Collaborative commissioning and devolution for specialised services, pop up uni, 3pm, 2 september 2015

Collaborative Commissioning and

Devolution for Specialised Services Alison Tonge –Regional Director of Specialised

Commissioning (North)

Specialised commissioning overview • NHS England directly commissions specialised services with a value of

approximately £14bn.

• Ministers are responsible for deciding which specialised services should be

commissioned directly by NHS England rather than by CCGs, based on

advice from the Prescribed Specialised Services Advisory Group (PSSAG), a multi-disciplinary Department of Health Committee.

• 145 services are currently prescribed as specialised.

• Around 60 of these are highly specialised (including services for people with

very rare diseases).

2

What are Specialised Services H

igh

ly s

pec

ialis

ed

• Rare conditions

• Very low patient numbers

• Very few hospitals

• Examples: • Heart and lung

transplantation

• Treatment of rare eye conditions

Sp

ecia

lised

se

rvic

es (

1) • Episodic

specialised services

• Examples: • Paediatric and

Neonatal Intensive care

• Severe burn care

• Specialised cancer surgery

Sp

ecia

lised

se

rvic

es (

2) • ‘Pathway’

specialised services

• Long term conditions

• Examples: • Kidney care

• Mental health

• Cardiac care • Cancer services

We commission with providers for all three

levels of services National services

Regional services

Health economy services

Trauma 0%

16%

36%

16%

28%

4%

Group of CCGs

Health Economy

Sub-region

Region

National

TBC

Collaborative commissioning

Strategy and service reviews

New models

Removing barriers to Place based accountability for Whole system and pathways

Clear vision on direction Prioritised service areas for New model of delivery

Transformed Commissioning

Enable new delivery model for specialised Based on a specialised network with Lead provider and peer partners In-built ‘right care models’ driving sustainability

Transformed Delivery

Place Based Alignment !

Why is change needed in specialised services?

Too many providers

Too much variation in quality and outcomes

Some hospitals don't have enough

specialist staff

Some Providers are

not seeing enough patients

Move towards 7 day working

Some providers are not meeting core quality standards

Lack of integrated

commissioning

Specialised Services Commissioning Development

what can we do better together

Champion the CHANGE in

quality needed Measure it !

Contract together Manage providers together

CRG’s and POCB’s to advise on

whole pathway

Improving – commissioning

for value evidence

Lead service reviews to

create sustainability

Create pathway supports that

are unavoidable

Needs assessment integrated

Single set of priorities for ‘place’ and intentions

National Direction and Progress

Principles

• Place based commissioning – specialised within a whole system

• Transformation of specialised services – consolidation , new care models and networks

• CCG’s collaboration in health economies, region to enable greater influence on specialised services plans and priorities

• CCG’s to see overall budget for the specialised portfolio for the population but influence this through two main collaborative structures

Progress

• Collaborative commissioning groups established in 10 regions

• Priorities have been identified to work on

• National program board – co-chaired Dr N Harding, R Jeavons

• Two services to transfer to CCG’s this year – Neurology OP and Wheelchairs

• Morbid obesity surgery to transfer 16-17 , Renal review

Priorities

• Most frequent priorities in the collaboratives

• CAMHS

• Morbid Obesity

• Renal

• Vascular

• Cancer surgery

• Radiotherapy

• Spinal surgery

• Complex and neuro rehabilitation

• Neonatal

• HIV networks

Complex Rehabilitation Example North West

Provision Integrated Network

Tier 3 (community and LA)

Tier 2 (DGH’s)

Tier 1 (tertiary hub)

Commissioning integrated commissioning model CCG, NHS E, LA

Single commissioning specification and model

Contract(?) money

Stimulated partnership through Clear process, resource, new Governance, capacity Used SCN’s /clinical networks

Case for change – point prevalence, National standards, across continuum! Single commissioner lead

Close working

Phase 2 – Enabling place based leadership

Governance and Transformation • Enable CCG’s to take more ownership of

– Redesign and service change of specialised services

– New care models and pathways

– Transformation initiatives

• Health economy level

• Ownership of transformation

• Service change decisions owned locally

• Legal framework to enable this within NHSEngland scheme of delegation

• Enable pooled budgets and lead contracting

Governance

• Specialised within a broader program

• Coherent strategy – based on service bundles

• Integration of specialised commissioning on system design

• Initiatives undertaken with CCG leadership and sponsorship

• Knowledge and opportunities shared from national team to support improvement

Transformation

Specialised Commissioning within the

context of Devolution Manchester

Gina Lawrence – Chief Operating Officer, NHS Trafford CCG

• Governance

• Principles

• Scope

• Commissioning

• Service Transformation

• Provision

Governance

Principles Specialised Commissioning Principles:

• To co-design and work together - both between commissioners (Greater Manchester and

NHS England) and with providers;

• To design services that are best for patients (not organisations);

• To set clinical standards that at least meet current specifications and also anticipate the future

needs of patients;

• For Greater Manchester to be “outward facing” in seeking optimum standards – to ensure

national standards, best practice and equity of access and quality are “in built” to locally

owned clinical standards

• To have cognisance of co-location and co-dependencies

• To anticipate future developments in technology and innovation;

• To build on previous successful commissioning approaches namely the commissioning of a

single service through a lead provider;

• To design optimal arrangements that recognise key inter linkages between services;

• To optimise estate utilisation and minimise further infrastructure investment.

Scope All 200 service specifications were considered and have been divided into 3 groups as below:

• Group 1

1. Highly specialised services

2. Small number of patients

3. One/two centres in the Country

4. Input from National Team

– To be managed by NW Specialised Commissioning with input by National Team

– AGG to have oversight of budgets/activity/performance/quality issues

Example – Bone Cancer Services

Scope continued • Group 2

1. More appropriate to be commissioned on a wider than GM footprint

2. Profile means difficult to split service

3. Large net importer from other areas

– To be managed jointly by Devo Manc with other NW CCG’s under the

guidance of the NW Spec Comm Team

– AGG under Devo Manc would offer high level input

– These services have an opportunity in future to move into full

commissioning within Devo Manc

Example – Bone Marrow Services

Scope continued • Group 3

1. These services are considered discrete

2. Inter-dependency

3. Work on a GM footprint

4. Population base of 3 million people

– Services can sit within a GM construct

– Services within this group will be considered for early transformation

Example – Vascular Services

Scope continued Software tools used to prioritise and group services

Scope continued Software tools used to prioritise and group services

Commissioning

• Services will need to be Co-commissioned with NHSE due to legislation

• Possible for full Devolution in the future

How might GM Commission the Service

• GM Devolution Centre Team

• Align services to the 12 GM CCG’s

• Led by a single CCG

Service Transformation

• Testing the approach during 2015/16

• OG/Urology cancer prioritised

• Baseline review of finances/risks/current pathway

• Development of clinical standard by clinical teams across GM

• Work with GM provider to develop thinking around provider models

• Test commissioning model

Provision

• Vanguard Models – Cancer

• Single Service

• Prime Vendor

• Integration

• New ways of collaboration under Devo Manc

Any Questions