1. Shaping Health Care Services in West Kent Developing our Commissioning Plans
Dr Bob Bowes
Chair – West Kent Clinical Commissioning Group

2. Five Giant Evils - Beveridge 1942
Squalor:
Beveridge said that the main reason the country was in financial trouble was because those who were poorer could not afford to seek medical attention, and thus could not work, which furthermore created less income, and led to lack of labourers available.
Ignorance:
Beveridge also believed that those who were in higher social class than those previously mentioned were ignorant to their role in a community.
Want
Idleness
Disease

3. Purchaser provider split
Started in 1991, various approaches have been tried
Designed to bring the benefits of the market (improved quality with
reduced costs) to the NHS
But….
“…..we have had the disadvantages of an adversarial system without as yet
seeing many benefits from the purchaser/provider split. If reliable figures for
the costs of commissioning prove that it is uneconomic and if it does not begin
to improve soon, after 20 years of costly failure, the purchaser/provider split
may need to be abolished.”
Report of Health Committee of House of Commons 2009
And…
“……available research indicates that the NHS may have found itself in a lose-lose situation—taking on the extra costs of competition without yet experiencing the benefits. “

5. What do Commissioners do?
Buy services for the populations they serve
And….
“Commissioners increasingly need to be advocates for health and wellbeing,
encouraging and enabling individuals, families and communities to take greater and shared responsibility for staying healthy and managing their health and conditions.
This means understanding better the determinants of health, effective engagement and enablement of people and populations and strengthened partnership working to improve health and wellbeing. As a result the role of commissioners has grown from a traditional fairly narrow base of needs assessment and contracting. The challenges to commissioning capability has risen accordingly”
Report of Health Committee of House of Commons 2009
Are there too many managers????

6. Clinical Commissioning Groups
There are 212 Clinical commissioning groups (CCGs) across England
The CCG’s purpose is to bring a clinical focus to commissioning
They are responsible for:
All acute hospital services, mental health, community services (75% of NHS spending
They are not responsible for:
GP services, Health Visiting, Specialised commissioning
Prison health services
West Kent CCG - 10th largest in England
Relationships with Patients, GPs, NHS trusts, Social care, Councils, Health Watch
Same area as Maidstone and Tunbridge Wells Trust catchment
463,000 population, £550m budget
71 contracts to set, manage and improve
,£8m savings ; £16m required (presently achieving 62% of that)

7. The West Kent CCG Board 12 GPs, elected by groups of practices
Nurse Board member, Specialist clinician, Lay member with finance and audit expertise, Lay member responsible for Patient and Public engagement
Accountable Officer, Chief Finance Officer
Supported by committees and a staff of about 50 as well as outside agencies
A crucial role for Patients, the Public and Councils in helping decide how to meet our challenges

11. Commissioning Priorities
Driven by the West Kent Joint strategic needs assessment (JSNA)
Shaped by local provider landscape (GP practices, Hospitals, Mental Health, Community and Social services), engagement with the Public, Councils, Clinicians and NHS commissioning board
Matching the area’s needs to provision
Ensuring good value for money, reducing waste
A new approach is now being used in West Kent, to make the process more rigorous and open
Not always achieved!

12. Diabetes Rising incidence of type 2 diabetes; now 4% =16000 in WK,
will rise by another 8000 within 15 years.
Considerable number of patients not diagnosed and still
others not receiving best care
Most care delivered by GPs and practice nurses so our
commissioning plan is to improve the capabilities and capacity
of these teams. Practice teams will be better educated;
hospitals’ role will expand to educating GP surgeries.
Re-focussing of hospital care on those who will benefit most

13. Reducing Emergency Admissions
Making sure that care pathways remain intact and competent,
“Apart from major accidents, an emergency admission is a failure of care pathways”
Making best use of clinical expertise at crucial points in the system;
Ambulance control centre
A+E department
GP surgeries working better with social services and community
nurses, more “emergency aware”
Challenge is to make sure that every part of the system is equally
aware
Non elective admissions to our hospitals are showing a small
reduction compared to last year

14. Dementia Expected 5500 patients in West Kent, just under 2100 have
had a formal diagnosis
Taboo: “how useful is earlier diagnosis?”
Complex needs including health and social care sectors, carer
support, medication, physical and mental health,
community nursing
Earlier intervention allows better planning and maintains
independent living for longer, ensures care can be delivered
in the most appropriate place

15. Improving the Falls Service
Falls not only cause injury; they are often a marker of frailty
and can signal a decline in general health
Patients who fall in West Kent now receive a comprehensive
review of their medical situation by a consultant led
multidisciplinary team with rapid access to
out patient appointments should unmet need be identified.
This will make sure that needs are identified and acted upon
sooner, reducing the need for non elective admissions

16. Referral and Treatment Criteria
Evidence based, to make sure that those who will benefit from
a procedure are offered it and those who will not benefit are not.
Sounds like Rationing???
Some surveys show that 30% of knee replacement patients
regret having had the operation, mostly because it was done
before it was needed.
GP referrals show a four fold variability in volume for any condition
Some consultants don’t see it as their role to advise patients
against having a procedure
A very high degree of agreement between patients, GPs and
consultants is needed to make sure this approach works

17. End of Life Care
A very important issue; we would like to know your views.