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A Commissioner’s Perspective
Annette Williamson Programme Lead - Reducing Infant Mortality Birmingham
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The Commissioners’ Role
Assess health need Consider the evidence base Involve the public and clinicians Design service specifications Procure the right services Stimulate the development of providers Performance manage, review services
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Commissioning Cycle
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Considerations The commissioners are PCTs and Local Authorities
There are national targets around infant mortality Determinants of risk are both medical and social Partnership working with wide range of stakeholders is essential for effective commissioning Practice based commissioning input
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World Class Commissioning
The NHS Plan 2000: a plan for investment, a plan for reform. Commissioning a Patient-Led NHS 2005: Shift in focus from spending to investing in health and well-being outcomes. NHS Next Stage Review – Emphasis on Quality. A Step Further Raising Ambitions – New Form of Commissioning Effective World Class Commissioning - 11 Organisational Competencies understand the needs of their local population. steer the local health agenda main focus – better outcomes – adding life to years and years to life.
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Determining the Quality of Maternity Services
Development of ‘Clinical Dashboards’ to support clinical teams Commissioners involve clinician groups in strategic planning and service development to drive improvements in health outcomes Use of tools and toolkits to measure the quality of care Use information from tools to inform commissioning
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CQUIN is one of several mechanisms for improving quality
The Commissioning for Quality and Innovation (CQUIN) framework is part of a package of measures for improving quality set out in the Next Stage Review
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CQUIN is one of several mechanisms for improving quality
The NSR built upon existing structures to introduce some powerful new ways to improve quality. These include: Getting the basics right eg Care Quality Commission enforcement powers, Never Events, improving measurement Strengthening leadership eg National Quality Board, SHA Boards and Medical Directors Improving accountability eg Quality Accounts, and developing independent quality standards Supplementing support tools eg NHS Evidence service, Quality Observatories CQUIN will operate alongside and reinforce these initiatives. CQUIN will also allow commissioners to demonstrate their World Class Commissioning competencies CQUIN will act as a vehicle to reinforce the Quality Framework, encouraging all NHS organisations to give a higher regard to quality.
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New national choice guarantees by Dec 2009
Choice of how to access maternity care Choice of type of antenatal care Choice of place of birth Home Midwifery unit; freestanding or alongside maternity unit Maternity team care in maternity unit Choice of postnatal care Also said women should have a midwife they know and trust throughout pregnancy & in postnatal period
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Birmingham 20791 births in 2006/07 2 Foundation and 1 NHS Trust
3 Coordinating Commissioning PCTs 2 Associate PCTs 1 Local Authority High rates of infant mortality & deprivation Very diverse population Variable quality of maternity services 2x less well performing Trusts 1x fair performing Trust
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What have we done? Perinatal Institute - data collection and needs assessment City wide commissioning group Develop common specification for maternity services Develop social risk assessment tool Develop pathways of care for social risk
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More of what we’ve done Birmingham Health and Wellbeing Partnership
Smoking, breast feeding Pregnancy Outreach Workers and other interventions for the very deprived, excluded, teenagers etc Workforce plan to Address rise in birth rate Deliver maternity matters choice guarantee Reduce caseload for community midwives in deprived areas
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West Midland-wide KPIs
Quality framework for hospital trust contracts including KPIs NICE and other guidance Booking before 12 weeks (80%) Antenatal detection of IUGR (60%) Smoking during pregnancy (below 15%) Breast feeding at 6-8 weeks (2% pa ^) Continuity of carer (75% named midwife)
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Other challenges Alignment and co-production - previously fragmented effort Commissioners and providers working together to deliver better safer care Increasing the availability of obstetricians on labour ward Meeting antenatal screening standards Offering choice and improving safety
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Gaps Absence of a nationally agreed risk assessment tool for social risk Absence of any evidence based intervention for obesity in pregnancy Need to develop cohesive care pathways for social risk across the city Weak evidence base for reducing infant mortality
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Thank you Any questions?
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