Intelligent Commissioning of Maternity Services How do we make it happen Suzanne Tyler

1. Intelligent Commissioning of Maternity Services How do we make it happen Suzanne Tyler

2. The key maternity messages • Birth rate has gone up 22% in last decade • Complexity and risk factors for women (BMI, age, LTC) have increased considerably) • Staffing levels in midwifery, obstetrics and sonography vary considerably around the country and in many areas fail to meet national recommendations • Outcomes are generally good, with considerable local variation and many opportunities for improving clinical outcomes and experience exist • Safety is the highest concern, but women’s experience of maternity services impacts longitudinally on health and wellbeing • It’s a high profile service which excites public and political attention especially around configuration • Focus tends to be on the birth event rather than the contribution of antenatal/postnatal care to long term health and wellbeing • Implementing policy around choice, continuity, 1:1 care in labour etc has been patchy and there is till much to do • There is a good track record of involving users but the voice of GPs has declined over time • Links to neonatal services and seamless transitions are essential and much excellent work has been done around the country – but it is not uniform

3. The Commissioning Challenge: Dame Barbara Hakin: October 2011 “ The system we are developing gives us a real opportunity to do things differently. I would encourage everyone who is involved with or has an interest in commissioning to really think about how we can be different, how can we use commissioning to give patients much more voice and choice”

4. Liberating the NHS: Legislative Framework and Next Steps December 2010 • While responsibility for commissioning maternity services should sit with GP consortia, we will expect the Board to give particular focus to promoting quality improvement and extending choice for pregnant women. The Board will support consortia to work together collaboratively to commission services: consortia will be able to group together, or pool resources with the Board, where this makes most sense. The Board will also directly commission specialist neonatal services* * i.e. the 10% of babies requiring SCBU

5. Developing the NHS Commissioning Board: July 2011 • In addition, the NHS Commissioning Board will host clinical networks, which will advise on distinct areas of care, such as cancer or maternity services. The Board will also host new clinical senates which will provide multi-disciplinary input to strategic clinical decision making to support commissioners, and embed clinical expertise at the heart of the Board. The purpose of these groups is to ensure that clinical commissioning groups and the Board itself have access to a broad range of expert clinical input to support and inform their commissioning decisions. The relationship between the Board and clinical networks and senates is likely to change as the new commissioning system matures. • Clear arrangements for key service areas, which would gain particular benefit from dedicated professional and clinical leadership. These might include children’s services, mental health, older people’s services, dementia, learning disabilities, maternity and primary care.

6. Clinical Commissioning Groups: what we know • c260 pathfinders • 11 CCGs in every neonatal network? • Size range from pop 18,900 to 755,906 • Pop 100,000 equates to approx 1400 births • Pop 200,00 equates to approx 2800 births • Pop 300,000 equates to approx 4000 births • Average maternity unit delivers around 3-4,000 babies a year • Around a quarter of units deliver over 6,000 babies a year • Low level of GP engagement with maternity services to date • Direct maternity spend accounts for about 3% of existing PCT budgets

7. What CCGs are likely to see

8. CCGs holding the ring in the new ‘architecture’ for maternity commissioning NHS Outcomes Framework Commissioning Outcomes Framework Fit with Child health Health Watch

9. This project • Identify CCGs who would like support to develop maternity commissioning skills and expertise • Work with them and other stakeholders to identify skills, tools and learning required • Share that learning amongst the CCG network and Commissioning Support Organisations • Inform the NHS Commissioning Board in developing its assurance role

10. Messages so far • Confusion about who commissions what • NHS CB: neonatal services and health visiting • What about transitional care • LAs: public health (smoking, obesity, teenage pregnancy) • CCGs: maternity – routine and specialist • Strong desire for locally provided services • Opportunity for shared commissioning arrangements • Links with Health & Wellbeing Boards emerging • It’s all about relationships

11. Scope for doing things differently • Pathway redesign of whole -9 months to 5 years services • Better integration of primary, acute based, community based and social care that supports new families • A clinical perspective to challenge existing provider behaviour where outcomes vary from neighbouring, regional or benchmarked norms • A clinical perspective into provider network discussions about configuration that ensures patients’ needs are at the heart of decision making ? What about neonatal care?

12. Likely ‘product’ • Key messages/principles about what is important in commissioning maternity services • Operating & Outcomes Framework • Policy • Links to resources, guides and templates that will help • Standard service specs • Benchmarking data • Professional guidance etc • Case studies from CCGs already engaged

13. Example: Aligning local and national priorities

14. What do CCGs need so they become informed commissioners of maternity services? • What do CCGs need to know about the needs of their local population, as well as local and national requirements and where will they get this information from? • How will they know whether the services they commission are safe and of high quality as well as meeting the specific needs of their local population? • How will CCGs make arrangements with their local providers to negotiate activity, service models investment decisions and outcome expectations? • What do GPs see as the priorities for improving maternity services? • How can maternity networks support CCGs in delivering their commitments?

15. Contacts: suzanne.tyler@dh.gsi.gov.uk