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George Leahy

Head of Public Health Development

Department of Health

PUBLIC HEALTH IN THE NEW COMMISSIONING WORLD:

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Purpose

• To discuss the new Commissioning Framework, and in particular JSNA

• To outline potential challenges for DsPH• To explore what support you need, and how

to get it

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hThe Commissioning Framework: Summary

• Launched March 2007; consultation ends 29th May

• Key development in system reform agenda• Focus on promoting health and well-being,

including prevention of ill-health• Stronger focus on commissioning for outcomes to reduce inequalities

• Emphasises importance of strong partnerships

• Recognises potential role of third sector

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The Commissioning Framework: Aims

1.A shift towards services that are personal, sensitive to the needs of the individual and focused on maintaining independence

2. 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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Where we are now

• Health reform and investment has changed the NHS

• Clinical outcomes have improved

• Increasing effectiveness of joint working across health & social care

• More choice among services, which are delivered closer to home

• Commissioning for volume and price - not quality and outcomes

• Too much care in institutional settings

• Health inequalities remain

• Focus on treating illness

• Limited diversity of providers

• Individual choices still limited, local voices sometimes unheard

BUTBUT

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hEight steps to more effective commissioning

1. Putting people at the centre of commissioning

2. Understanding the needs of populations and individuals

3. Sharing and using information more effectively

4. Assuring high quality providers for all services

5. Recognising the interdependence of work, health and well-being

6. Developing incentives for commissioning for health and well-being

7. Making it happen: local accountability

8. Making it happen: capability and leadership

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hUnderstanding the needs of populations and individuals: JSNA

• Key building block of commissioning process

• Duty of local authority and PCT

– LAA and local targets based on the JSNA

• Must be focussed on outcomes

• Must be focussed on the future

o 3-5 years: improvements in outcomes/reductions in health inequalities

o 5-15 years: for major infrastructure planning(transport, housing, healthcare facilities)

o 1 year: contractual changes at frontline / PBC level

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hJSNA:What it isn’t, what it can do

• Need to define scope

• Not the whole commissioning process

• Not the plan to deliver changes in service delivery

• It is a process and a ‘document’

• (DsPH must be involved in whole commissioning process)

• It is the information & evidence to support other parts of the commissioning process: medium & short term

• Includes Patient and Public ‘voice’

• PCT Prospectus & Sustainable Community Strategy

– Signals to the ‘market’ that changes in provision expected

– Services as they are currently delivered could be decommissioned

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JSNA and the Commissioning Cycle

Demography

Joint Strategic Needs

Assessment

the desired health and well being outcomes in 3 –

5 years time for your population

Social & environmental context

Current known health

status of populations

Current met needs of

the population

Patient/Service User voice

Public demands

Programme of systematic service reviews

(NHS / Social Care)

Prioritisation framework for annual contracting

procurement

Medium-term market development: capacity to

deliver desired service configuration

(Local Government and NHS)

Primary Care Investment Commissioning decisions

(NHS)

Capital Investment Plans (local / regional government

and NHS)

OUTPUTS

(The link to other stages of

commissioning)

INPUTS

(Data/information needed)

What decisions will be made by whom?

LSP

PCT

SCS, LAA and Outcome indicators (35/200)

PCT Prospectus & outcome

metrics chosen

Analysis of inequalities

- Outcomes

- Service Access

Programme budgets and outcomes

Evidence of effectiveness

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Interpersonal Relationships

• Statutory guidance

• Duty on the DPH/DASS/DCS to work together

• Poor relationships could undermine JSNA and commissioning

• Do you require support in developing, e.g. negotiation and relationship management skills?

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Prioritisation & Leadership

• JSNA focuses on outcomes

• Over the short to medium term

• Aligned with SCS & LAA cycles

• What will prevent an agreement on outcomes?

• How will priorities be set?

• Will there be any ‘political’/power imbalances?

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hPrioritisation & Leadership: Decommissioning

• What part will you play?

• How could JSNA support you?

• How will you maintain PH as a priority?

• JSNA is “backdrop” & supports prioritisation

– annual contracting

More importantly…• Longer time periods• Provides ‘defensible’ process

for decisions on priorities• This includes building local

support for decommissioning(patient/public/political voices)

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Which Model Suits You?

DCSDASS

DPH

DPH

DCS DASS