Shaping Health Care Services in West Kent Developing our Commissioning Plans Dr Bob Bowes Chair – West Kent Clinical Commissioning Group

Five Giant Evils - Beveridge 1942 Squalor: Beveridge said that the main reason the country was in financial trouble was because those who were poorer could not afford to seek medical attention, and thus could not work, which furthermore created less income, and led to lack of labourers available. Ignorance: Beveridge also believed that those who were in higher social class than those previously mentioned were ignorant to their role in a community. Want Idleness Disease

Purchaser provider split Started in 1991, various approaches have been tried Designed to bring the benefits of the market (improved quality with reduced costs) to the NHS But…. “…..we have had the disadvantages of an adversarial system without as yet seeing many benefits from the purchaser/provider split. If reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.” Report of Health Committee of House of Commons 2009 And… “……available research indicates that the NHS may have found itself in a lose-lose situation—taking on the extra costs of competition without yet experiencing the benefits. “ http://www.civitas.org.uk/nhs/download/Civitas_LiteratureReview_NHS_market_Feb10.pdf

What do Commissioners do? Buy services for the populations they serve And…. “Commissioners increasingly need to be advocates for health and wellbeing, encouraging and enabling individuals, families and communities to take greater and shared responsibility for staying healthy and managing their health and conditions. This means understanding better the determinants of health, effective engagement and enablement of people and populations and strengthened partnership working to improve health and wellbeing. As a result the role of commissioners has grown from a traditional fairly narrow base of needs assessment and contracting. The challenges to commissioning capability has risen accordingly” Report of Health Committee of House of Commons 2009 Are there too many managers????

Clinical Commissioning Groups There are 212 Clinical commissioning groups (CCGs) across England The CCG’s purpose is to bring a clinical focus to commissioning They are responsible for: All acute hospital services, mental health, community services (75% of NHS spending They are not responsible for: GP services, Health Visiting, Specialised commissioning Prison health services West Kent CCG - 10th largest in England Relationships with Patients, GPs, NHS trusts, Social care, Councils, Health Watch Same area as Maidstone and Tunbridge Wells Trust catchment 463,000 population, £550m budget 71 contracts to set, manage and improve 2011-12,£8m savings ; 2012-13 £16m required (presently achieving 62% of that)

The West Kent CCG Board 12 GPs, elected by groups of practices Nurse Board member, Specialist clinician, Lay member with finance and audit expertise, Lay member responsible for Patient and Public engagement Accountable Officer, Chief Finance Officer Supported by committees and a staff of about 50 as well as outside agencies A crucial role for Patients, the Public and Councils in helping decide how to meet our challenges

Commissioning Priorities Driven by the West Kent Joint strategic needs assessment (JSNA) Shaped by local provider landscape (GP practices, Hospitals, Mental Health, Community and Social services), engagement with the Public, Councils, Clinicians and NHS commissioning board Matching the area’s needs to provision Ensuring good value for money, reducing waste A new approach is now being used in West Kent, to make the process more rigorous and open Not always achieved!

Diabetes Rising incidence of type 2 diabetes; now 4% =16000 in WK, will rise by another 8000 within 15 years. Considerable number of patients not diagnosed and still others not receiving best care Most care delivered by GPs and practice nurses so our commissioning plan is to improve the capabilities and capacity of these teams. Practice teams will be better educated; hospitals’ role will expand to educating GP surgeries. Re-focussing of hospital care on those who will benefit most

Reducing Emergency Admissions Making sure that care pathways remain intact and competent, “Apart from major accidents, an emergency admission is a failure of care pathways” Making best use of clinical expertise at crucial points in the system; Ambulance control centre A+E department GP surgeries working better with social services and community nurses, more “emergency aware” Challenge is to make sure that every part of the system is equally aware Non elective admissions to our hospitals are showing a small reduction compared to last year

Dementia Expected 5500 patients in West Kent, just under 2100 have had a formal diagnosis Taboo: “how useful is earlier diagnosis?” Complex needs including health and social care sectors, carer support, medication, physical and mental health, community nursing Earlier intervention allows better planning and maintains independent living for longer, ensures care can be delivered in the most appropriate place

Improving the Falls Service Falls not only cause injury; they are often a marker of frailty and can signal a decline in general health Patients who fall in West Kent now receive a comprehensive review of their medical situation by a consultant led multidisciplinary team with rapid access to out patient appointments should unmet need be identified. This will make sure that needs are identified and acted upon sooner, reducing the need for non elective admissions

Referral and Treatment Criteria Evidence based, to make sure that those who will benefit from a procedure are offered it and those who will not benefit are not. Sounds like Rationing??? Some surveys show that 30% of knee replacement patients regret having had the operation, mostly because it was done before it was needed. GP referrals show a four fold variability in volume for any condition Some consultants don’t see it as their role to advise patients against having a procedure A very high degree of agreement between patients, GPs and consultants is needed to make sure this approach works

End of Life Care A very important issue; we would like to know your views.