Managing the Transition Sept 2011

Agenda Where are we? Clinical Commissioning Groups (CCGs) Health and Well Being Boards Issues

Reasons for Change Clinicians at the heart of decision making Involvement and Empowering Patients Best outcomes in the world - Driving up quality

New Architecture CCGs SHA Clusters PCT Clusters Health and Wellbeing Boards

CCGs 95% Pathfinders Variable maturity Variable size Governance Scope of Commissioning Population based In addition, it is vital that the needs of homeless and excluded people are fully addressed by commissioning consortia, who must be responsible for meeting the needs of everyone residing in their area, not just those who are registered with GPs. We were encouraged to see an amendment agreed to this effect at the Bill’s committee stage

Pre-authorisation PCTs and SHAs formed clusters Assignment of staff and delegation of commissioning responsibilities Shadow Health and Well Being Boards Issues: End State NCB Relationship Authorisation with conditions Commissioning Support

To be authorised consortia will need to demonstrate… Clinical focus and added value Engagement with patients and communities A clear and credible plan to deliver quality improvement within the allotted financial resource Capacity and capability to deliver all their responsibilities, including delivery of financial control Collaborative arrangements for commissioning with other consortia, Local Authorities and the NHS CB Leadership capacity and capability

Collaborative arrangements for commissioning How does the consortium plan to work with other consortia and local authorities? What commissioning support arrangements do they have in place to help them commission across wider geographies? Standards Partnership arrangements e.g. pooled budgets, lead commissioning etc in place with other consortia and local authorities Effective ways of working with NHS CB in place Suitable arrangements in place to access the right public health advice. The consortium is a member of all relevant shadow health and wellbeing boards Robust commissioning support arrangements in place to support collaboration Tests JSNA/Health and Wellbeing strategy Commissioning Plan Constitution Commissioning support arrangements 360 degree input Face-to-face meeting Evidence

Clinical Focus and Added Value Plans to assess local need, reduce inequalities, and ensure continual quality improvement, to improve patient experience and outcomes Demonstrate engagement of constituent GPs, also the involvement of other clinical professionals. Standards Are key programmes of work led by clinicians from a range of appropriate disciplines? Arrangements for effective participation of all the consortium’s practices Is the consortium engaging with stakeholders Does the consortium have plans to use peer to peer challenge Tests Joint Health and Wellbeing strategy Commissioning plan Constitution Membership agreement 360 degree input Face-to-face meeting Evidence

Pre Authorisation Risk Assessment Clinical ownership Commissioning boundaries LA boundaries Size

Draft Authorisation Issues Raised Why? Accountability and authorised with conditions NCB Relationship Support services Running costs Sustainability

Health and Well Being Boards Responsible for developing joint strategic needs assessments and a joint health and wellbeing strategy. Scrutiny powers of local authorities to be restricted; use their power of referral to the Secretary of State only for significant changes to designated services. Min membership: the Director of children’s services, the Director of adult social services, the Director of public health, at least one elected representative, which may be the elected mayor or leader of the council, or a councillor nominated by them The Local Healthwatch, Relevant GP consortium

Post Pause Stronger role in promoting joint commissioning and can act as lead commissioner for some services. Stronger role in the development of commissioning plans and will be able to refer plans back to the NCB

Post Pause 2 Formal role in the authorisation of clinical commissioning groups and will lead on local public involvement. Restrictions on scrutiny powers of local authorities lifted.  Consideration to be given to the feasibility of “Citizens right” to challenge poor service There should be a requirement for every JSNA to assess groups in the community with the poorest health to ensure that the needs of the most excluded are recognised. Every JSNA must also assess, and take steps to meet the housing needs of the local population. The JSNA should be aligned with the most recent assessment of housing needs.

Consortia Support Consortia will succeed or fail by quality of support Need to identify functions Need to consider scale Alternative models Voluntary sector Independent sector January 2011

Importance of Housing issues to CCGs House design Damp Specialist housing Extra care Aids and adaptions Care and repair Housing related support

Examples of Different Schemes Care and repair Supported Assisted technology Step up step down Enable early discharge prevent readmits and prevent falls

Getting housing on the agenda Health and well being strategy JSNA Commissioning plans Strategic planning Greater awareness of skills and capabilities of voluntary organisations

The King’s Fund 10 High Impact Changes Self-management Primary prevention Secondary prevention Managing ambulatory conditions Integrating mental & physical health care To achieve triad quality cost effectiveness and experience Self manage diet exercise DESMOND Primary brief intervention smoke alcohol ……family for child obesity AF Secondary disease registers Post MI hypertension DM Core set 19ACS EoE 12% all admits…case management , telephone coaching easy access urgent care….Birmingham Ownhealth telephone coaching case mangers Angina, asthma , cellulitis,DM Heart failure dehydration COPD Physical and mental health provision of psychological support for angina in Liverpool reduced cost per pat per year by £1300 DM and depression; record code IAPT ETC

The King’s Fund 10 High Impact Changes Care coordination & integration End-of-life care Medicines management Managing elective activity Managing emergency activity Evi on health outcome limited but highly integrated p care with continuity and co ord better patient experiences = Torbay multi prof teams case manage joint care planning personal health pans End of life2/3 want to die at home 1/3 do facilitated discharge rapid response co ord 24/7 gold standards framework Meds reviews decision support script switch pharmacy monitoring Elective activity comparative info Peer review Urgent integrated coord whole system clinical dashboard to inform changes

Enablers Post Industrial Primary Care Integrated Care Systematic and proactive management of Long term Conditions Empowerment of patients Population management

Issue for Clinically Led Commissioning Size Patient Voice Leadership and Ownership Commissioning “differently”

Issues for Clinically Led Commissioning 2 Balance quality, cost effectiveness and experience Manage risk Joint commissioning Time needed to develop to maturity

Getting housing on the agenda Health and well being strategy JSNA Commissioning plans Strategic planning Greater awareness of skills and capabilities of voluntary organisations