1. Professor Pam Enderby

2. Political history of the internal market First experiments in the 1990s proved inconclusive. ‘ quasi market ’-’half-hearted’ 1997 labour government-health market- incrementally bolder Introduction of the payment by results- incentives-national tariff for HRGs Patient choice. From 2008- Choose from any accredited provider. Can meet from national tariff-patient becomes Commissioner

3. Marketing mantra Know your product Know your unique selling point Know the cost of provision Know who you are selling to

4. Responsibility of Commissioners Assessing the health and social care needs of the target population Identify associated costs and consequences Identify effective, safe interventions Custodian of public purse (prevent political mayhem)

5. Commissioning/procurement with local government is likely to happen in mental health, older people’s services and children’s services. Will commissioning be truly locally driven? Likely to have a central influence

6. In the market Need to examine: Effective commissioning Effective tendering

7. In the market Who is buying? What do they want? What do we have to sell? Why should they buy it? What choice do they have?

8. Effective Health Commissioning Identification of need and demand Shaping of the markets Holding market to account: –cost –quality –safety

9. Knowing the commissioner ‘ reshaping health service through commissioning will probably be the most significant challenge facing the NHS over the next few years.’ Health Policy Forum Dec 06

10. Knowing the commissioner How will we demonstrate effectiveness? benchmarking coverage for cost equity access complaints/satisfaction Overseen by SHA scrutiny committees

11. ‘The reforms are means to improvements rather than a blue print for how services should be delivered. They will support the development of high quality services by embedding the right balance of incentives, transparency, plurality of providers and patient choice into the system. Better commissioning of health care services will be critical.’ Department of Health 2005p2

12. Inherent bias towards local providers Burge et al 2006

13. Types of Service/ Clients Needs 1.Assessment, information, advice 2.Prevention and maintenance 3.Guided/supported stimulation 4.Routine regular therapy – time limited 5.Routine regular therapy – not time limited 6.Intensive therapy 7.Specialist input

15. Acquired Neurological 1 2 3 4 5 6 7

17. STRATEGIC DEVELOPMENT define population define needs define principles/objectives identify existing resources identify relationships

18. STRATEGIC DEVELOPMENT Define Population age client groups included exceptions epidemiology

19. ‘HAMBURGER’ SOLUTION

20. Generic therapists

21. ‘HAMBURGER’ SOLUTION Generic therapists

22. whole system approach (rather than piecemeal) communication between partners (local information) Two main problems as I see them

23. CONCLUSION Challenge is to protect and develop specialist services and skills whilst providing a whole system Identifying what is really unique

24. “ a positive attitude may not solve all your problems, but it will annoy enough people to make it worth the effort.” Herm Albright 1876