World Class Commissioning Claire Whittington Deputy Director, Commissioning Department of Health.

World Class Commissioning

Claire WhittingtonDeputy Director, CommissioningDepartment of Health

Building capacity in the system

Introducing the reforms

High quality care for all

1

23

• NHS Plan saw greatest investment in the history of the NHS

• More doctors, more nurses, better facilities

• Patient choice and payment by results

• Foundation trusts• Stronger commissioning

• NHS Next Stage Review local clinical visions, national enabling report and NHS Constitution

Assess needs

Assess needs

Review current service

provision

Review current service

provisionDecide

prioritiesDecide

priorities

Strategic planningDesign serviceDesign service

Shape structure of

supply

Shape structure of

supply

Specify outcomes &procure services

Manage demand

and ensure appropriate access to

care

Manage demand

and ensure appropriate access to

care

Clinical decision making

Clinical decision making

Managing performance

(quality, performance,

outcomes)

Managing performance

(quality, performance,

outcomes)

Managing demand and performance

£70 billion£200m a

day

“The aim of world class commissioning, and therefore the ultimate test of its success,

will be an improvement in health outcomes and a

reduction in health inequalities”

NHS Spend - £bn

4% average increase from 2008/09 – 2010/11

VISION AND COMPETENCIESVISION AND COMPETENCIES

ASSURANCE SYSTEMASSURANCE SYSTEM

SUPPORT ANDDEVELOPMENT MODEL

SUPPORT ANDDEVELOPMENT MODEL

11 Competencies

1. Locally lead the NHS

2. Work with community partners

3. Engage with public and patients

4. Collaborate with clinicians

5. Manage knowledge and assess needs

6. Prioritise investment

7. Stimulate the market

8. Promote improvement and innovation

9. Secure procurement skills

10. Manage the local health system

11. Make sound financial investments

Information as the first key driver

Secondly, it’s about partnership with

2008/9 Assurance

Competencies Strategic Plans Outcomes Transformational

AmberAmber

Nati

on

al

Teenage pregnancy

Health inequalities

Stroke mortality

Cancer mortality

Smoking prevalence

Childhood obesity

All-age all-cause mortality

Suicide mortality

100

–

0.1

–

0.9

-1.8

2.5

3.2

–

1.1

-0.2

1. Local leader of NHS

2. Collaborates with partners

3. Patient and public engagement

4. Clinical leadership

5. Assess needs

6. Prioritisation

7. Stimulates provision

8. Innovation

9. Procurement and contracting

10. Performance management

HEALTH OUTCOMES COMPETENCIES GOVERNANCE

Below baseline

World class

Lo

ca

l

Current

Previous

Upper quartile

Adding years to life and life to years

Rate of change %*Strategic priority

Healthy life expectancy

CVD mortality rate

National average

* relative to national average rate of change

GreenGreen

AmberAmber

AmberAmber

Strategy

Finance

Board controls and processes

Outcomes, competencies and governance

PCTs failing to meet governance standards will be expected to • Receive

interventions and support

• Meet the standard within a short time period

PCTs failing to meet governance standards will be expected to • Receive

interventions and support

• Meet the standard within a short time period

PCTs that have improved greatly or reached world class should be recognised. They would also be expected to share their knowledge and experience

PCTs that remain below baseline, or have had static performance, should receive intervention to ensure they improve

PCTs that have improved greatly or reached world class should be recognised. They would also be expected to share their knowledge and experience

PCTs that remain below baseline, or have had static performance, should receive intervention to ensure they improve

Those improving faster than the national average should be rewarded

Those that have lost growth relative to the national average should be addressed

Those improving faster than the national average should be rewarded

Those that have lost growth relative to the national average should be addressed

Be prepared to revise your hypothesis as evidence accumulates…

Most frequently chosen health outcomes1. Smoking quitters

2. Rate of hospital admissions per 100,000 for alcohol related harm

3. CVD mortality

4. Percentage of all deaths that occur at home

5. Under 18 conception rate

6. Cancer mortality rate

7. Diabetes controlled blood sugar

8. Infants breastfed

9. Percentage of stroke admissions given a brain scan within 24 hours

10.Clostridium Difficile infection rate

Success built on

Architect of the local health system Active engagement of partners Understanding the provider economics Relentless focus on health outcomes Commissioning behavioural change within the

population Recognising the need to transform themselves and

develop new capabilities

2009 – Way Forward

Clinical commissioningProvider models

Integrated careRegulator role

Commercial skillsFocus on quality

Quality accounts

Measurement for improvement

Primary care commissioningPPE/PROMS

www.dh.gov.uk/worldclasscommissioning