Commissioning High Quality Stroke Services

1. EALING Primary Care Trust North West London Cardiac & Stroke Network Commissioning High Quality Stroke Services Peter Kottlar Joint Head of Older People Commissioning and Lead for Stroke Services Ealing PCT & NW London Cardiac and Stroke Network 20th March 2009

2. History of Commissioning in NHS • 1991 introduction of ‘purchasing’ • Aim: separating the interest of those receiving healthcare from those supplying them • 1990s: GP fund-holding move to Primary Care Groups (PCGs) • 2001: Primary Care Trusts (PCTs) created

3. What is Commissioning? • Process of ensuring health and care services provided most effectively meet the needs of the population   • Roles of PCTs • the advocate for patients; and • the custodian of taxpayers’ money

4. Objectives of Commissioning • Improve health and wellbeing and reduce health inequalities • Improve quality, effectiveness and efficiency • Increase choice and responsiveness • Develop comprehensive services • Achieving best value within available resources

5. Commissioning Cycle Review Services Decide Priorities Needs Assessment PATIENTS and PUBLIC Design services Seeking patient views Capacity Planning Managing performance Shaping Structure of Supply

6. COMMISSIONING: Strategic Planning Stage NEEDS ASSESSMENT • Public Health data • Other statistics/data • identify unmet need? REVIEW SERVICES • Service Mapping • Gap analysis • Identify service improvements DECIDE PRIORITIES • Development of strategic plan • Resources/Budgeting • Involve users and carers

7. COMMISSIONING: Service Procurement Stage DESIGN SERVICES • Development of service model • Involve service users and carers CAPACITY PLANNING, DEMAND MANAGEMENT • Development of strategies for care and resource utilisation • PCT develop service specification, PIs • Support & encourage providers to develop services • Invite NHS/private/3rd sector providers SHAPING STRUCTURE OF SUPPLY

8. COMMISSIONING: Monitoring & Evaluation Stage MANAGING PERFORMANCE • Ensure agreed targets are met • Review patient set goals • Develop improvement plans SEEKING PATIENT/ PUBLIC VIEWS • Patient outcomes & experiences • Informs commissioning actions

9. Commissioning Cycle Review Services Decide Priorities Needs Assessment PATIENTS and PUBLIC Design services Seeking patient views Capacity Planning Managing performance Shaping Structure of Supply

10. World Class Commissioning ‘WCC will deliver a more strategic and longer-term approach to commissioning services, with a focus on improving health outcomes’Commissioning Assurance Handbook, 2008

11. World Class Commissioning VISION ASSURANCE SYSTEM WORLD CLASS COMMISSIONING COMPETENCIES DEVELOPMENT FRAMEWORK

12. World Class Commissioning VISION ‘Adding life to years and years to life’ Better health and well-being for all, better care for all, and better value for all.

13. World Class Commissioning COMPETENCIES 6 Stimulate the market 1 Locally lead the NHS 7 Promote improvement and innovation 2 Engage with public/patients 8 Secure procurement skills 3 Collaborate with clinicians 9 Secure procurement skills 4 Manage knowledge /assess needs 10 Manage the local health system 5 Prioritise investment 11 Make sound financial investments

14. World Class Commissioning ASSURANCE SYSTEM PURPOSE: to understand whether PCTs are improving as commissioners of better health outcomes PCT are assessed by NHS London across three elements: Rate of improvement OUTCOMES Level 1 - 4 COMPETENCIES R A G GOVERNANCE

15. World Class Commissioning DEVELOPMENT FRAMEWORK BOARD DEVELOPMENT FRAMEWORK FOR PROCURING EXTERNAL SUPPORT FOR COMMISSIONERS

16. World Class Commissioning “The aim of world class commissioning,and therefore the ultimate test of its success,will be an improvement in health outcomes and a reduction in health inequalities” Commissioning Assurance Handbook, 2008

17. References • Health Reform in England: Update on Commissioning Framework– Department of Health, 2006 • World Class Commissioning, Department of Health, 2007 http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm • Commissioning Specialised Services, Department of Health, 2007, http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Commissioningspecialisedservices/index.htm

19. WORLD CLASS COMMISSIONING COMPETENCIES 1 Locally lead the NHS SKILLS PROCESS AND KNOWEDGE REQUIREMENTS OUTPUTS

20. WORLD CLASS COMMISSIONING COMPETENCIES Locally lead the NHS 1 • SKILLS (sub-components) • Listens to partner NHS organisations and other providers • Signals future priorities of the local NHS • Has good presentation and influencing skills, e.g. in reputation management • Has good organisational development skills • PROCESS AND KNOWEDGE REQUIREMENTS • Able to articulate vision of NHS, fair personal, effective and safe • Is skilled in engagement & involvement methods • Understands own the strengths and weaknesses, and develops its competence • OUTPUTS • Clear Communication policy on reports, findings, commissioning plan • Strong interaction with other organisations • Good understanding of reputation management

21. WORLD CLASS COMMISSIONING COMPETENCIES Locally lead the NHS 1 Level 4 Level 3 • Key stakeholders strongly agree that the • PCT is the local leader • of the NHS • The PCT actively • participates in and • leads the local health • agenda, effectively • participating in • multi-agency and NHS • wide agendas • The local population • strongly agree that the • local NHS is improving • services Level 2 • Key stakeholders agree that the PCT is the local leader of the NHS • The PCT actively • participates in and • leads the local health agenda • The local population • agree that the local • NHS is improving • services Level 1 • Key stakeholders • somewhat agree that PCT is the local leader of NHS • PCT has an • understanding of its • current and intended reputation, with • strategies in place to address this Does not meet Level 2 requirements