1. Commissioning Iain Marley Commissioning Officer – Children Commissioning Systems Development – South South Tees Clinical Commissioning Group

2. ….and today, I’m…. The “Acceptable Face” of NHS Tees

3. Context – the overall picture 42 major contracts across NHS Tees Majority are nationally mandated standard contracts: –NHS Standard Acute Contract - NTHFT, STHFT, Nuffield, Ramsay etc –NHS Standard Community Contract - North Tees Community Provider, MRCCS, Assura Sexual Health, Hospices etc –NHS Standard Mental Health Contract - TEWV, Alliance, MIND etc. Total Contract Budget of £856m Over 200 providers QIPP Challenge

4. QIPP Challenge: 2012/2013 Middlesbrough Redcar & Cleveland TotalTees Acute Services - Planned Care £469,000£2,000,000£2,469,000£3,269,000 - Urgent Care £2,000,000£5,434,000£7,434,000£10,557,000 Prescribing £1,375,000£1,242,000£2,617,000£5,031,000 Estate and “Other” £1,536,000£420,000£1,956,000£2,946,000 Total £5,380,000£9,096,000£14,476,000£21,803,000

5. Contract Negotiation Constraints 12/13 Affordability versus Forecast Outturn activity/cost SHA/DH expectations –Operating Framework requirements must be negotiated in to contracts –Deadlines for contract signature FAILURE TO AGREE WITH PROVIDERS WILL RESULT IN NOT HAVING A SIGNED CONTRACT AND CCGS AFFECTED WON’T ACHIEVE AUTHORISATION Clinicians views are not necessarily the organisation’s views Payment by Results (PBR) –It is in the Foundation Trusts (FTs) interests to grow their business –Commissioners are immediately on the back foot once a patient enters “the system” – “Patient Pinball” FTs will exploit Primary Care’s inability to manage demand “It is what it is” – a negotiation: we don’t get everything we want!

6. Contract Negotiation Constraints Delayed publication of Operating Framework and Standard National Contracts Lack of evidence based, clinically credible proposals resisted as unsafe/high risk to FTs New services/changes to pathways – “Pilot Vs. Procurement” Overall impact of Commissioning Intentions: –Don’t do anything which may increase overall costs –Consider system wide impacts on other stakeholders, e.g. Social Care

7. Timetable

8. Meanwhile, back in the land of Clinical Commissioning… NHS Hartlepool and Stockton on Tees Clinical Commissioning Group –Hartlepool CCG –Stockton-On-Tees CCG South Tees Clinical Commissioning Group –Middlesbrough CCG –Redcar and Cleveland CCG –Greater Eston CCG

9. Clinical Commissioning Agenda Still in process of formation –Structures –Leadership –Priorities Heavy Authorisation Process Wide Agenda –CAMHS IS part of it – we do have clinical engagement!

10. CAMHS Priorities Earlier intervention in CYPs Emotional Health and Well-being Shifting resources upstream through 2 priorities: –CAMHS service transformation (TEWV CAMHS contract – changing the core service to deliver accessible, community based services) –Developing Tier 1 and 2 services Co-ordinating commissioning across Tees Developing/increasing the capacity of the broader delivery system – schools, VCOs

11. Progress to date Strategic CAMHS Stakeholder Group – meets monthly - LA rep, GPs, Head Teacher and VSO rep – increased commitment to CYP’s MH Strategic Tees-wide Plan - response to NST review, needs assessment - mapping of ‘tier 2’ services TEWV CAMHS Performance dashboard - using new Info management system in TEWV Service transformation funding agreed…. BOND – capacity building in early intervention MH third sector services

12. Aims Aim to drive down T3 referrals - increase earlier intervention, and increase capacity within other services through consultation, training and shared, co-ordinated pathways Potential non-recurring - £0.5m –fund increased activity and development at tier 2 –embed workforce plan for sustaining new service model –manage risk/existing demand at tier 3/4 £200k ring-fenced for third sector sub contracting – to extend good practice in pathway development and increase access for vulnerable groups

13. Why now? Funding window – speedy action required NHS capacity to drive change through commissioning Financial climate – mitigate impact of early intervention cuts BOND – building interest and momentum –Schools – interest in funding services –Improving quality of VCS/alternative providers –Identifying and sharing models of good practice

14. Next steps… Strengthen LA/NHS commissioning –co-ordinating/joint commissioning for LAC, VSO etc –commissioning with/by schools for early intervention support in schools Develop outcomes framework - for CYPs MH services Tier 1 – 3 – as a basis for commissioning Develop core TEWV offer/spec Commission training programme from CAMHS - for T1 and 2 service providers as part of service transformation