Integrated Ambulance Commissioning Mark Docherty

1. Integrated Ambulance Commissioning Mark Docherty Director – London Ambulance Service Commissioning Former Chair of NACG 2nd April 2014

2. What I am going to cover • Getting ambulance commissioning right • Collaborative commissioning: the implications for the Independent Service • An update from the National Ambulance Commissioners Group (NACG)

3. THE EXTRAORDINARY ADVENTURES OF AN AMBULANCE COMMISSIONER

5. What is Commissioning? • 1988 – 12 mentions in parliament • 1997 – 248 mentions • 2007 – over 1,000 mentions • 2011- ,000s of mentions in both chambers • In 20 years it is a concept that has come from nowhere….and is now everywhere

6. What is commissioning really? • Conscience – stewardship, quality assurance, public protection • Brain – resource allocation, service design, planning • Eyes and Ears – patient experience, receiving and analysing information back to brain and conscience (Smith & Mays, 2005) • Not Arms and Legs – doing and delivering

7. CCGs? • 211 CCGs and average 226,000 population replace • 151 PCTs with average population of 284,000 • 19 Commissioning Support Units (At April 2013) Why? • Because commissioners are the local NHS and local Social Care – there is no one else • Because somebody needs to decide what’s needed locally and how best to get it • Because someone needs to challenge existing vested interests and unresponsive services • Because one day I’ll need services too….

8. * *NHS Commissioning Board is now known as NHS England

9. 999 Call Activity - London

10. Category A (Red 1 & 2) Activity

11. Category A Performance - LAS

12. Ambulance Demand Challenges

13. The Financial Context

17. Collaboration

18. Types of CCG Collaboration e.g.

19. A collaborative model

20. National and Sub-National

21. CCG and Local

22. The National Ambulance Commissioners Group • A forum for the lead commissioners, hosted by NHS Clinical Commissioners (NHSCC) • A national expert group • No statutory or legal status • Undertakes high quality national work-streams • Contributes to National Publications e.g. “Tackling Demand Together” & the “Good Practice Guide for Ambulance Commissioning (RCGP)” • Invited to give evidence to the 2013 Health Committee on Urgent Care

24. The National Ambulance Commissioners Group • Produces national models – e.g. national ambulance contract, PbR, Clinical Indicators, HART Specification • Develops shared strategic direction ‘Achieving Integrated Unscheduled Care’ and shares technical knowledge and skills to improve their local leadership and contract management • Provides informal induction and ongoing peer support for members • Discussions are underway to enhance the role of the NACG and to formalise it’s status, so that it formally becomes the organisation that influences national commissioning direction

25. Key Points • CCGs are in the driving seat • Massive challenges ahead • NHS Ambulance Providers on their own unlikely to be able to solve all the urgent care challenges • Partnerships are likely • Relationships are key