PowerPoint Presentation

Towards informed and innovative commissioningCommissioning Workshop for Library & Knowledge Services October 2013

sue.lacey-bryant@nhs.net1Commissioning definedContextEvidence-based commissioningUnderstanding the customerBest valueHow can librarians evolve to meet the need?Sue Lacey Bryant This session will include some opportunities for personal reflection and goal setting.

2The library as a platform for change

Health is a knowledge- based industry Health is a people based industry What more can librarians do to help? What more can I do to help?

Sue Lacey Bryant Where can knowledge have the most impact? How can we improve business performance by building know-how?How can we share and spread good practice & embed lessons learned?What do we need in the way of information products and services?

See also ; Platform for Change: The Educational Policy Statement of the Medical Library Association, The Medical Library Association, 1992 http://www.mlanet.org/education/platform/

31. Commissioning definedthe process of allocating public resources to achieve the greatest gains in health within a defined population

Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/

Sue Lacey Bryant 4Shift in approach to commissioning 20th Century Hospital centredChallenges met by growth

Clinician-centredBenefits of treatmentQuality improvement Focus on individual Patient compliance; public & patient engagement High carbon usage

21stCenturyCare closer to homeTransformation; innovation; whole system; redesign

Patient-centredPrevention; risk stratification Reduce waste; increase valuePopulation perspectivePatient as co-producer

Low carbon usageSue Lacey Bryant 2. Context: key factsThe NHS in England:Deals with over ? patients every 36 hoursServes ? peopleEmploys ? staffBudget of ? BillionAv. CCG is commissioning care for ? people; Av. CCG has been allocated ? m in 2013-14Life expectancy risingInfant mortality falling

Sue Lacey Bryant Only the Chinese Peoples Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ

In the UK, life expectancy has been rising and infant mortality has been falling since the NHS was established. Both figures compare favourably with other nations.

6Key factsThe NHS in England:Deals with over 1m patients every 36 hoursServes 53m peopleEmploys 1.35m staffBudget of 95.6 billionAv. CCG is commissioning care for 226,000 people; Av. CCG has been allocated c 300m in 2013-14Life expectancy risingInfant mortality fallingSue Lacey Bryant Only the Chinese Peoples Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ

In the UK, life expectancy has been rising and infant mortality has been falling since the NHS was established. Both figures compare favourably with other nations.

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Sue Lacey Bryant CCGs are managing c60% of the total NHS budget

Responsible for commissioning the majority of health services, including emergency care, elective hospital care, maternity services, and community and mental health servicesAlready flagged their responsibility towards the integration of health and social care

In 2015/16 the average CCG will have c3% of its allocation, c10m taken out of its budget to pay for the governments planned 3.8bn fund for the integration of health and social care, according to NHS England

And noting general election 7th May 2015

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19 CSUs; 105 CCGs; 27 Area Teams

2010 study by the Commonwealth Fund 7 industrialised countries Australia, Canada, Germany, Netherlands, New Zealand, UK and USA

10Where in the world are we?

NHS ranked 2ndafter Holland2nd patient equality & safetyScored highly on access

Best system in terms of efficiency, effective care and cost-related problems 2010 : NHS cost 2,021 per person in UK - less than half than the 4,926 per head in US2nd to last for 'long, healthy, productive livesBottom for life expectancy of patients at age 60 22.5 yrs vs 24.6 in Australia

Much higher death rates from conditions amenable to medical care. In 2003 rates were 25% - 50% higher than Canada and Australia

Sue Lacey Bryant Platform for change

Harsh financial climate: find 20 billion efficiency savings by 2015

Berwick report: give patients quality care every time

Sue Lacey Bryant Effectively flat real terms funding for the next four years; against backdrop of wider economic recession

Never let a good crisis go to waste; Take the opportunity to do things you think you could not do before

The Burning Platform Explosion the Piper Alpha oil-drilling platform in the North Sea in 1988One of the survivors, a superintendent on the rig, jumped 15 stories from the platform to the water where he knew he could only survive for 20 mins. Why? It was either jump or fry. He chose possible death over certain death; the price of staying on the platform was too high.

12PressuresUnprecedented demand

Ageing populationmore complex health needsIncreasing demand

Patient involvementNo decision about me without me

Sue Lacey Bryant Deloitte: 350 m consultations pa [2001] ... 433m [2035]

Within next few years, 3m people will have 3 LTCs. By 2020, no. people with dementia alone will exceed 1m.

The rich world is ageing; more people living longer - at 2030 22% of the people on the planet 65+; Elderly people who are chronically unwell rather than seriously ill can be maintained with nursing rather than medical care in their own homes.

No decision about me, without me

13PrioritiesStemming the increase in emergency admissions

Service reconfiguration; making the shift from hospital to community care; seamless care

Addressing inappropriate variations in clinical practice; clinical safety and quality

Improving Public Health; reducing inequalities

Sue Lacey Bryant Demand continues to rise, especially for unplanned and emergency care; rise in levels of chronic conditions and obesity

In areas with several hospitals within 30 mins driving distance we might expect to see some reconfiguration of health services to offer patients the very best specialist care where available

Better drugs and improved surgical techniques, along with the advent of day surgery, have meant good after-care, rather than medical intervention, is what increasingly determines a full recovery

A whole year's care by a GP costs about one tenth of a day in hospital.

Dealing with the duplication and fragmentation that occurs in care that crosses provider and budgetary boundaries

Using data to illuminate unexplained / inappropriate variation to drive up quality.

No decision about me without me 14Primary care at the helmGPs manage the lions share of NHS medical workHigh level of patient confidence and satisfactionOne year's care by a GP costs c1/10th of a day in hospital

CCGs responsible for 65 billion of the 95b commissioning budget

Increasing choice and service integration

Sue Lacey Bryant Primary care itself a success 15m inpatient admissions to NHS hospitals in England [Health &Social information centre, 2011] 350 m consultations pa [Deloitte, 2001]

British Social Attitudes survey 2012: public satisfaction with the NHSSatisfaction with GP services traditionally high slight decline in recent years 74% in 2012 (80% 2009).In new landscape, policy places GPs at the centre of success and sustainability

153. Evidence-based commissioningthe process of allocating public resources to achieve the greatest gains in health within a defined population

Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/

Sue Lacey Bryant

Sue Lacey Bryant All of the four elements of the cycle are sequential and of equal importance. Different elements may operate at the same time; does not operate in isolation; informed by the previous stage and drives subsequent stages of the cycle.Essentially this commissioning cycle should drive purchasing and contracting activities and be open to influence from all stakeholders via ongoing engagement activities to secure the delivery of community objectives.Value for MoneyBest Valuehttp://www.val.org.uk/page/commissioning-basics#cycle Voluntary Action Leeds

17Evidence based commissioning Redesigning services in the NHS can be an incredibly complex task, with differential demands for information and evidence originating from the nature of the task itself

Emerging research suggests that, for redesigning and commissioning or recommissioning services, equal attention may need to be paid to both clinical and non-clinical evidence.

Emmanouil Gkeredakis & ClaudiaRoginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011 Sue Lacey Bryant Emmanouil Gkeredakis, Claudia Roginski The need for clarity in evidence based commissioningHSJ, 23 May, 2011

http://www.hsj.co.uk/resource-centre/best-practice/the-need-for-clarity-in-evidence-based-commissioning/5030129.article#.UlMNucdwb48

18A plurality of evidence

HSJ 26 May 2011 p23-25Sue Lacey Bryant The evidence base Need different forms of evidence- clinical and non-clinicalPlurality rather than hierarchy of evidence - different types of evidence is needed to work together

19Top Tips for gathering evidence Consider the different forms of evidence needed for different tasks Value plurality of evidence (from authoritative bodies & local knowledge)Be proactiveAsk advice from people who have already tackled the challengeDerived from Emmanouil Gkeredakis; Claudia Roginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011

Sue Lacey Bryant Consider the different forms of evidence needed for different commissioning tasks in the early stagesValue plurality of evidence (from both authoritative bodies and local commissioning knowledge)Be proactive and pay attention to the timing for using a piece of evidenceIdentify, facilitate and balance contributions from different experts, understand who will be affected by decisions of redesigning services; involve all groups actively and early onCreate meaningful interfaces between different tasks and different stakeholdersScrutinise the merits of redesign decisions in terms not only of high clinical standards but also of workable commissioning arrangementsAsk advice from people who might already have gone through the challenges you face, e.g., setting up a new service, or conducting a complex procurement. They can be a valuable source of information

20 Pressing need for innovation

We need to radically transform the way we deliver services. Innovation is the only way we can meet these challenges Put simply, we must make innovation a priority. We know that the NHS can spread new ideas at pace and scale when it puts its mind to it, and we need to do more of this. Innovation ... needs to be replicable and replicated across similar settings. So innovation is as much about applying an idea, service or product in a new context, or in a new organisation, as it is about creating something entirely new. Copying is good.

Sue Lacey Bryant 21The value of library and knowledge services to QIPP

David Nicholson. HSJ. 10 Sept 2009

Sue Lacey Bryant Linda Cox

Librarians are pollinators Prof Paul Glazsiouhttp://www.qualitymk.nhs.uk/default-ContentID-3011.htm

22What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making. We need to look at how information links together to get a holistic picture of the situation. Dr Shahid Ali, GP and Clinical Lead, Patients and Intelligence Directorate, NCB4. Understanding the customerInformation services & products for commissioners

Sue Lacey Bryant What do commissioners ask?How have others done it?Data on outcomes?BenchmarkingData and models to support development of specificationsKey performance indicators?Summaries

Sue Lacey Bryant Examples - Evidence searchesImpacting on hospital use (re)admission, Outpatient Dept, A&E, community careGPs in A&E departmentsHas anyone charged for DNAs?Outcomes of MSK servicesService specifications inc. Community cardiology, MSK, Urgent CareWhat self care tools will we need to support our new MSK Clinical Assessment & Triage services?Predictive modelling tools Return on Investment in telehealth/telecareWhy are our antenatal admissions so high?Self management, decision aidsOutcomes based contracting

Sue Lacey Bryant 26Anne carried out three targeted data searches for me to support the CCGs three Local Priorities in its Integrated Commissioning Plan (ICP). Rather than merely searching for relevant articles, Anne reflected on the problem areas, searched for evidence of a range of successful interventions achieved elsewhere and provided a new measurable solutions for the CCG to adopt. This saved me time in developing the ICP and added real value and a new angle of approach.

Tim Deeprose: Interim Director of Commissioning, NHS Milton Keynes CCG, July 2013Sue Lacey Bryant What sources do commissioners value?Survey n=300Very/quite important Local public health intelligence Expert adviceExamples of best practiceLocal policiesGuidelinesGovernment pubnsBenchmarkingCost effectiveness

Not important/did not useGeneral published literatureProfessional association guidanceManagement studiesAcademic researchManagement consultants

Sue Lacey Bryant HSJ 26 May 2011 p23-255. Best value

Benefits CostSue Lacey Bryant Working in an increasingly cash-strapped system

29Core offer into CCGs & CSUs?Generic/At scale offer

Horizon scanningTailored and targeted dissemination of evidence, by stakeholder groupConcise summaries of key policy documents Intranet/web knowledge zone

Aligned with the strategic objectives of the organisation

Sue Lacey Bryant Core offer into CCGs & CSUs?Specialised services for individuals ; for teams

Investigative research and enquiry service covering clinical & cost effectiveness; best practice; models of serviceProducing Easily read, synthesised reports ie. retrieve, select, appraise, summariseSDI to key personnel - by profile Supporting pathway review & service redesign Information skills training

Sue Lacey Bryant Targeted alerting services Client focus; ensuring insights into CCG agendanational policy driverstransforming pathwaysQIPP challenge; financial balancesupporting service redesign; models of deliverypromoting best evidencepromoting tools and resourcessharing best practice to drive innovation and enable transformation

Sue Lacey Bryant A bang for the buck

Work to strengths: what are we really good at? Collaborate to improve products & services? Efficiency: at-scale delivery of back officeUnderstand which functions can routinely be delivered remotely? Which require engagement?Use strengths in networking to enhance impactHelp to overcome silo mentalitiesRaise our expectations; demonstrate impactQuality = clarity and standards Reflect on service specifications and KPIs

Sue Lacey Bryant What does good look like?Performance areaKPIPerformance scoreTimelinessSearch reports to be delivered byAvailability & ResponsivenessRoutine queries to be dealt within.Priority queries to be dealt with within Client SatisfactionUse baseline client survey to develop Value for MoneyIncorporate planned efficiency of back office functions into delivery of serviceQuality. Q - Is this the sum of the parts? Impact?Meeting clearly defined standardsDelivery of added value Sue Lacey Bryant In undertaking our risk assessment process became evident that the CCG must undertake a substantial amount of work on developing service specifications for each of the functions inc:

Defining what the service will deliver; Understanding what good performance looks like; Developing a range of KPIs, metrics, targets and thresholds; Agreeing reporting processes, including frequency of reporting; Confirming contractual penalties.

34BenefitsBenefits: Cost effective;Time effective Expertise in sourcing, selecting, summarisingKnowledge of resourcesRapid response optionBuild a knowledge resource

High quality service to support both strategy & operationsScale up across the potential customer base

Sue Lacey Bryant 35Criteria by which to assess CSSAlignment: demonstrable commitment to achieving CCG objectives inc. high quality care Responsive: to the individual priorities of our CCG and the population on behalf of which we commission Agile: flexibility to support changing demands on CCG

Cost effective: value for money; added value

Innovation: sharing best practice; lift & shift where practical

Business focus: robust arrangements to support multiple clients

Sue Lacey Bryant Feel the heatInformed by a Preliminary Brief for commissioning support hub, Milton Keynes CCG, Nov 2011

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What is already in place? For the library/information service represented around the table - list the services and products you consider most relevant to commissioners that are already available/being provided

37Actions speak louder than words 3 actions from this session inc. the presentation and your group discussion

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3.Sue Lacey Bryant 6. How can health librarians evolve to meet the need?

Source: A visualizao da imagem anterior desperta para a leitura do artigo: "Evolving Web, evolving librarian" de Amy and Robert Favini balcaodebiblioteca.blogspot.com

Sue Lacey Bryant A time of enormous change in the NHSAre we a profession in Transition at a time when both medical/health education, and the NHS, and indeed the wider landscape of health and social care in the UK, is in a state of change? Concept of Evolution - Develop gradually, esp. from a simple to a more complex formDevelop over successive generations, esp. as a result of natural selection.

39Enhancing the role of librariansRole enhancement involves expanding a group of workers' skills so they can assume a wider and higher range of responsibilities through innovative and non-traditional roles

Sue Lacey Bryant Carl-Ardy Dubois and Debbie Singh. From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management. Human Resources for Health 2009, 7:87http://www.human-resources-health.com/content/7/1/87

40Positioning librarians as catalysts for improvementAligning with NHS prioritiesBringing research, education and practice closer togetherSpreading innovationMultidisciplinary workingChanging skill mix: role substitution, role enlargement & enhancement

Sue Lacey Bryant So this is the challenge for us today

41Libraries will get you through times of no money better than money will get you through times of no libraries

Anne Herbert, writer. b1952Towards informed and innovative commissioningSue Lacey Bryant