated consultations
• Joint Appointments Directors of Public Health
• Statutory Partnerships for Health and Wellbeing
  to carry out a Strategic Needs Assessment
• Lead Members big role in commissioning
  decisions
• Single performance framework
• Building on Supporting People
• National Housing Strategy Ageing population
• Third Sector 3 year funding

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Our Health, Our Care, Our Say - Making it Happen
Roadmap for change
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The State of Social Care in England 2005-06
what it says about commissioning...(i)

• Continuing improvement but at a disappointing
  pace
• Better outcomes needed through well-functioning
  local market that
• ensures consumer choice
• safeguards continuity of good quality supply
• deals with poorly functioning businesses
• encourages innovation
• Long term financial planning demonstrating good
  use of resources
• Very mixed practice in analysis of needs and
  market and communications with providers and
  local people
• Need to commission for whole population

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The State of Social Care in England 2005-06
what it says about commissioning...(ii)

• Managing against a tough financial background
• Problems with Health budgets impacts on Social
  Care
• Need for strong local leadership organisational
  support
• More complexity-
• Increased expectations and higher demand
• Transformation at same time as workforce problems
• A rapidly changing policy agenda

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The Commissioning Framework for Health and
Wellbeing

• 1. A shift towards services that are personal,
  sensitive to the needs of the individual and
  focused on maintaining independence.
• A reorientation towards promoting health and
  well-being, and proactive prevention of ill
  health.
• 3. A stronger focus on commissioning for
  outcomes, across health and local government,
  working together to reduce health inequalities
  promote equality

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Eight steps to more effective commissioning

• Putting people at the centre of commissioning
• Understanding the needs of populations and
  individuals
• Sharing and using information more effectively
• Assuring high quality providers for all services
• Recognising the interdependence of work, health
  and well-being
• Developing incentives for commissioning for
  health and well-being
• Making it happen local accountability
• Making it happen capability and leadership

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The hard stuff

• Strategic commissioning v personalised care
• Dis-investment and de-commissioning of
  traditional services and re-investment in
  prevention and individualised care
• Implications of self-directed care for assessment
  and care management
• Engaging providers in the conversation
• Moving towards outcomes
• Engaging communities in the conversation
• Supporting people to take risks
• Performance monitoring and quality control
• Role of other services in delivery

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Why Demand Forecasting ?

• Need for twenty year commissioning strategies
• More clarity about what is required from a
  community and user perspectives
• Demography brings its own challenges
• Expectations raised
• Recognise opportunities
• Greater integration required but of what?
• Need for sound dis-investment and re-investment
  plans

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What is demand forecasting ?

• Assessing the type and quantity of services
  required far enough in advance to ensure good
  investment decisions
• Properly considered timescales
• Bringing the right service levels and quality to
  the right people in the manner they wish them at
  the right time
• Most efficient delivery methods
• Most cost-effective price
• It will also assist in equitable rationing if
  this is required

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The Four Dimensions of Demand Forecasting
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The Four Dimensions of Demand Forecasting
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Population

• Variable use of population data by authorities,
  but analysis tends to be in generalisations
• Can provide information about general trends,
  particular issues or with service data something
  about strike rate
• Can enable reasonable look ahead for planning
  purposes
• Data tends to become less useful as the next
  census draws nearer
• POPPI (Projecting Older People Population
  Information) website for local data analysis
  www.poppi.org.uk

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Shire in 1911
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Shire 2001
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Shire 2001 to national comparison
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Shire data

• Shire predominantly a rural county
• 40 of the population lives in very rural areas
  or in settlements of less than 2,000 people.
• Of the remaining 60 half live in the larger
  villages and smaller towns with populations
  between 2,000 and 10,000 and the other half in
  the nine larger settlements of over 10,000 people
  ( this compares to over 80 in England and Wales
  living in settlements of this size).
• The distribution of older people in the County
  reflects this. 25 of people aged 75 and over
  living in areas with a population density of
  fewer than one person per hectare and 14 living
  in settlements of fewer than 1,500 people.

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Shire data
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Potential impact on Shire in twenty years

• Extrapolating the population trends could mean
• 6,660 additional assessments of older people per
  annum.
• Another 18,000 hours of domiciliary care per
  annum.
• An additional 2,220 places in residential and
  nursing home care.
• 2,715 people aged over 75 providing more than 50
  hours care per week to another person.

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The Four Dimensions of Demand Forecasting
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Surveying anticipated futures

• How do changing needs and perceptions translate
  to new services the unexperienced cannot always
  be expressed, only dreamed of
• National data rarely built on locally
• What we want is not what we plan for others
• Known unknowns - increased wealth and health,
  pensions black hole, new or different medical
  interventions
• A lack of ways to meaningfully engage with
  communities

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The Four Dimensions of Demand Forecasting
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Service User Profiling

• Need to map existing provision to see if it
  matches current usage
• Information about provision is not the same as
  knowing demand
• Ways of recording data and sharing across
  boundaries is not well developed
• Analysis skills often poor in both Health and
  Social Care systems
• What is the way in which we can best understand
  public reactions to new professional thinking (eg
  outcomes, telecare)
• Can we describe how people use services and then
  as questions at critical key moments?

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The Four Dimensions of Demand Forecasting
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Conditional or perverse demand

• Are services outcome or output driven?
• Example meals service, provision of equipment.
• Are there needs being presented where targeted
  interventions could improve outcomes but where
  this is not occurring?
• Example Alternatives to res. care, dehydration.
• Is the intensity of the service provided
  sufficient to achieve the outcomes desired?
• Example stroke rehabilitation, continence
  services.
• Are service delivered at the right time to have
  the maximum impact?
• Example Support to carers of people with
  dementia.

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Next steps

• Clear establishment of local data sets that focus
  on information at the interface of health, social
  care and housing and that enable agencies to much
  more effectively target key populations.
• For those target populations establish a much
  clearer idea of cause / effect and cost /
  benefit.
• Agreement on use of POPPI data.
• Build better skills in data analysis and local
  interpretation.
• Use national surveys to much more effectively
  develop local consultation exercises which build
  on rather than replicate that survey data.
• Is this a regional rather than local role? What
  is the role of Public Health and the Health
  Observatories?

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Key effects of good data and understanding

• Wider understanding of all needs across local
  govt and health
• Informed communities willing to pay for relevant
  public services
• People having more control
• Systems and services integrated where they need
  to be
• Better use of the money
• Fully integrated workforce planning and teams
  where that makes sense
• Providers giving good and affordable services
  that people want and will buy
• Recognition that prevention is better than cure

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Try to ensure you dont get it wrong!
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Contact details
Nigel Walker, Network Lead Tel- 07795
266936 nigel.walker_at_csip.cat.org.uk Commissionin
g Framework for Health and Wellbeing
consultation site www.commissioning.csip.org.uk w
ww.cat.csip.org.uk/commissioningebook
www.changeagentteam.org.uk www.integratedcare.gov
.uk