Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham Commissioning post the Health and Social Care Act, 2012

 The Health and Social Care Bill puts clinicians at the centre of commissioning, frees up providers to innovate, empowers patients and gives a new focus to public health.  Arguably the most radical shake up of the NHS since its inception and unequivocally the most extensive reorganisation of the structure of the NHS to date The Health and Social Care Act in a nutshell

 Rising demand and treatment costs  Need for improvement  State of the public finances Case for change

 Clinically led commissioning  Provider regulation to support innovative services  Greater voice for patients  New focus for public health  Greater accountability locally and nationally  Streamlined armslength bodies Key legislative changes

 The focus of new commissioning system is Accountability and Outcomes  Clinical Commissioning Groups (CCGs) are the new statutory (accountable) bodies for most commissioning - Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are abolished  NHS England holds CCGs to account and is accountable for other commissioning (e.g. Primary Care and specialist services)  Various other national bodies are being developed as well as Public Health moving to Local Authorities and Public Health England  CCGs will have £25 per head of population to spend on their organisations (we call this commissioning support)  CCGs have to balance how they spend this – In house staff / purchased from a CSS / shared The new NHS commissioning system

What’s happening in London…

Camden 7 Hillingdon Harrow Brent Ealing Hounslow Central London Barnet Enfield Haringey Islington Richmond Merton Croydon Wandsworth Kingston Bromley Bexley Greenwich South- wark Lambeth Newham Tower Hamlets City & Hackney Havering Redbridge Waltham Forest Sutton Wave 1 – 3 CCGs Wave 2 – 15 CCGs Wave 3 – 11 CCGs Wave 4 – 3 CCGs Barking & Dagenham Hammersmith & Fulham West London Commissioning Lewisham Camden There are 32 emerging CCGs in London, who will need to demonstrate they have robust commissioning support in place

What type of organisation is a Commissioning Support Unit? The 2013 NHS will be genuinely different – CCGs will be small, light, clinical commissioning organisations – CSUs will be vital to getting CCGs up and running and critical to the success of the commissioning system overall – Hosted by NHS England – 23 CSUs in England, 3 in London – CSUs are funded by CCG income and by income from other customers CCG NHS England CSU Services Account- ability

Three CSUs are taking shape in London North West London South London North Central and East London

SLCSU is developed from CCG views SLCSU is designed to give CCGs benefit of local services and the benefits of working at a larger scale to centralise expertise £30m+ organisation, c300 staff, all 12 CCGs will purchase core services The South London CSU Story so far

Well prepared for the transition – Started on 1 st April – First board meetings taking place Development of South London Clinical Commissioning Groups

 Stressful!  People are applying for new jobs or their old ones  £20 billion of NHS efficiency savings required nationally.  Large LA budget reductions  In Lewisham GPs are increasingly becoming more on board with changing referral patterns. Less lone operators, more group think and peer pressure.  There is still the tendency to think like providers rather than commissioners… What’s it really like….

 2 posts transferring to the CCG. One part funded by the LA  c.£90m budget  Covering:  Adult Mental Health – for health and social care  IAPT service  NHS Specialist services  NHS Forensic services  Mental Health of Older Adults – for health and social care  Dementia services – for health and social care  Adult Mental Health Voluntary sector – for health and social care  £4.5m health savings and £600k LA savings required from 2011/12 – 2013/14. More savings to come…. Lewisham Joint Mental Health Commissioning

 The scale of efficiency savings make it imperative to do things differently – real radical change is required  E.g.  Closed a two 16 bedded specialist Continuing Healthcare Unit and reinvested £1.6m of recurring money into our Dementia pathway with £370k taken as QIPP  Commissioned a 3 month Forensic triage model which has diverted 75% of people away from Medium Secure Units and saved £1.3m to commissioning budgets  Commissioned a support planning and brokerage service to support people to use their Individual Budgets  Commissioned local secondary care ASD and ADHD diagnosis and treatment clinics rather than using specialist services Some positives to savings!

 Lobbying CCGs and Health and Wellbeing Boards  Support commissioners in their role – not just GPs  Identify gaps in provision  Share best practice  Share evidenced based practice  Give ideas for efficiency savings – support whole system transformation  Improve public awareness and engagement  Influence big decision makers How can the you influence the health and social care agenda