Commissioning post the Health and Social Care Act, 2012

1. Commissioning post the Health and Social Care Act, 2012 Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham

2. The Health and Social Care Act in a nutshell The Health and Social Care Bill puts clinicians at the centre of commissioning, frees up providers to innovate, empowers patients and gives a new focus to public health. Arguably the most radical shake up of the NHS since its inception and unequivocally the most extensive reorganisation of the structure of the NHS to date

3. Case for change Rising demand and treatment costs Need for improvement State of the public finances

4. Key legislative changes Clinically led commissioning Provider regulation to support innovative services Greater voice for patients New focus for public health Greater accountability locally and nationally Streamlined armslength bodies

5. The new NHS commissioning system The focus of new commissioning system is AccountabilityandOutcomes Clinical Commissioning Groups (CCGs) are the new statutory (accountable) bodies for most commissioning - Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are abolished NHS England holds CCGs to account and is accountable for other commissioning (e.g. Primary Care and specialist services) Various other national bodies are being developed as well as Public Health moving to Local Authorities and Public Health England CCGs will have £25 per head of population to spend on their organisations (we call this commissioning support) CCGs have to balance how they spend this – In house staff / purchased from a CSS / shared

6. What’s happening in London…

7. There are 32 emerging CCGs in London, who will need to demonstrate they have robust commissioning support in place Enfield Barnet Harrow Haringey Waltham Forest Hillingdon Brent Redbridge City & Hackney Camden Camden Islington Ealing Havering Newham Barking & Dagenham Hammersmith & Fulham Central London Tower Hamlets West London Commissioning Hounslow South- wark Richmond Greenwich Wandsworth Lambeth Lewisham Bexley Kingston Merton Bromley Sutton Croydon Wave 1 – 3 CCGs Wave 2 – 15 CCGs Wave 3 – 11 CCGs Wave 4 – 3 CCGs 7

8. The 2013 NHS will be genuinely different • CCGs will be small, light, clinicalcommissioning organisations • CSUs will be vitalto getting CCGs up and running and critical to the success of the commissioning system overall • Hosted by NHS England • 23 CSUs in England, 3 in London • CSUs are funded by CCG income and by income from other customers NHS England Account-ability CCG CSU Services What type of organisation is a Commissioning Support Unit?

9. Three CSUs are taking shape in London North Central and East London North West London South London

10. The South London CSU Story so far • SLCSU is developed from CCG views • SLCSU is designed to give CCGs benefit of local services and the benefits of working at a larger scale to centralise expertise • £30m+ organisation, c300 staff, all 12 CCGs will purchase core services

11. Development of South London Clinical Commissioning Groups • Well prepared for the transition • Started on 1st April • First board meetings taking place

12. What’s it really like…. Stressful! People are applying for new jobs or their old ones £20 billion of NHS efficiency savings required nationally. Large LA budget reductions In Lewisham GPs are increasingly becoming more on board with changing referral patterns. Less lone operators, more group think and peer pressure. There is still the tendency to think like providers rather than commissioners…

13. Lewisham Joint Mental Health Commissioning • 2 posts transferring to the CCG. One part funded by the LA • c.£90m budget • Covering: • Adult Mental Health – for health and social care • IAPT service • NHS Specialist services • NHS Forensic services • Mental Health of Older Adults – for health and social care • Dementia services – for health and social care • Adult Mental Health Voluntary sector – for health and social care • £4.5m health savings and £600k LA savings required from 2011/12 – 2013/14. More savings to come….

14. Some positives to savings! The scale of efficiency savings make it imperative to do things differently – real radical change is required E.g. Closed a two 16 bedded specialist Continuing Healthcare Unit and reinvested £1.6m of recurring money into our Dementia pathway with £370k taken as QIPP Commissioned a 3 month Forensic triage model which has diverted 75% of people away from Medium Secure Units and saved £1.3m to commissioning budgets Commissioned a support planning and brokerage service to support people to use their Individual Budgets Commissioned local secondary care ASD and ADHD diagnosis and treatment clinics rather than using specialist services

15. How can the you influence the health and social care agenda Lobbying CCGs and Health and Wellbeing Boards Support commissioners in their role – not just GPs Identify gaps in provision Share best practice Share evidenced based practice Give ideas for efficiency savings – support whole system transformation Improve public awareness and engagement Influence big decision makers