Joint Commissioning-or just how do we turn the system around? Gary Nethercott & Karen Taylor

What`s the issue?! If joint commissioning is so universally accepted as a concept then why do we see so little of it? Just what are the barriers? If joint commissioning is so universally accepted as a concept then why do we see so little of it? Just what are the barriers?

Barriers? Central government and regulators still operate with separate service areas which often have different statutory accountabilities and different targets/inspection frameworks. Finance officers don't let their policy officers out to play-especially in times of fiscal constraint!

Barriers? How many Inspectors and government ministers have you heard say “failure is the most important tool of learning”. Different cultures – as professionals we can bring different perspectives which can be both beneficial and challenging

Show us the money! 152 Local authorities-£2.7 billion public health budget 27 NHS England area teams-£25 billion for primary care & specialist services 211 Clinical commissioning groups-£65 billion budget for secondary care & community services 152 Health & wellbeing boards

Show us the money! Previous 3 groups equates to $138billion State education= $133billion Children’s services= $24billion Total= $295billion GDP? Finland $263 Ireland $221

So what underpins Joint Commissioning? ...............Effective Partnerships.

What are the characteristics of effective partnership? Partnerships share: Priorities Resources Accountabilities Successes & failures

Seed bed for partnerships? ................The front line

Be patient-take the long view! It takes courage not to go for just quick wins! With EH&C plans to be delivered the first step on the 1000 mile journey to joint commissioning is single agency commissioning being joined up! We must not fall into the trap of excellent being the enemy of good!-remember world class commissioning?!

So what is the spectrum? Co-operation Collaboration Partnership Joint commissioning.

So what ............and all of this is services talking to themselves unless we engage with children & young people/parents/carers on what the reality is for them in their lives and what makes a difference.

So what can this workstream do to contribute? Firstly, not telling commissioners how to commission! Secondly, giving them information on the needs of children and young people with sensory impairment so they can make effective decisions about what and how to commission effectively to maximise outcomes.

JC should be informed by a clear assessment of local needs JC should be informed by a clear assessment of local needs. The H&WB Board develop the JSNA and Joint health and well being strategies to support prevention, identification, assessment and early interventions and a joined up approach. The NHS Mandate which local CCGs must follow contains a specific objective on supporting CYP with sen and disabilities including the offer of personal budgets. Joint commissioning arrangements must cover service for 0-25 years both with and without EHC plans.

Code of Practice Local authorities must work to integrate educational provision and training provision with health and social care provision where they think this would promote the wellbeing of children and young people with SEN or disabilities or improve the quality of special educational provision. Local partners must co-operate with the local authority in this. J

Code of Practice At a strategic level partners must engage children and young people with SEN and disabilities and children’s parents in commissioning decisions, to give useful insights into to how to improve services and outcomes.

The JSNA will inform the local commissioning decisions made for CYP with SEN and disabilities. Which will in turn be reflected in the services set out in the Local Offer. LAs and CCGs have considerable freedom in how they work together to deliver integrated support that improves CYP outcomes. However, local governance arrangements must be in place to ensure clear accountability for commissioning services for CYP and disabilities 0-25 years. Clear decision making structures so partners can agree the changes that JC will bring in the design of services. This is to help ensure JC is focussed on delivering outcomes. Partners should ensure there is a designated Medical Officer to support the CCG in meeting its statutory responsibilities , primarily by providing a point of contact for local partners when notifying parents and LAs about CYP have SEN or D and when seeking advice on SEN or D.

Code of Practice – data sets Population and demographic data Prevalence Numbers with EHC plans and their main needs Use of out of area placements for low incidence needs Analysis of key PIs Outcomes of developmental assessments (2 yr old check) EYFS information Where they are educated Analysis of local challenges and sources of health inequalities Employment rates – leaving education Local data of disabled CYP including low incidence which are particularly difficult to plan for from national data sets

Code of Practice – outcomes Individual e.g. Alex can communicate independently with friends at lunchtime Service level e.g. paternal mental health has improved in 10 families Strategic e.g. 10% increase in YP supported into employment and independent living

Code of Practice – outcomes To achieve the above outcomes provision needs to be put in place e.g. Speech and language and social skills programme A short breaks programme A newly commissioned transition strategy

This is where you come in!

Task Today Nominate a scribe and someone to feed back for your group Read the draft Joint Commissioning document. Answer the following questions; 1.  What is useful about this document? 2.  What is less useful?   3.  Is there any additional information you would like to see in the document?   4. Do you know any good examples of Joint Commissioning?