World Class Commissioning Claire Whittington Deputy Director, Commissioning Department of Health

Building capacity in the system Introducing the reforms High quality care for all NHS Plan saw greatest investment in the history of the NHS More doctors, more nurses, better facilities Patient choice and payment by results Foundation trusts Stronger commissioning NHS Next Stage Review local clinical visions, national enabling report and NHS Constitution

Assess needs Review current service provision Decide priorities Strategic planning Design service Shape structure of supply Specify outcomes & procure services Manage demand and ensure appropriate access to care Clinical decision making Managing performance (quality, performance, outcomes) Managing demand and performance

£70 billion £200m a day

“The aim of world class commissioning, and therefore the ultimate test of its success, will be an improvement in health outcomes and a reduction in health inequalities”

NHS Spend - £bn 4% average increase from 2008/09 – 2010/11

VISION AND COMPETENCIES ASSURANCE SYSTEM SUPPORT AND DEVELOPMENT MODEL SUPPORT AND DEVELOPMENT MODEL

11 Competencies 1. Locally lead the NHS 2. Work with community partners 3. Engage with public and patients 4. Collaborate with clinicians 5. Manage knowledge and assess needs 6. Prioritise investment 7. Stimulate the market 8. Promote improvement and innovation 9. Secure procurement skills 10. Manage the local health system 11. Make sound financial investments

Information as the first key driver

Secondly, it’s about partnership with

2008/9 Assurance  Competencies  Strategic Plans  Outcomes  Transformational

Outcomes, competencies and governance PCTs failing to meet governance standards will be expected to Receive interventions and support Meet the standard within a short time period PCTs that have improved greatly or reached world class should be recognised. They would also be expected to share their knowledge and experience PCTs that remain below baseline, or have had static performance, should receive intervention to ensure they improve Those improving faster than the national average should be rewarded Those that have lost growth relative to the national average should be addressed

Be prepared to revise your hypothesis as evidence accumulates…

Most frequently chosen health outcomes 1.Smoking quitters 2.Rate of hospital admissions per 100,000 for alcohol related harm 3.CVD mortality 4.Percentage of all deaths that occur at home 5.Under 18 conception rate 6.Cancer mortality rate 7.Diabetes controlled blood sugar 8.Infants breastfed 9.Percentage of stroke admissions given a brain scan within 24 hours 10.Clostridium Difficile infection rate

Success built on  Architect of the local health system  Active engagement of partners  Understanding the provider economics  Relentless focus on health outcomes  Commissioning behavioural change within the population  Recognising the need to transform themselves and develop new capabilities

2009 – Way Forward Clinical commissioning Provider models Integrated care Regulator role Commercial skills Focus on quality Quality accounts Measurement for improvement Primary care commissioning PPE/PROMS