eleanor davies associate director joint mental health commissioning lewisham clinical commissioning...

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Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning post the Health and Social Care Act, 2012

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Page 1: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham

Commissioning post the Health and Social Care

Act, 2012

Page 2: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

The Health and Social Care Bill puts clinicians at the centre of commissioning, frees up providers to innovate, empowers patients and gives a new focus to public health.

Arguably the most radical shake up of the NHS since its inception and unequivocally the most extensive reorganisation of the structure of the NHS to date

The Health and Social Care Act in a nutshell

Page 3: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Rising demand and treatment costs Need for improvement State of the public finances

Case for change

Page 4: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Clinically led commissioning Provider regulation to support innovative

services Greater voice for patients New focus for public health Greater accountability locally and nationally Streamlined armslength bodies

Key legislative changes

Page 5: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

The focus of new commissioning system is Accountability and Outcomes

Clinical Commissioning Groups (CCGs) are the new statutory (accountable) bodies for most commissioning - Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are abolished

NHS England holds CCGs to account and is accountable for other commissioning (e.g. Primary Care and specialist services)

Various other national bodies are being developed as well as Public Health moving to Local Authorities and Public Health England

CCGs will have £25 per head of population to spend on their organisations (we call this commissioning support)

CCGs have to balance how they spend this – In house staff / purchased from a CSS / shared

The new NHS commissioning system

Page 6: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

What’s happening in London…

Page 7: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Camden

7

Hillingdon

Harrow

Brent

Ealing

Hounslow

Central London

Barnet

Enfield

Haringey

Islington

Richmond

Merton

Croydon

Wandsworth

Kingston

Bromley

Bexley

Greenwich

South-wark

Lambeth

NewhamTower

Hamlets

City & Hackney

Havering

Redbridge

Waltham Forest

Sutton

Wave 1 – 3 CCGsWave 2 – 15

CCGsWave 3 – 11 CCGs

Wave 4 – 3 CCGs

Barking &Dagenham

Hammersmith & Fulham

West London Commissioning

Lewisham

Camden

There are 32 emerging CCGs in London, who will need to demonstrate they have robust commissioning support in place

Page 8: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

What type of organisation is a Commissioning Support Unit?

• The 2013 NHS will be genuinely different– CCGs will be small, light,

clinical commissioning organisations

– CSUs will be vital to getting CCGs up and running and critical to the success of the commissioning system overall

– Hosted by NHS England – 23 CSUs in England, 3 in

London– CSUs are funded by CCG

income and by income from other customers

CCG

NHS Englan

d

CSUServices

Account-ability

Page 9: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Three CSUs are taking shape in London

North West London

South London

North Central and East London

Page 10: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

• SLCSU is developed from CCG views

• SLCSU is designed to give CCGs benefit of local services and the benefits of working at a larger scale to centralise expertise

• £30m+ organisation, c300 staff, all 12 CCGs will purchase core services

The South London CSU Story so far

Page 11: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

• Well prepared for the transition

– Started on 1st April

– First board meetings taking place

Development of South London Clinical Commissioning Groups

Page 12: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Stressful! People are applying for new jobs or their old ones £20 billion of NHS efficiency savings required

nationally. Large LA budget reductions In Lewisham GPs are increasingly becoming more on

board with changing referral patterns. Less lone operators, more group think and peer pressure.

There is still the tendency to think like providers rather than commissioners…

What’s it really like….

Page 13: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

2 posts transferring to the CCG. One part funded by the LA

c.£90m budget Covering:

Adult Mental Health – for health and social care IAPT service NHS Specialist services NHS Forensic services Mental Health of Older Adults – for health and social care Dementia services – for health and social care Adult Mental Health Voluntary sector – for health and

social care £4.5m health savings and £600k LA savings required from

2011/12 – 2013/14. More savings to come….

Lewisham Joint Mental Health Commissioning

Page 14: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

The scale of efficiency savings make it imperative to do things differently – real radical change is required

E.g. Closed a two 16 bedded specialist Continuing Healthcare

Unit and reinvested £1.6m of recurring money into our Dementia pathway with £370k taken as QIPP

Commissioned a 3 month Forensic triage model which has diverted 75% of people away from Medium Secure Units and saved £1.3m to commissioning budgets

Commissioned a support planning and brokerage service to support people to use their Individual Budgets

Commissioned local secondary care ASD and ADHD diagnosis and treatment clinics rather than using specialist services

Some positives to savings!

Page 15: Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning

Lobbying CCGs and Health and Wellbeing Boards Support commissioners in their role – not just GPs Identify gaps in provision Share best practice Share evidenced based practice Give ideas for efficiency savings – support whole

system transformation Improve public awareness and engagement Influence big decision makers

How can the you influence the health and social care agenda