Commissioning High Quality Stroke Services

Peter KottlarJoint Head of Older People Commissioning and

Lead for Stroke Services

Ealing PCT & NW London Cardiac and Stroke Network

20th March 2009

North West London Cardiac & Stroke Network

EALING Primary Care Trust

History of Commissioning in NHS

• 1991 introduction of ‘purchasing’

• Aim: separating the interest of those receiving healthcare from those supplying them

• 1990s: GP fund-holding move to Primary Care Groups (PCGs)

• 2001: Primary Care Trusts (PCTs) created

What is Commissioning?

• Process of ensuring health and care services provided most effectively meet the needs of the population  

• Roles of PCTs– the advocate for patients; and– the custodian of taxpayers’ money

Objectives of Commissioning

• Improve health and wellbeing and reduce health inequalities

• Improve quality, effectiveness and efficiency

• Increase choice and responsiveness

• Develop comprehensive services

• Achieving best value within

available resources

Nee

ds

Ass

essm

ent

Review

ServicesDecide Priorities

Desig

n

services

Shaping

Structure

of Supply

Cap

acity

P

lann

ing

Managing

performance

Se

ek

ing

p

ati

en

t v

iew

s

Commissioning Cycle

PATIENTSand

PUBLIC

PATIENTSand

PUBLIC

COMMISSIONING: Strategic Planning Stage

NEEDS ASSESSMENT

NEEDS ASSESSMENT

REVIEWSERVICES

REVIEWSERVICES

DECIDEPRIORITIES

DECIDEPRIORITIES

– Public Health data– Other statistics/data– identify unmet need?

– Service Mapping – Gap analysis – Identify service improvements

– Development of strategic plan – Resources/Budgeting– Involve users and carers

COMMISSIONING: Service Procurement Stage

DESIGN SERVICES

DESIGN SERVICES

SHAPING STRUCTURE OF SUPPLY

SHAPING STRUCTURE OF SUPPLY

CAPACITY PLANNING, DEMAND MANAGEMENT

CAPACITY PLANNING, DEMAND MANAGEMENT

– Development of service model– Involve service users and carers

–PCT develop service specification, PIs–Support & encourage providers to develop

services– Invite NHS/private/3rd sector providers

–PCT develop service specification, PIs–Support & encourage providers to develop

services– Invite NHS/private/3rd sector providers

–Development of strategies for care and resource utilisation

–Development of strategies for care and resource utilisation

COMMISSIONING: Monitoring & Evaluation Stage

MANAGING PERFORMANCE

MANAGING PERFORMANCE

SEEKING PATIENT/PUBLIC VIEWS

SEEKING PATIENT/PUBLIC VIEWS

–Ensure agreed targets are met–Review patient set goals–Develop improvement plans

–Patient outcomes & experiences–Informs commissioning actions

Nee

ds

Ass

essm

ent

Review

ServicesDecide Priorities

Desig

n

services

Shaping

Structure

of Supply

Cap

acity

P

lann

ing

Managing

performance

Se

ek

ing

p

ati

en

t v

iew

s

Commissioning Cycle

PATIENTSand

PUBLIC

PATIENTSand

PUBLIC

World Class Commissioning

‘WCC will deliver a more strategic and longer-term approach to commissioning services, with a focus on improving health outcomes’

Commissioning Assurance Handbook, 2008

World Class Commissioning

VISION VISION ASSURANCE SYSTEM

ASSURANCE SYSTEM

DEVELOPMENT FRAMEWORK

DEVELOPMENT FRAMEWORKCOMPETENCIES COMPETENCIES

WORLD CLASS COMMISSIONIN

G

WORLD CLASS COMMISSIONIN

G

World Class Commissioning

VISION VISION

‘Adding life to years and years to life’

Better health and well-being for all, better care for all,

and better value for all.

World Class Commissioning

COMPETENCIESCOMPETENCIES

Locally lead the NHS Locally lead the NHS

Engage with public/patients Engage with public/patients

Collaborate with clinicians Collaborate with clinicians

Manage knowledge /assess needs Manage knowledge /assess needs

Promote improvement and innovation Promote improvement and innovation

Secure procurement skills Secure procurement skills

Secure procurement skills Secure procurement skills

Manage the local health system Manage the local health system

Make sound financial investments Make sound financial investments Prioritise investment Prioritise investment

Stimulate the market Stimulate the market

11

22

33

44

55

66

77

88

99

1010

1111

World Class Commissioning

ASSURANCE SYSTEM ASSURANCE SYSTEM

PURPOSE: to understand whether PCTs are improving as commissioners of better health outcomes

PCT are assessed by NHS London across three elements:

OUTCOMES

COMPETENCIES

GOVERNANCE

Rate of improvement

Level 1 - 4

R A G

World Class Commissioning

DEVELOPMENT FRAMEWORKDEVELOPMENT FRAMEWORK

BOARD DEVELOPMENTBOARD DEVELOPMENT

FRAMEWORK FOR PROCURING EXTERNAL SUPPORT FOR COMMISSIONERS

FRAMEWORK FOR PROCURING EXTERNAL SUPPORT FOR COMMISSIONERS

World Class Commissioning

“The aim of world class commissioning,and therefore the ultimate test of its success,will be an improvement in health outcomes

and a reduction in health inequalities”

Commissioning Assurance Handbook, 2008

References

• Health Reform in England: Update on Commissioning Framework – Department of Health, 2006

• World Class Commissioning, Department of Health, 2007 http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm

• Commissioning Specialised Services, Department of Health, 2007, http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Commissioningspecialisedservices/index.htm

WORLD CLASS COMMISSIONING

COMPETENCIESCOMPETENCIES

Locally lead the NHS Locally lead the NHS

SKILLSSKILLS

11

PROCESS AND KNOWEDGE REQUIREMENTS

PROCESS AND KNOWEDGE REQUIREMENTS

OUTPUTSOUTPUTS

WORLD CLASS COMMISSIONING

COMPETENCIESCOMPETENCIES Locally lead the NHS Locally lead the NHS

SKILLS (sub-components)•Listens to partner NHS organisations and other providers •Signals future priorities of the local NHS •Has good presentation and influencing skills, e.g. in reputation management •Has good organisational development skills

SKILLS (sub-components)•Listens to partner NHS organisations and other providers •Signals future priorities of the local NHS •Has good presentation and influencing skills, e.g. in reputation management •Has good organisational development skills

11

PROCESS AND KNOWEDGE REQUIREMENTS•Able to articulate vision of NHS, fair personal, effective and safe •Is skilled in engagement & involvement methods •Understands own the strengths and weaknesses, and develops its competence

PROCESS AND KNOWEDGE REQUIREMENTS•Able to articulate vision of NHS, fair personal, effective and safe •Is skilled in engagement & involvement methods •Understands own the strengths and weaknesses, and develops its competence

OUTPUTS•Clear Communication policy on reports, findings, commissioning plan•Strong interaction with other organisations•Good understanding of reputation management

OUTPUTS•Clear Communication policy on reports, findings, commissioning plan•Strong interaction with other organisations•Good understanding of reputation management

COMPETENCIESCOMPETENCIES

WORLD CLASS COMMISSIONING

Locally lead the NHS Locally lead the NHS 11

Level 1Level 1

Level 4Level 4

Level 3Level 3

Level 2Level 2

Does not meet Level2 requirements

• Key stakeholderssomewhat agree that PCT is the local leader of NHS•PCT has anunderstanding of itscurrent and intended reputation, withstrategies in place to address this

•Key stakeholders agree that the PCT is the local leader of the NHS•The PCT activelyparticipates in andleads the local health agenda• The local populationagree that the localNHS is improvingservices

• Key stakeholders strongly agree that thePCT is the local leaderof the NHS• The PCT activelyparticipates in andleads the local healthagenda, effectivelyparticipating inmulti-agency and NHSwide agendas• The local populationstrongly agree that thelocal NHS is improvingservices