from painting by numbers to creative expression - moving commissioning to a new era nigel walker –...

From painting by numbers to creative expression -

moving commissioning to a new era

Nigel Walker – National Lead – Commissioning

Care Services Improvement Partnership

The developing agenda...Contradictory messages don’t help

The developing agenda...A developing agenda...

•Strong and Prosperous Communities

•Our Health, Our Care, Our Say – Making it Happen

•New Outcomes Framework – Performance of Adult Social Care

•Relentless Optimism – Commissioning for personalised Services

•Options for Excellence – Social Care Workforce Planning

•Third Sector initiatives

•Health Care Commissioning Framework

•NHS Operating Framework 2007/08

•State of Social Care in England 2005-06

•Commissioning Framework for Health and Wellbeing (March 07)

Drivers for Change – Strong and Prosperous Communities

•Local Involvement Networks (LINKs)

•Community Call for Action

•Co-ordinated consultations

•Joint Appointments – Directors of Public Health

•Statutory Partnerships for Health and Wellbeing to carry out a Strategic Needs Assessment

•Lead Members – big role in commissioning decisions

•Single performance framework

•Building on Supporting People

•National Housing Strategy – Ageing population

•Third Sector – 3 year funding

Our Health, Our Care, Our Say - Making it Happen – Roadmap for change

The State of Social Care in England 2005-06 – what it says about commissioning...(i)

•Continuing improvement but at a disappointing pace

•Better outcomes needed through well-functioning local market that

ensures consumer choice

safeguards continuity of good quality supply

deals with poorly functioning businesses

encourages innovation

•Long term financial planning demonstrating good use of resources

•Very mixed practice in analysis of needs and market and communications with providers and local people

•Need to commission for whole population

The State of Social Care in England 2005-06 – what it says about commissioning...(ii)

•Managing against a tough financial background

•Problems with Health budgets impacts on Social Care

•Need for strong local leadership & organisational support

•More complexity:-

•Increased expectations and higher demand

•Transformation at same time as workforce problems

•A rapidly changing policy agenda

The Commissioning Framework for Health and Wellbeing

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

• Putting people at the centre of commissioning• Understanding the needs of populations and individuals • Sharing and using information more effectively• Assuring high quality providers for all services• Recognising the interdependence of work, health and

well-being • Developing incentives for commissioning for health and

well-being• Making it happen: local accountability• Making it happen: capability and leadership

Eight steps to more effective commissioning

The hard stuff

•Strategic commissioning v personalised care

•Dis-investment and de-commissioning of traditional services and re-investment in prevention and individualised care

•Implications of self-directed care for assessment and care management

•Engaging providers in the conversation

•Moving towards outcomes

•Engaging communities in the conversation

•Supporting people to take risks

•Performance monitoring and quality control

•Role of other services in delivery

Why Demand Forecasting ?

•Need for twenty year commissioning strategies

•More clarity about what is required from a community and user perspectives

•Demography brings its own challenges

•Expectations raised

•Recognise opportunities

•Greater integration required – but of what?

•Need for sound dis-investment and re-investment plans

What is demand forecasting ?

•Assessing the type and quantity of services required far enough in advance to ensure good investment decisions

•Properly considered timescales

•Bringing the right service levels and quality to the right people in the manner they wish them at the right time

•Most efficient delivery methods

•Most cost-effective price

•It will also assist in equitable rationing if this is required

The Four Dimensions of Demand Forecasting

Population needs

assessment or population

profiling

Defines need based on the assumption that the presence of certain characteristics or conditions is a reliable indicator of demand for services.

Surveys of anticipated future need

Defines need based on the assumption that people

know what they want now and in the future and that

their articulation of need is not influenced by any potential limitations of

supply.

Analysis of conditional demand

Redefines need through examining the key factors

driving demand, and the potentiality and amenability

of that perceived demand, to change.

Service user profiling

Defines need based on the current take up of services to meet identifiable demand multiplied by changes in the population

The Four Dimensions of Demand Forecasting

Population needs

assessment or population

profiling

Defines need based on the assumption that the presence of certain characteristics or conditions is a reliable indicator of demand for services.

Population

•Variable use of population data by authorities, but analysis tends to be in generalisations•Can provide information about general trends, particular issues or with service data something about strike rate•Can enable reasonable look ahead for planning purposes•Data tends to become less useful as the next census draws nearer•POPPI (Projecting Older People Population Information) website for local data analysis www.poppi.org.uk

Shire in 1911

Shire 2001

Shire 2001 to national comparison

Shire data

Shire predominantly a rural county: • 40% of the population lives in very rural areas or in settlements of

less than 2,000 people.• Of the remaining 60% half live in the larger villages and smaller

towns with populations between 2,000 and 10,000 and the other half in the nine larger settlements of over 10,000 people ( this compares to over 80% in England and Wales living in settlements of this size).

• The distribution of older people in the County reflects this. 25% of people aged 75 and over living in areas with a population density of fewer than one person per hectare and 14% living in settlements of fewer than 1,500 people.

Shire data

Table 1. Estimated number of people aged 80 and over with a dementia:

2001 2011 2028

5016 6080 8870

Table 2. Provision of care by older people

All people providing 50 or more hours careper week

People aged 75-84providing 50 or more hours care per week

People aged 85+ providing 50 or morehours care per week

13,107 1,532 278

Potential impact on Shire in twenty years

Extrapolating the population trends could mean:

• 6,660 additional assessments of older people per annum.

• Another 18,000 hours of domiciliary care per annum.• An additional 2,220 places in residential and nursing

home care.• 2,715 people aged over 75 providing more than 50

hours care per week to another person.

The Four Dimensions of Demand Forecasting

Surveys of anticipated future need

Defines need based on the assumption that people

know what they want now and in the future and that

their articulation of need is not influenced by any potential limitations of

supply.

Surveying anticipated futures

•How do changing needs and perceptions translate to new services – the unexperienced cannot always be expressed, only dreamed of

•National data rarely built on locally

•What we want is not what we plan for others

•Known unknowns :- increased wealth and health, pensions black hole, new or different medical interventions

•A lack of ways to meaningfully engage with communities

The Four Dimensions of Demand Forecasting

Service user profiling

Defines need based on the current take up of services to meet identifiable demand multiplied by changes in the population

Service User Profiling

•Need to map existing provision to see if it matches current usage

•Information about provision is not the same as knowing demand

•Ways of recording data and sharing across boundaries is not well developed

•Analysis skills often poor in both Health and Social Care systems

•What is the way in which we can best understand public reactions to new professional thinking (eg outcomes, telecare)

•Can we describe how people use services and then as questions at critical key moments?

The Four Dimensions of Demand Forecasting

Analysis of conditional demand

Redefines need through examining the key factors

driving demand, and the potentiality and amenability

of that perceived demand, to change.

Conditional or perverse demand

• Are services outcome or output driven?

Example: meals service, provision of equipment.• Are there needs being presented where targeted interventions could

improve outcomes but where this is not occurring?

Example: Alternatives to res. care, dehydration.• Is the intensity of the service provided sufficient to achieve the

outcomes desired?

Example: stroke rehabilitation, continence services.• Are service delivered at the right time to have the maximum impact?

Example: Support to carers of people with dementia.

Next steps

• Clear establishment of local data sets that focus on information at the interface of health, social care and housing and that enable agencies to much more effectively target key populations.

• For those target populations establish a much clearer idea of cause / effect and cost / benefit.

• Agreement on use of POPPI data.• Build better skills in data analysis and local interpretation.• Use national surveys to much more effectively develop local

consultation exercises which build on rather than replicate that survey data.

• Is this a regional rather than local role? What is the role of Public Health and the Health Observatories?

Key effects of good data and understanding

•Wider understanding of all needs across local gov’t and health

•Informed communities willing to pay for relevant public services

•People having more control

•Systems and services integrated where they need to be

•Better use of the money

•Fully integrated workforce planning and teams where that makes sense

•Providers giving good and affordable services that people want and will buy

•Recognition that prevention is better than cure

Try to ensure you don’t get it wrong!

Contact details

Nigel Walker, Network Lead

Tel:- 07795 266936

nigel.walker@csip.cat.org.uk

Commissioning Framework for Health and Wellbeing – consultation sitewww.commissioning.csip.org.uk

www.cat.csip.org.uk/commissioningebook www.changeagentteam.org.ukwww.integratedcare.gov.uk