Integrated Ambulance Commissioning Mark Docherty Director – London Ambulance Service Commissioning Former Chair of NACG 2 nd April 2014

What I am going to cover Getting ambulance commissioning right Collaborative commissioning: the implications for the Independent Service An update from the National Ambulance Commissioners Group (NACG)

THE EXTRAORDINARY ADVENTURES OF AN AMBULANCE COMMISSIONER

What is Commissioning? 1988 – 12 mentions in parliament 1997 – 248 mentions 2007 – over 1,000 mentions 2011-,000s of mentions in both chambers In 20 years it is a concept that has come from nowhere….and is now everywhere

What is commissioning really? Conscience – stewardship, quality assurance, public protection Brain – resource allocation, service design, planning Eyes and Ears – patient experience, receiving and analysing information back to brain and conscience (Smith & Mays, 2005) Not Arms and Legs – doing and delivering

CCGs? 211 CCGs and average 226,000 population replace – 151 PCTs with average population of 284, Commissioning Support Units (At April 2013) Why? Because commissioners are the local NHS and local Social Care – there is no one else Because somebody needs to decide what’s needed locally and how best to get it Because someone needs to challenge existing vested interests and unresponsive services Because one day I’ll need services too….

*NHS Commissioning Board is now known as NHS England *

999 Call Activity - London

Category A (Red 1 & 2) Activity

Category A Performance - LAS

Ambulance Demand Challenges

The Financial Context

Emergency PreparednessHazardous ResponseMERIT / HEMS999 Life ThreateningUrgent Primary CarePatient Transport Services

Collaboration

Types of CCG Collaboration e.g.

A collaborative model

National and Sub-National

CCG and Local

The National Ambulance Commissioners Group A forum for the lead commissioners, hosted by NHS Clinical Commissioners (NHSCC) A national expert group No statutory or legal status Undertakes high quality national work-streams Contributes to National Publications e.g. “Tackling Demand Together” & the “Good Practice Guide for Ambulance Commissioning (RCGP)” Invited to give evidence to the 2013 Health Committee on Urgent Care

The National Ambulance Commissioners Group Produces national models – e.g. national ambulance contract, PbR, Clinical Indicators, HART Specification Develops shared strategic direction ‘Achieving Integrated Unscheduled Care’ and shares technical knowledge and skills to improve their local leadership and contract management Provides informal induction and ongoing peer support for members Discussions are underway to enhance the role of the NACG and to formalise it’s status, so that it formally becomes the organisation that influences national commissioning direction

Key Points CCGs are in the driving seat Massive challenges ahead NHS Ambulance Providers on their own unlikely to be able to solve all the urgent care challenges Partnerships are likely Relationships are key