1. Alcohol Commissioning - The role of Public Health - A view from Tower Hamlets Chris Lovitt- AD Public Health Rachael Sadegh- DAAT Joint Commissioning Manager

2. 1 Knowledge, Insight and Action Public Health Commissioning &

3. 2 Overview 1. Local work on developing a strengthened Public Health role in commissioning 2. Developing a framework for commissioning 3. Prioritising areas for engagement 4. Reality

4. 3 Strengthening local commissioning 333 Developing an Inner London Health Intelligence Unit -strengthen acute commissioning -City and Hackney, Newham and Tower Hamlets -Supported by McKinsey's -interviews, research & workshops Develop model of commissioning Identified 6 priority areas Focus action on priority areas to further strengthen commissioning

5. 4 KEY PUBLIC HEALTH/ HEALTH INTELLIGENCES ACTIVITIES THAT TAKE PLACE ALONG THE COMMISSIONING PROCESS – Informatics Public and clinical engagement Assess needs and prioritise Care pathway design Strategic planning Define contract specifications Contract & procure Market Management Quality and performance Claims management and coding review Treatment cost management Condition prevention and management Condition and risk monitoring Patient engagement Health needs assessment and strategic planning Condition management & influencing health behaviours Specification, contracting and procurement Performance, contract and quality management Informatics Public & Clinical & Partner Engagement E F ABCD E,F ABC D

6. 5 5 SIX AREAS FOR FOCUS ALONG THE COMMISSIONING PROCESS Assess needs and prioritise: Data driven assessment of the health needs of the population leading to agreed commissioning priorities that will improve health outcomes Care pathway design: Use clinical knowledge and experience and evidence base to develop pathways and ensure joined up approach across service lines and a common currency across London Strategic planning: Work with key strategic partners to agree commissioning priorities that will improve health outcomes; plan resource allocation over long term, map desired service configuration and provider market Condition prevention and management: Identification and Management of high-risk groups with pro-active engagement, targeted interventions and health promotion campaigns and evidence of effectiveness Condition and risk monitoring: Trends analysis and anticipation of predispositions to disease states by individual Patient engagement : Effective patient registration, capturing transient populations; ensure patients understand available services and quality to inform choice; Facilitate and respond to feedback and work to improve patient experience Define contract specifications : Specify delivery target, outcome and quality metrics in contracts; prepare tender specifications Contract and procure: Run open and fair procurement processes, negotiate contracts and appointing high quality providers with best value- for-money Market Management: Ensure competitive market, and an adequate number and diversity of providers to meet London’s healthcare needs; Monitor and manage service delivery networks Quality and performance: Track and regulate performance and compliance against contracts. Monitor quality indicators; adjust or terminate contract where necessary Claims management and coding review: Review and validate invoices; Check for clinical coding errors in handling of patient episode; Negotiate disagreements with providers Pharmaceutical/ treatment cost management: Analyse activity, intervention costs and effectiveness; Create incentives for GPs and monitor compliance Informatics: Ensure effective data storage, management and availability to support commissioning Public and clinical engagement: Build effective channels of communication with the public and clinicians to understand opinion on services and optimal care pathways Health needs assessment and strategic planning Condition management and influencing health behaviours Specification, contracting and procurement Performance, contract and quality management Informatics Public and Clinical and Partner Engagement E F ABCD E,FABCD 1 2 3 456 Priority area x

7. 6 REALITY Health needs assessments Integrating data from multiple local & national sources Annual Report NAO report Integration with other healthy lifestyle activity Capacity modelling Commissioning Intentions Support Audit of A&E alcohol related admissions Implementation of new projects & evidence reviews Patient pathway mapping Valuation and outcome monitoring Social marketing Training Research and publications Representation at meetings

8. 7 Action Overview & scrutiny review of young people & alcohol Alcohol LES Retender of Enhanced Community Alcohol Service Alcohol Social Marketing A&E diversion intervention Forthcoming alcohol NST Support visit Young People Alcohol Health Improvement Officer Alcohol Public Health Strategist

9. 8 Knowledge, Insight and Action Public Health Commissioning &

10. 9 Conclusion Public Health & Commissioning Together providing: Knowledge Insight Action

11. Assess needs and prioritise: Data driven assessment of the health needs of the population leading to agreed commissioning priorities that will improve health outcomes http://www.empho.org.uk/Themes/ alcohol/alcohol4.aspxhttp://www.empho.org.uk/Themes/ alcohol/alcohol4.aspx http://www.alcohollearningcentre.o rg.uk/Topics/Browse/Data/http://www.alcohollearningcentre.o rg.uk/Topics/Browse/Data/ http://www.homeoffice.gov.uk/rds/ pdfs2/dpr6.pdfhttp://www.homeoffice.gov.uk/rds/ pdfs2/dpr6.pdf Care pathway design: Use clinical knowledge and experience and evidence base to develop pathways and ensure joined up approach across service lines and a common currency across London http://www.alcohollearningcentre.o rg.uk/Topics/Browse/PrimaryCare/ ?parent=4608&child=4618http://www.alcohollearningcentre.o rg.uk/Topics/Browse/PrimaryCare/ ?parent=4608&child=4618 http://www.sussedprofessionals.n et/node/441http://www.sussedprofessionals.n et/node/441 Strategic planning: Work with key strategic partners to agree commissioning priorities that will improve health outcomes; plan resource allocation over long term, map desired service configuration and provider market http://www.nao.org.uk/publications/0 708/reducing_alcohol_harm.aspx Condition prevention and management: Identification and Management of high-risk groups with pro-active engagement, targeted interventions and health promotion campaigns and evidence of effectiveness Use tools such as SASQ, FAST, AUDIT C, AUDIT PC Use of tools such as SASQ, FAST, AUDIT C, AUDIT PC Role of Primary Care http://www.emphasisnetwork.o rg.uk/events/alcoholnov2008 /presentations/donlavoie.ppt Condition and risk monitoring: Trends analysis and anticipation of predispositions to disease states by individual Patient engagement : Effective patient registration, capturing transient populations; ensure patients understand available services and quality to inform choice; Facilitate and respond to feedback and work to improve patient experience Define contract specifications : Specify delivery target, outcome and quality metrics in contracts; prepare tender specifications Contract and procure: Run open and fair procurement processes, negotiate contracts and appointing high quality providers with best value- for-money Market Management: Ensure competitive market, and an adequate number and diversity of providers to meet London’s healthcare needs; Monitor and manage service delivery networks Quality and performance: Track and regulate performance and compliance against contracts. Monitor quality indicators; adjust or terminate contract where necessary Claims management and coding review: Review and validate invoices; Check for clinical coding errors in handling of patient episode; Negotiate disagreements with providers Pharmaceutical cost management: Analyse prescribing activity, drug costs and effectiveness; Create incentives for GPs and monitor compliance Informatics: Ensure effective data storage, management and availability to support commissioning Public and clinical engagement: Build effective channels of communication with the public and clinicians to understand opinion on services and optimal care pathways E,FABCD Some resources