Right Care in action

1. Right Care in action Doncaster CCG – Commissioning for Value: Successes, Challenges and Solutions DrAnna Kirkman& Martha Coulman NHS | Presentation to [XXXX Company] | [Type Date]

2. Commissioning for Value: Successes, Challenges and Solutions Dr Anna Kirkman NHS Doncaster CCG Martha Coulman NHS Doncaster CCG

3. Background • Successes and challenges • Solutions

4. National context Local context Reduction in running costs (50%) taking account of retained commissioning function Flat cash plus impact of capitation formula (8% reduction in financial allocation) Bottom quartile for unplanned admissions growth

5. Intelligence-driven approach to identify opportunities to improve the value that our population gets for the money invested in healthcare Management and supporting resources focussed on the priorities of the organisation Consistent framework and underpinning processes to support decision making

6. Respiratory 1. Identified variation 2. Commissioned deep dive pack in respiratory; identified specific elements of the pathway where there is variation 3. Clinically led redesign currently being implemented Mental Health 1. Identified variation 2. Commissioned review of mental health services; due to complete November 2013

7. Key Successes: Planning Technically successful; the process enabled a strategic focus on the clinical areas that represented the greatest opportunities for improvement Partnership Positive mechanism to influence partners; mental health is a HWBB priority Delivery Deep dive approach supported the development of structured delivery plans Key Challenges: Planning Debate about the “quality of strategic priorities”; i.e. is the information “good enough”? Partnership Changing commissioning architecture of NHS, we do not have commissioning responsibility for critical elements of pathways for example smoking cessation Delivery Streamlined business processes in order to align delivery and facilitate prompt implementation of decisions Successes and challenges

8. Improve the quality of system wide planning What Solution We need to bring our partners along and create energy for change in order to achieve system transformation Involving partners in planning process; intelligence is sense checked, current service transformation is considered, partners plans are taken into account, commissioning responsibilities are understood and “elephants in the room” are addressed at an early stage Robust service user engagement; on-line survey, social media, print media, face to face consultation, develops a broader understanding of the issues Robust system wide plans that reflect benchmarked intelligence and “soft” intelligence • Provider engagement; we rely on our providers to translate our plans into delivery • Co commissioners; we can’t use our resource allocation to commission elements of service that are not our responsibility but we can influence • Service user engagement; we need to develop a local understanding of the pressures that the NHS is facing

9. Delivery: Turning plans into reality What How Engage transformation teams from the outset Stream line the decision making process/ governance structure Simplify business planning processes; introduction of initial viability assessments, sourcing assessments etc. Ensure that management and clinical capacity is focussed on priorities; development of delivery plans and aligned objective setting; (strategy, delivery plan, team objectives, personal objectives) • Transformation teams “bought in to the process” • Time taken from decision to implementation • Understanding potential delays in deliverability • Managerial and clinical capacity dispersed

10. System improvement Clinical leadership, clinical engagement, provider engagement, service user engagement, co commissioner engagement, and effective business processes

11. Right Care for Populations • The NHS Right Care website offers resources to support CCGs in adopting this approach: • online videos and ‘how to’ guides • casebooks with learning from previous pilots • tried and tested process templates to support taking the approach forward • advice on how to produce “deep dive” packs locally to support later phases, within the CCG or working with local intelligence services • access to a practitioner network • Follow Right Care online • Subscribe to get a weekly digest of our blog alerts in your inbox, • Receive occasional eBulletins • Follow us on Twitter @qipprightcare Find the full series at: www.rightcare.nhs.uk/resourcecentre