Commissioning Cycles – World Class and Better Alcohol Improvement Programme 5 th Early Implementer National Conference Birmingham 1 st December 2009

To boldly go … Galactic-class and beyond …  The World Class Commissioning Cycle  Cycle or spiral?  Making it real ….  …. and a shameless bit of opportunism …

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

Commissioning Spiral upward spiral is achievable downward spiral can be avoided  analysing  planning  executing  reviewing

Relationship of commissioning StrategicOperationalIndividual commissioning for the future whilst supporting the here and now local enablement of the here and now, with an eye to future supply and demand meeting immediate needs to optimise function in the here and now (leading and influencing behaviours; facilitating relationships across all the sectors) (creating viable local market conditions) (getting it right for one person aggregates up into getting it right for all)

Commissioning levels

Strategic Planning Assess needs Review Current Provision Decide Priorities  Multi-sourced data  Credible, cogent detail  Understanding local markets  Working with the data  Collaborating with partners / stakeholders  Deciding priorities  Disseminating commissioning intentions  Planning action

Market Review & Market Dynamics Demand Supplier Relationships  JSNA  State-provided  Self-funded  Self-managed  Brokered  Open dialogue  Provider signalling  Shared plans  Shared risk  Planned disinvestment  Micro-markets  Additional provider support The market  What range  How many  How much  How flexible  How viable  Where sited  What reputation  What quality  What price

Specify Outcomes & Procure Services Design Service Shape and Structure of Supply  Organic and consensual  Reflecting local needs  Meeting local expectation  Getting desired outcomes  Stakeholder involvement in design  Market intelligence  Influencing supply  Market intervention  De-commissioning  Disinvestment strategies

An opinion … “There is limited experience in influencing local care markets either by an individual authority/ PCT or collaboratively across (statutory commissioning) authorities. Even where there is an appreciation of its importance, there is often a lack of capacity to spend adequate time engaging productively with providers in planning to transform health and social care services. Discussions may take place with larger providers but often commissioners make little attempt to engage with the range of smaller providers who may be important innovators, particularly for specific ‘niche’ communities’ needs”. [Kings Fund response to Transforming Adult Social Care]

The Commissioner’s Scope? What is the scope of the commissioner to influence local markets?  Purchasing power?  Budgets (growing or contracting)?  Market Share? And what about the effects of …  Self-managed Support/personal budgets?  External factors – e.g. regulation?  Local/national/global economic health?  … or … focused too much on price ?

Commissioning Preoccupations Individual outcomes Personalisation (PPF/TASC) Innovation Quality Price/Cost

Managing Demand & Performance Manage Demand and Ensure Access Clinical Decision - making Managing Performance  It’s not ‘Open All Hours’  Targeted / segmented  Using planning data  Developing forecasting techniques  Driving quality  Utilising resources  Contract compliance  Financial regularities  Continuous improvement in quality and outcomes

Bench-marking performance  World-Class performers  Google ?  BBC ?  Tesco ?  Anytownshire PCT ??  In whose judgement?  Based on what results ?  To what end ?

Getting it Right First Time – or not It’s tough scaling the ladders … … and you might have to slide down an awful lot of snakes

… Oh! And the Opportunism  An alcohol harm reduction tool  Establishing a sense of ‘readiness’  On-line self assessment  strategic planning  local programme review and  the implementation of the HICs  … ideas welcome!

Thank you for your kind attention Janet Crampton