Tendering for special care services

1. Tendering for special care services Dr David Geddes Head of Primary Care Commissioning

2. Aim of session • Cover the process of tendering for special care services. • Types of services NHS England will be looking to commission and what they will expect to be provided (and how).

3. The Mandate • The NHS and its public sector partners need to work together to help one another to achieve their objectives. This is a core part of what the NHS does and not an optional extra. • NHS England Board’s objective is to make partnership a success. This includes, demonstrating progress against the Government’s priorities including: • continuing to improve services for both disabled children and adults • continuing to improve safeguarding practice in the NHS • contributing to multi-agency family support services for vulnerable and troubled families

4. Overview • NHS England will directly commission services in five areas: • primary medical, dental, pharmacy and optical services as well as all other dental services • specialised services • some specific public health screening and immunisation services • services for members of the armed forces • services for offenders in institutional settings

5. Overview Everyone counts lays out five offers to help commissioners deliver for the public: • support for routine NHS care seven days a week; • greater transparency on outcomes; • mechanisms to enhance patient feedback; • better data collection to drive evidence-based medicine; • high professional standards.

6. Overview • From 1 April 2013 NHS England will commission all NHS dental services: primary, community and secondary care including dental hospitals and out of hours services • Providing opportunity for consistency in approach and direction across England • Care pathway approach to align dental services with thesingle operating model • Responsible for £600m budget for secondary dental services (overall budget is £2.8b, with over 10,000 primary care dental contracts)

7. Building relationships and links Dementia services patients with dementia can often have rapid decline in dental health. Safeguarding identifying children who may need early intervention General dental services shared care model of where services begin and end to provide better outcomes. Also prevents feeling of being overwhelmed by workload Primary medical services timely interventions and prevention

8. Types of special care services commissioned • Comprehensive preventive care management and treatment services to patients with special needs of all ages • Access for vulnerable groups • A referral service for GDPs and other health and social care practitioners for appropriate patients • General dental care for defined patients who experience difficulties accessing regular General Dental Services • Domiciliary dental care • Treatment (and rehabilitation) of phobic patients including conscious sedation services for both children and adults • Dental treatment under general anaesthesia – as appropriate • Specialist led – Special Care and Paediatric Dentistry

9. What to include in a tender • Will you be offering a consultant-led service? • Describe how you will meet the needs outlined in tender document needs assessment • Identify how many people will have access to this service • Describe how you will deliver the service and focus on outcomes • Be clear on why your service may be more expensive and provide examples • Illustrate how you meet other global needs i.e. access for wheel chair users • Describe how you will prevent unnecessary domiciliary care

10. Other areas to include within tender • Illustrate how the links you have made and relationship you have built enable you to only carry out the treatment requiring a specialist led service and describe examples of sharing e. g. routine assessment with primary care GDPs • How you link with children services not just from a safeguarding perspective but also in terms of repeated general dental anaesthetics (GDA) • How you are able to predict and prevent treatments • Describe how you will utilise skill mix to remain affordable • Describe the added value your specialist led team offers and the impact of not delivering what you do

11. Also consider… • Being clear that you are aware of the ‘new world’ i.e. mandate, everyone counts, securing excellence – relationships • Producing evidence to illustrate your links with other services and commitment to shared care model. • Training and education i.e. everyone’s right to be free of pain and be able to eat, speak and socialise • How you will measure outcomes i.e. KPIs included in PDS contract, which could also describe special care

12. …and perhaps….. • Case mix model - assesses the following on a four point scale: ability to communicate, ability to cooperate, medical status, oral risk factors, access to oral care and legal and ethical barriers to care. Use this now to describe the needs of patients who attend your service. • Prepare a bid on a social enterprise model or perhaps seek a partner in GDS to link up with and also think about combining smaller services to offer economies of scale and effective use of specialists and equipment and clinical directors • Think about patients and population needs - offering twilight and saturday am clinics?

13. Process for tendering • Oct 2008 NHS Supply2Health was set up as a national website designed to help commissioners link up with providers of health and social care services. The website advertises opportunities to provide health and social care services to the NHS in England and will announce which organisations have been awarded contracts (www.supply2health.nhs.uk) • NHS Supply2Health was developed as part of a suite of system management tools set out in the Operating Framework for the NHS for 2008/9 to support the principles of transparency, objectivity and non-discrimination in NHS commissioning. In cases where commissioners are seeking to appeal to an international marketplace, commissioners may still opt to advertise their tenders elsewhere including in the Official Journal of the European Union (OJEU) but in all cases the opportunity will appear on NHS Supply2Health at the same time.

14. Case Study Case study 1: Oral health information for parents of chronically ill children A Vocational Dental Practitioner Project, which was carried out by Bracknell Forest PCT Community Dental Service in 2006, involved paediatricians and dieticians working to encourage consistent dental health education advice for children with chronic illnesses or on high-sugar/calorie diets. The project aimed to: • assess and provide evidence of the need for preventive advice aimed at the target group • create a tool (in the form of an oral health education leaflet) for dieticians, paediatricians and other health professionals to use when discussing oral health with parents • educate parents about the importance of good oral health from an early stage in cases where children were chronically ill or required special diets • encourage communication of consistent messages from all dental and medical services • produce local recommendations on prevention strategies and future projects to increase multidisciplinary involvement in dental health.

15. Stages • Open discussions with paediatricians and dieticians. • Assessment of the health information given out routinely by paediatricians and dieticians, and the risk that this may contravene preventive dental advice. • Acquisition of local data pertaining to children aged 0–17 treated in dietetics departments (number treated, what they were treated for and where they were treated) • Finally, creation of an oral health education leaflet aimed specifically at preventing dental disease in chronically ill children and those requiring high-sugar diets.

16. Findings • It was evident that children with chronic medical conditions, or those requiring dietary intervention, were a population at high risk of developing dental disease. The health leaflets available regarding dietary advice for children requiring high-sugar/calorie diets or those with chronic medical conditions contained information that increased the risk of dental disease; little or no preventive dental advice was offered in conjunction with the distribution of these. • The health professionals involved in the project were keen to provide effective oral health advice to their patients, whom they felt would greatly benefit from a more multi-professional approach • The ensuing oral health education leaflet, which was created with the support of dieticians and paediatricians, became an educational tool for all healthcare professionals involved in children’s care; the main message, aimed at the parents and carers of children with chronic disease or requiring high-calorie diets, is that prevention of dental disease is possible without changing the underlying dietary advice from dieticians or paediatricians. The leaflet was distributed in paediatric outpatient departments and wards where most patient contacts were made.

17. Case Study The importance of oral care in the overall healthcare plan A 37-year-old man with moderate learning disabilities was referred, by his social worker, to the local PCT dental service (PCTDS) at Central Lancashire PCT, which has a department of special care dentistry, for a dental examination. Clinical examination confirmed the patient to be free of dental caries. However, oral hygiene was very poor, with an extensive accumulation of plaque and calculus covering all tooth surfaces. The carer, who supported the patient, assured the dentist that his client was provided with a toothbrush and toothpaste twice a day. Unfortunately, the patient was not able to brush his teeth without active support and intervention. The carer was alerted to this problem and to the potential for deterioration of his client’s dental health. Further to this visit, the patient’s healthcare plan was amended to include a section on oral health. The support the patient required from the carer was detailed and the carer was provided with training in tooth brushing and oral hygiene education, in order to support his client. A review appointment two weeks later confirmed a significant improvement in the patient’s oral hygiene. Dental examinations at regular intervals, including reinforcement of preventive advice, can be provided within local primary care dental services. This case highlights the importance of incorporating oral care into all healthcare plans.