Commissioning How can the third sector become involved National Programme for Third Sector Commissio

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Commissioning How can the third sector become
involved?National Programme for Third Sector
Commissioning Myths Explored and Exploded
14/07/2008Paul Corrigan Director of Strategy
and Commissioning NHS London
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Commissioning How can the third sector become
involved?

• The architecture of the new NHS
• The nature of the service we provide medicine,
  health and change over the next decade
• The London context for the next 10 years
• Why does commissioning matter so much
• Why World class commissioning?
• The WCC competencies
• The WCC assurance framework and development
• The rules of cooperation and competition
• What does WCC and the rules mean for the third
  sector

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The architecture of the new NHS

• Four themes of reform
• 1 Developing better value in demand
• 2003 Locality population based Commissioning
  through PCTs. More patient choice
• 2 Developing better value in supply
• 2004 to date public hospitals with more
  independence Foundation Trusts, new private
  providers new forms of primary care provision
• 3 Developing the transactional relationship
  between demand and supply
• Ensuring providers have to earn money rather
  than just spend it 2003 to date developing
  pricing at a national level for 70 of hospital
  work. The Understanding primary and community
  health services
• 4 Developing the N in the HS
• Developing the system as a whole national
  frameworks for main disease patterns and national
  agreements for which drugs can be used National
  independent inspection. Competition rules

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The nature of the service we provide medicine,
health and change over the next decade

• The certainty over the next decade is very rapid
  change in the nature of health services both in
  terms of technology and service
• What operations that now need 3 day stay in
  hospital will still do so?
• What proportion of chemotherapy will be carried
  out at home?
• What proportion of long term conditions will be
  solved through genetics?
• What proportion of health improvement will be the
  concern of medical professionals?
• In the next 10 years each important part of the
  health service will change several times
• The NHS in London has a choice in keeping up with
  implementing these changes or, because of its
  inability to create change quickly enough falling
  behind.
• One of Health Care for London's criticisms is our
  slowness to bring about change
• If we fall behind the 2018 election will be about
  the failure of the NHS model

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The London Context for the next 10 years

• With luck London remains a world city In the top
  3 or 4 selling hard and soft skills and service
  expertise
• World cities drive the world and increasingly the
  world wants to go and live in them because of
  that.
• Health inequalities will be recreated all the
  time by the influx of new poor and new rich that
  are made rich and poor elsewhere
• World cities contain more movement and churn
  than other places and (as long as they are world
  cities) this will increase
• For health services this international churn
  provides a very fractured epidemiology that will
  change and change again. This is very important
  for health and health services
• For medical research it provides a massive
  opportunity for the world is here
• The specificity of culture, genetics and
  epidemiology demands a very segmented health
  service rather than one size fits all

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Why does commissioning matter so much?

• The NHS architecture places commissioning as the
  main driver for improvement
• Commissioning will set the standards for what
  improvements need to happen
• Producing commissioning guidelines for
  implementation for each service area
• These need to be developed with existing
  provision and its journey to improvement in mind,
  but NOT giving them a block to change
• The development of world class commissioning is a
  vital part of this journey as PCTs build share
  and buy capacity

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Why World Class Commissioning is a driver in this?

• The DH has been slow in placing the development
  of PCTs at the core of NHS activity (Be careful
  what you wish for)
• Clinically based commissioning is the main driver
  for improvement
• We now have a rigorous programme of development
  which will involve detailed assurance against a
  set of 11 competencies and a development
  programme that springs from that.
• Build share and buy competencies
• WCC assurance will take place over autumn/winter
  2008/9 with calibration in February (private
  results)
• It will be based on self assurance and an
  external panel discussing with the board
• It will essentially focus on the board and its
  capacity to own and develop. The Organisational
  Development Plan will show what the board will do
  about its assessment
• (Confed Conference gave PCTs 3.3 out of 10 on
  19/06)

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World Class Commissioning Competencies

• Are recognised as the local leader of the NHS
• Work collaboratively with community partners to
  commission services that optimise health gains
  and reductions in health inequalities
• Proactively seek and build continuous and
  meaningful engagement with the public and
  patients, to shape services and improve health
• Lead continuous and meaningful engagement with
  clinicians to inform strategy and drive quality,
  service design and resource utilisation
• Manage knowledge and undertake robust and regular
  needs assessments that establish a full
  understanding of current and future local health
  needs and requirements
• Prioritise investment according to local needs,
  service requirements and the values of the NHS
• Effectively stimulate the market to meet demand
  and secure required clinical and health and
  well-being outcomes
• Promote and specify continuous improvements in
  quality and outcomes through clinical and
  provider innovation and configuration
• Secure procurement skills that ensure robust and
  viable contracts
• Effectively manage systems and work in
  partnership with providers to ensure contract
  compliance and continuous improvements in quality
  and outcomes
• Make sound financial investments to ensure
  sustainable delivery of priority outcomes

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The WCC assurance framework and development

• The assurance framework for PCTs starts now
• The development of known gaps starts now
• The writing of the CSP by November 28th
• Discussion with PCTs and work with the panel as a
  board to board
• National calibration of where PCTs are
• Development programmes to fill in gaps-already
  identified commercial skills, board development
  and partnership with local government

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The principles of competition and co-operation

• The ten principles outlined in this document are
• 1.Commissioners should commission services from
  the providers who are best placed to deliver the
  needs of their patients and population
• 2.Providers and commissioners must cooperate to
  ensure that the patient experience is of a
  seamless health service, regardless of
  organisational boundaries, and to ensure service
  continuity and sustainability
• 3.Commissioning and procurement should be
  transparent and non-discriminatory
• 4.Commissioners and providers should foster
  patient choice and ensure that patients have
  accurate and reliable information to exercise
  more choice and control over their healthcare
• 5.Appropriate promotional activity is encouraged
  as long as it remains consistent with patients
  best interests and the brand and reputation of
  the NHS

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The principles of competition and co-operation
(contd)

• 6.Providers must not discriminate against
  patients and must promote equality
• 7.Payment regimes must be transparent and fair
• 8.Financial intervention in the system must be
  transparent and fair
• 9.Mergers, acquisitions, de-mergers and joint
  ventures are acceptable and permissible when
  demonstrated to be in patient and taxpayers' best
  interests and there remains sufficient choice and
  competition to ensure high quality standards of
  care and value for money
• 10.Vertical integration is permissible when
  demonstrated to be in patient and taxpayers' best
  interests and protects the primacy of the GP
  gatekeeper function and there remains sufficient
  choice and competition to ensure high quality
  standards of care and value for money

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What does WCC and the rules mean for the third
sector

• PCTs as commissioners will be judged as WCC
  against -
• 2 Collaborative commissioning with partners
• 3 Building engagement with the public that
  optimise health gain
• 4 Undertake robust and regular needs assessments
• 5 Prioritise investment according to local needs
• 6 Stimulate the market to meet demand
• 9 Work with providers for continuous improvements
  in outcomes
• Competition rules
• Commissioners should be transparent and non
  discriminatory with transparent payment regimes
  etc etc