PlanningPlanningCommissioningCommissioning

Performance Performance ManagementManagement

Andrew McCormickAndrew McCormick

14 June 200614 June 2006

Frederick DouglasFrederick Douglas

““If there is no struggle there is no If there is no struggle there is no progress... Power concedes progress... Power concedes

nothing without a demand. It nothing without a demand. It never did and it never will”never did and it never will”

Progress on RPA...Progress on RPA...

Trust LegislationTrust Legislation CE Designate of HSSACE Designate of HSSA Trust ChairsTrust Chairs Trust CEs – adverts outTrust CEs – adverts out Road shows – 4 so far, positive Road shows – 4 so far, positive

feedbackfeedback Primary Legislation – instructions Primary Legislation – instructions

end Juneend June

Never mind the RPA, where’s Never mind the RPA, where’s the Service...?the Service...?

12 months is far too long12 months is far too long 34 weeks from referral to treatment 34 weeks from referral to treatment A&E standards are just not acceptableA&E standards are just not acceptable More chronic disease management is More chronic disease management is

essential – but won’t save moneyessential – but won’t save money Care for the vulnerable old and youngCare for the vulnerable old and young Health and well being, not just servicesHealth and well being, not just services

STRUCTURES MUST DELIVER THIS!STRUCTURES MUST DELIVER THIS!

The Reform Triangle The Reform Triangle Choice/ Commissioning

Performance Management

Funding based on Outcomes

Overarching ThemesOverarching Themes

Leadership CommitmentLeadership Commitment Quality CultureQuality Culture Clarity of FocusClarity of Focus Professional/Physician EngagementProfessional/Physician Engagement EmpowermentEmpowerment Approach to Continuous Approach to Continuous

ImprovementImprovement Use of DataUse of Data

The New HPSSThe New HPSS Distinguishes procurement from provisionDistinguishes procurement from provision Works with human nature, not against itWorks with human nature, not against it

the super-ego and the egothe super-ego and the ego– commissioning based on public sector valuescommissioning based on public sector values

the super-ego: comprehensive, local, free and the super-ego: comprehensive, local, free and fairfair

– provision based on entrepreneurialismprovision based on entrepreneurialism the ego: ‘my’ organisation, customers and the ego: ‘my’ organisation, customers and

rewardreward– an an externalexternal market market

fitness for purpose is the only requirement – fitness for purpose is the only requirement – we do what deliverswe do what delivers

Performance ManagementPerformance Management

Smaller numbers of core targets – a Smaller numbers of core targets – a ‘dashboard’‘dashboard’

In the context of standards In the context of standards framework – systematic use of NSFsframework – systematic use of NSFs

Mandatory compliance – incentives Mandatory compliance – incentives and sanctionsand sanctions

Balanced scorecard approachBalanced scorecard approach access, responsiveness, outcomes, access, responsiveness, outcomes,

financial management, qualityfinancial management, quality

Performance ManagementPerformance Management

Payment by ResultsPayment by Results Marginal costsMarginal costs

– minimal impact of doing one more (or less) minimal impact of doing one more (or less) Full costsFull costs

– exaggerated impact of doing one more (or less)exaggerated impact of doing one more (or less) Radical mechanismRadical mechanism

– ..too radical could bankrupt the system..too radical could bankrupt the system Too acute-centricToo acute-centric

– could we drive up acute activity at the expense of primary could we drive up acute activity at the expense of primary carecare

THE ANSWER IS THE ANSWER IS YESYES BUT... BUT...

We create We create OUROUR system to address these problems system to address these problems and also...and also...

Commissioning Rules...Commissioning Rules... assessment of the health and social assessment of the health and social

care status of the populationcare status of the population service frameworks service frameworks service realitiesservice realities specific contracts for service specific contracts for service

provision (single or multiple to be provision (single or multiple to be decided)decided)

monitoring of compliancemonitoring of compliance SanctionsSanctions plurality and choice in providers and plurality and choice in providers and

enhancing contestabilityenhancing contestability

Key ChallengesKey Challenges

Early start to the new LCGsEarly start to the new LCGs Changing the balance of powerChanging the balance of power IntegrationIntegration Whole life, whole personWhole life, whole person Balance of regional and local Balance of regional and local

commissioningcommissioning

Emerging Proposals for Emerging Proposals for MembershipMembership

1 x Chief Commissioning Officer for the 1 x Chief Commissioning Officer for the locality locality

5 x professional officers of the Authority 5 x professional officers of the Authority including 2 social services including 2 social services representatives and others from public representatives and others from public health, nursing and Allied/Community health, nursing and Allied/Community Health representativesHealth representatives

4 x GPs 4 x GPs 3 x other Independent Contractors 3 x other Independent Contractors

Roles for LCGsRoles for LCGsFour distinct roles:Four distinct roles: targeted improvements in the health status targeted improvements in the health status

and social wellbeing of the populationand social wellbeing of the population Commissioning health, social and care Commissioning health, social and care

services to meet the population’s needs, and services to meet the population’s needs, and strategic targets and standards set by the strategic targets and standards set by the Department and Authority - Department and Authority - CONTESTABILITYCONTESTABILITY

Securing the delivery of cost-effective service Securing the delivery of cost-effective service to meet presenting demand; andto meet presenting demand; and

Overseeing the development of practice-Overseeing the development of practice-based commissioningbased commissioning

Through this we create...Through this we create...

Strong centrally driven adherence to Strong centrally driven adherence to targets and standardstargets and standards

Performance improvements through Performance improvements through financial incentives and financial incentives and contestabilitycontestability

Strong local commissioning always Strong local commissioning always looking to ‘make’ before ‘buying’looking to ‘make’ before ‘buying’

“…“…[decision makers] … must be [decision makers] … must be allowed to contest provision and allowed to contest provision and commission from different sources commission from different sources where they believe it to be in the where they believe it to be in the interests of the user. The independent interests of the user. The independent treatment centres; diagnostic centres; treatment centres; diagnostic centres; … the expertise of both the voluntary … the expertise of both the voluntary sector and the private sector. Then, the sector and the private sector. Then, the money needs to follow these choices. money needs to follow these choices. This is the spur for improvement. This is the spur for improvement.

Tony Blair 6 June 2006Tony Blair 6 June 2006