Getting to grips with the commissioning cycle - working with cycles, processes and potential to innovate

Ali Jan Haider

DHEZ Presentation – 30th June 2016

‘what is commissioning?’

Question

“Commissioning is the cycle of assessing theneeds of people in an area, designing andthen achieving appropriate outcomes. Theservice may be delivered by the public,private or civil society sectors”.

Question

“Commissioning is the process of specifying,securing and monitoring services to meetpeople’s needs at a strategic level. Thisapplies to all services, whether they areprovided by the local authority, NHS, otherpublic agencies, or by the private andvoluntary sectors.”Institute of Public Care Commissioning Framework

Contracting and Purchasing

PurchasingPurchasing The process of acquiring

goods, works or services from (usually)

external providers/suppliers and managing these

through to the end of contract.

ContractingContractingThe process of negotiating and

agreeing the terms of a contract for services,

and on-going management of the contract including

payment and monitoring.

Why do we need to transform how we Commission?

10 years of increased spend

Increase in demand

25% to 40% budget cuts

Rising public expectation

6September 2011

THE BIG PICTURE(If you think its bad now …)

A call to action (2013)

BRADFORD DISTRICT CCG FINANCIAL PLAN

WHERE WE SPENT OUR MONEY IN 2013/14

TOTAL SPEND IN 2013/14 WAS £400.1MBREAK-EVEN

2013/14 IN YEAR RESOURCES AVAILABLE WAS £400.1M

£228.7M

£18.4M

£35.6M£14.5M

£6.2M£2.9M

£53.4M

£40.4M

Total ServicesAcute Services

Continuing Care Services

Mental Health Services

Other Programme Services

Running Costs

Primary Care Out of Hours

Primary Care Prescribing

Primary & Community

Who commissions what in health?

• 3 Clinical Commissioning Groups (CCGs)– Bradford City (BCCCG)– Bradford Districts (BDCCG) – Airedale, Wharfedale & Craven (AWCCCG)

• CCGs are: NHS bodies, membership organisations, clinically led; plan and buy healthcare services for local people

• Public Health (transferred to the Local Authority in April 2013)

• NHS England

CCGs NHSE Public Health

emergency and urgent care (including: A&E, ambulance and out of hours services)

community health services

maternity services planned hospital care rehabilitation services healthcare services for

people with mental health conditions or learning disabilities

continuing healthcare

• primary medical care• community pharmacy• dental services• NHS sight tests • specialised services and high security psychiatric services• prison health and services for military personnel• some public health services

• sexual health services• the Healthy Child programme• local programmes to promote activity, healthy eating and weight management• drug and alcohol misuse services• stop smoking services• local programme to prevent accidents or reduce deaths, for example, winter planning

DH Commissioning Model

IPC model for joint strategic commissioning & purchasing

11

Task

Grit Commissioners

Bradford expects a tough winter 16/17 and a very heavy downfall of snow; You have been tasked with commissioning grit for 16/17 for the whole of Bradford District:

•How do you work out how much grit would be needed?•Which areas would you prioritise for gritting?•How would you ensure good value for money?•Why is quality and safety important?•How do you promote self-care and prevention?

Question

How does the commissioning cycle bring health and well-being to life?

THE BIG PICTURE Mission impossible?

• Prevent people from dying early• Enhance the quality of life for people with

long term conditions• Help people recover following episodes of ill

health or following injury• Improve patient experience• Improve patient safety• Reduce health inequalities

THE BIG PICTUREGreat expectations!

• A health service – not just an illness service• Give patients greater control over their health• Harness transformational technologies• Exploit potential for transparent data• Move away from ‘one-size fits all’ model of care• Unlock healthcare as a key source of economic

growth

THE BIG PICTUREThe Wizard of Oz

• If I only had a brain– Integration of health and social care• We must make real connections

• If I only had a heart– Care closer to home• Locally delivered, culturally sensitive services

• If I only had courage– Self care• We have to let go so that the people (aka ‘patients’)

become the experts (or at the very least – make shared decisions!)