world class commissioning in the nhs elizabeth wade senior policy manager (commissioning)
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World Class Commissioning in the NHS Elizabeth Wade Senior Policy Manager (Commissioning) SSRG Annual Workshop – 20 th April 2009. Overview. Commissioning in the NHS The World Class Commissioning Programme What do we know about effective commissioning? - PowerPoint PPT PresentationTRANSCRIPT
World Class Commissioning in the NHS
Elizabeth Wade
Senior Policy Manager (Commissioning)
SSRG Annual Workshop – 20th April 2009
Overview• Commissioning in the NHS• The World Class Commissioning Programme• What do we know about effective
commissioning?• Priorities for practice development, policy and
research• Questions
What are PCTs?• Primary Care Trusts (PCTs) are statutory NHS
bodies
• 152 across country serving average population of 330,000
• Funded directly by the Department of Health with average budget of £527m p.a.
• Accountable to Strategic Health Authorities
What are PCTs?Responsible for ensuring access to health services, and
improving health outcomes for people in their area by:– Commissioning health (and social care) services– Providing health services (usually community
health services, sometimes mental health and learning disabilities)
– Working in partnership with other local agencies
What is healthcare commissioning?Process by which organisations:1. Assess the healthcare/health improvement needs of their
local population and review how well existing service provision meets those needs
2. Identify priorities for investment and design services/identify opportunities to meet the needs
3. Acquire these services/create opportunities through contracts with a variety of service providers including GPs, NHS Trusts, Foundation Trusts, third sector and independent sector organisations, and partnerships with other agencies
4. Ensure the services are provided effectively, and monitor quality and outcomes
Assess needs
Assess needs
Review current service
provision
Review current service
provision Decide prioritiesDecide
priorities
Specify servicesSpecify services
Shape structure of
supply
Shape structure of
supply
Manage demand and
ensure appropriate access to
care
Manage demand and
ensure appropriate access to
care
Clinical decision making
Clinical decision making
Manage performance
(quality, performance,
outcomes)
Manage performance
(quality, performance,
outcomes)
Strategic Planning
Specifying outcomes and procuring services
Managing demand and performance
Who does healthcare commissioning?
• PCTs (hold the statutory responsibility)• Practice-Based Commissioners• Specialised commissioning teams • Local Authorities (through pooled budgets, joint
commissioning arrangements etc.)• Care managers/coordinators• ? Individual service users (patient choice,
personal budgets)
Why do we need commissioners? • To act as an advocate for patients and custodian for
taxpayers
• To ensure NHS planning and provision is needs/demand-led, not supplier-led
• To address the challenge still facing the NHS to simultaneously improve:
– Service responsiveness and performance
– Patient experience
– Efficiency and value for money
– Public/population health outcomes
Perceptions of healthcare commissioning
“… we have concerns about the implementation of the [Next Stage Review], which will be the responsibility of PCTs, because we doubt that most PCTs are currently capable of doing the task successfully. As we have noted in a series of inquiries, PCT commissioning is too often poor. In particular, PCTs lack analytical and planning skills and the quality of their management is very variable. This reflects on the whole of the NHS: as one witness told us, "the NHS does not afford PCT commissioning sufficient status". We consider this to be striking and depressing”.
Health Select Committee - January 2009
“Kids, you tried your best and you failed miserably. The lesson is, never try”
The conclusion of two decades of commissioning in the NHS?
World Class Commissioning
• Programme developed and launched in 2007
• Significant involvement of/ ‘co-production’ with the NHS
• High profile within the Department of Health
• Assurance process initiated 2008
Th
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ram
me
Vision and competencies
Assurance framework
Support and development tools
World Class Commissioning
Competencies
Competencies
Assessed through a combination of. . .
Self-assessment and certification
Feedback from partners (including local authorities)
Evidence and data review
Panel assessment day (including a local authority panel member)
0010151
09135
8
02
10941
01102
49
006686
04116
32
019556
0049
103
0017135
020124
8
2 31 4
4. Collaborate with clinicians
3. Engage with public and patients
1. Locally lead the NHS
5. Manage knowledge and assess needs
10. Manage the local health system
6. Prioritise investment
8. Promote improvement and innovation
9. Secure procurement skills
7. Stimulate market
2. Work with community partners
Frequency
Source:152 panel scores as of 31 January 2009 (post national calibration)
The potential impact of WCC
World class commissioning has the potential to deliver more than 25,000 years of healthy life expectancy
… if the PCTs that prioritised the following outcomes bring their performance up by a quartile, it will result in the following impact over 10 years:
– Smoking quitters: an additional 3,600 life years gained and 5,000 quality-adjusted life years gained
– Diabetes management and stroke care: an additional 20,000 life years gained and 20,000 quality adjusted life years gainedMark Britnell, Director General Commissioning and System Management, DH - February 2009
What do we know about ‘world class’ commissioning?
“Experience and available evidence from Europe, New Zealand and the US indicates that in no system is commissioning done consistently well. To be sure, there are examples of innovation and ‘good practice’ in all systems, but equally there are examples of the limits to effective commissioning and the barriers that have inhibited commissioners from negotiating on equal terms with providers. Why is health care commissioning so difficult? The answer can be found in the complex nature of health care and the need for commissioners to have a high level of technical and managerial skills…”
Ham, 2008
What do we know about ‘world class’ commissioning?
“The best American commissioning groups have concluded that health care is far more complicated to purchase than anything else … Their salary and bonus packages are designed to attract the best and the brightest. They require excellent data systems analysts and programmers, clinical epidemiologists, clinical managers, organizational experts, financial specialists and legal advisers”.
Light, 1998
What do we know about ‘world class’ commissioning?“Authors in this volume agree that, despite prevalent rhetoric,
strategic purchasing is not in place in many countries and, as a result, the impact has been limited…”
“… Overall, the political, technical and financial ability to implement strategic purchasing is the single most important factor in determining its success or otherwise. Most, if not all, strategies reviewed here are very complex and require a high level of technical and managerial skills together with wide ranging information systems that are lacking in many countries”.
Figueras, Robinson, and Jakubowski, 2005
What do we know about ‘world class’ commissioning?
“This report [into primary-care led commissioning] clearly demonstrated the link between adequate levels of management and analytical expertise and the achievement of commissioning objectives”
Smith et al, 2004
What do we know about ‘world class’ commissioning?
“Existing evidence tells us little about the specific mechanisms through which commissioning competency does, or does not, lead to improved health system outcomes. This does not undermine attempts to articulate and develop commissioning competency. However, acknowledgement of this complexity and ambiguity should be seen as the starting point for intelligent discussion of the issue”.
Woodin and Wade, 2007
Development priorities for PCTs
PCTs need to meet massively raised expectations in a very short timeframe, during an economic downturn
Rapid development of commissioning capacity and capability is required
Particular development needs include:– Clinical engagement/expertise– Communication with the public (to influence and engage)– ‘Up-stream’ public health (demand management)– Commercial acumen and skills (procurement, contracting,
market management etc.)
Policy prioritiesIf WCC is to be successful, we need:
• More commissioning-focussed policy, strategy and regulation• Minimal central intervention in structure of PCTs• More ‘freedoms’ for PCTs• ‘Industrial scale’ interventions to develop commissioning
organisations• Significantly improved data quality and availability• Alignment of approach to commissioning in different
government departments
Research questions and priorities
How can we raise the performance of all PCTs, all at the same time? Are there models/examples of rapid organisational development and performance improvement across a whole sector that the NHS could learn from?
What tools, techniques, skills and experience can PCTs import from other sectors/countries/industries, and what is unique to health care commissioning?
Research questions and priorities
Is it possible to demonstrate a link between individual competence, organisational competence, effective commissioning, and improved health outcomes?
What are the longer-term implications of a commissioning-led NHS (where provision is dispersed across a range of competing providers)?
What are the implications of individual budgets and personal health budgets for commissioners?
The ultimate challengePublic service commissioning is essentially an exercise in
managing scarcity and complexity.
It will always be the case that some groups and individuals in the system will feel that commissioning has ‘failed’ them
The response of commissioners should not be to give up, but to remember their responsibilities as advocates and custodians, and to accept that ‘world class’ status may always be elusive
ReferencesHam, C. (2008) Health Care Commissioning in the International Context:
Lessons from Experience and Evidence. Birmingham: Health Services Management Centre
Figueras, J., Robinson, R., & Jakubowski, E. (2005) Purchasing to improve health systems performance. Maidenhead: Open University Press
Light, D. W. (1998) Effective Commissioning: lessons from purchasing in American managed care. London: Office of Health Economics
Smith, J., Mays, N., Dixon, J., Goodwin, N., Lewis, R., McClelland, S., & Wyke, S. (2004) A review of the effectiveness of primary care-led commissioning and its place in the NHS. London: The Health Foundation
Woodin, J. and Wade, E. (2007) Towards World Class Commissioning Competency. Birmingham: Health Services Management Centre