Commissioning - What are we trying to achieve

1. Commissioning - What are we trying to achieve? Alex Stewart – Regional Manager – Stroke Association

2. Our Health, our care, our say Better prevention and early intervention for improved health, independence and wellbeing More choice and a stronger voice for individuals and communities Tackling inequalities and improving access to services More support for people with long term needs Introduction On 6 March 2007, the Department of Health (DH) published a commissioning framework aimed at commissioners and providers of services in health and social care. It is part of the implementation of the Health White Paper ‘Our Health, Our Care, Our Say’ and is underpinned by the policies in the 'Every Child Matters' agenda and the Wanless reviews. The document has been published for consultation. The deadline is 28 May 2007. The DH intends to publish final guidance in summer 2007 with implementation from 2008/09. Who is the framework aimed at? local authorities  primary care trusts (PCTs) GPs people working in or through local strategic partnerships (LSPs), including the business community, government regional offices and the third sector. The framework covers commissioning for all of the population in a locality: adults and children their family and carers all care groups. Introduction On 6 March 2007, the Department of Health (DH) published a commissioning framework aimed at commissioners and providers of services in health and social care. It is part of the implementation of the Health White Paper ‘Our Health, Our Care, Our Say’ and is underpinned by the policies in the 'Every Child Matters' agenda and the Wanless reviews. The document has been published for consultation. The deadline is 28 May 2007. The DH intends to publish final guidance in summer 2007 with implementation from 2008/09. Who is the framework aimed at? local authorities  primary care trusts (PCTs) GPs people working in or through local strategic partnerships (LSPs), including the business community, government regional offices and the third sector. The framework covers commissioning for all of the population in a locality: adults and children their family and carers all care groups.

3. Evidence Required Joint Strategic Needs Assessment Enabling local services to plan short and medium term objectives through LAA Underpinning the Sustainable Community Strategy Effective community engagement – patients, services users, carers, providers, innovation, research……

4. Eight identified key steps to effective commissioning putting people at the centre of commissioning understanding the needs of populations and individuals sharing and using information more effectively assuring high-quality providers for all services giving people greater choice and control over services and treatments, and access to good information and advice. – this is about undertaking joint stra– this is about sharing information effectively while taking proper account of confidentiality. tegic needs assessments. giving people greater choice and control over services and treatments, and access to good information and advice. – this is about undertaking joint stra– this is about sharing information effectively while taking proper account of confidentiality. tegic needs assessments.

5. Eight identified key steps to effective commissioningcont. recognising the interdependence between work, health and wellbeing developing incentives for commissioning for health and well-being ‘Making it happen’: local accountability 'Making it happen': capability and leadership – about developing relationships with providers and engaging them in needs assessments. – improving employee health and wellbeing and helping people into employment – for example, encouraging PCTs and practice-based commissioners to be more flexible in using NHS funds. – how local commissioners will be held to account. building commissioning leadership and capability. – about developing relationships with providers and engaging them in needs assessments. – improving employee health and wellbeing and helping people into employment – for example, encouraging PCTs and practice-based commissioners to be more flexible in using NHS funds. – how local commissioners will be held to account. building commissioning leadership and capability.

6. The Problems that we all face Information is typically out of date Geographical boundaries are inflexible, changeable and not easily related to local communities Official statistics cannot be linked to other data from the same or different sources due to differnces in definition

7. However………. We all maintain reasonably up-tyo-date databases GP Registers School Census Housing Tenure Benefit Records Births, deaths etc. And from these records we can produce evidenced GIS mapping which effectively and accurately demonstrate needs in geographical areasAnd from these records we can produce evidenced GIS mapping which effectively and accurately demonstrate needs in geographical areas

8. Case Study - Early supported discharge and rehab for stroke sufferer What steps would you need to undertake to achieve early discharge, provide adequate support to ensure key outcomes (QMs) from the Stroke Strategy are achieved? What sort of overarching outcomes would you hope to achieve?

9. The Berkshire Example Achieved more timely discharge together with improved outcomes for eligible complex stroke patients through the provision of intensive, multi-disciplinary, stroke rehabilitation in the community that followed immdiately from the intensive rehab received in the Stroke Unit, and dovetails with timely and appropriately stroke skilled support from Local Authority Community Care

10. The Berkshire Example cont. Provision of adequate scope to support the implementation of key acute objectives of the National Stroke Strategy by optimising patient flow across the hyper-acute patient pathway (specifically, early scanning and thrombolysis, and treatment of all patients in a Stroke Unit

11. The Berkshire Example cont. Increased capacity to deliver intensive, stroke specialised rehabilitation to complex patients already in the community who would benefit and otherwise face acute readmission or being left with avoidable increased dependency

12. The Berkshire Example cont. Multi stakeholder project group formed to oversee development Community based neuro-rehab team expanded to deliver service Local groups established with clinician, partner and public representation Made use of existing fora to communicate key messages Service changes were overseen by the Director of Clinical Services at a monthly review Steering Group meeting attended by Project Managers and reps from commissioning, Local Authority partners and Practice Based commissioners Service changes were overseen by the Director of Clinical Services at a monthly review Steering Group meeting attended by Project Managers and reps from commissioning, Local Authority partners and Practice Based commissioners

13. The Overarching Aim is to Achieve Reduction in deaths due to stroke Reduced levels of dependency following stroke Reduction in acute (Tariff) bed days, excess bed days, and total bed days Maximising capacity in the Stroke Unit Improved support to patients and carers Improved stroke specialist skills of formal and informal carers Essential for achieving Stroke Strategy and Operating Framework targets for all stroke patients to spend the majority of their acute spell on a stroke unit and by freeing up capacity in the unit, enabling more stroke patients to be thrombolysedEssential for achieving Stroke Strategy and Operating Framework targets for all stroke patients to spend the majority of their acute spell on a stroke unit and by freeing up capacity in the unit, enabling more stroke patients to be thrombolysed

14. Key Strengths The Approach was:- Commissioner led and funded Demonstrable and measurable health outcomes Patients and Carers are supported and informed by a Centre of Excellence in Stroke care Steering Group was jointly managed by PCT, LA, and representatives from Practice Based Commissioners

15. National charity Mission to: Prevent strokes Reduce their effect by Providing services Campaigning Education Research