Meeting the Information Needs of Commissioners

1. Meeting the Information Needs of Commissioners Nick Allan-Smith Intelligence for Commissioners Programme

2. Objectives • To update and further engage Directors of Information in the Commissioning agenda • To make DIs aware of examples of local solutions (visions and plans) • To obtain views on optimal models for commissioning informatics service • To agree mechanisms for ongoing engagement

3. “Information, combined with the right support, is the key to better care, better outcomes and reduced costs.” Equity & Excellence: Liberating the NHS The Vision: Government White Paper

4. No decision without me - fundamental change in the relationship with patients Health service that is open, transparent responsive Clinical evidence - effectiveness Safety Transforming patient experience Outcomes Context

5. Clinical commissioning Based on clinical practice Focus on a patient, groups of patients and populations Focus on self care, self directed support Care pathways not described in current PbR language Procurement, contracting back room functions The CCG Narrative

6. Now part of wider NHSCB P&I Programme NHS Commissioning Board Intelligence Clinical Commissioning Groups Intelligence inc best practice Information Governance Standards and data quality Patient Intelligence Finance & Contracts Intelligence for Commissioners Programme

7. CCG Identify intelligence needs – urgent and new Input to national systems enhancement & local decision-making Develop systems & services catalogue and community of interest Links to national PHE & CSO groups CCG IfC Aims

8. Started early 2011 Clinically-led, bottom up approach June to September – identifying best practice August & September – requirements gathering. Engagement document sent to wide range of stakeholders plus workshops October - first iteration of information framework November/December – artefacts for national solutions; user-friendly requirements spec Progress to Date - CCG

9. Devolved down to practices Not real time Not connected to individual patient info Not connected to finance Often inaccurate or incomplete Difficult to engage with Focus on contract validation Traditional Information

10. Intelligence needs of CCGs Shared Patient Information visible by primary care that supports clinical practice and care pathway-based commissioning Data and intelligence aggregated from the care record Patients access to their care record Risk stratification tools

11. Intelligence needs of CCGs – continued Systems should be inter-operable between care settings to allow Commissioners to track patients through a pathway Integrated finance and activity data (inc ‘forward order book’) Information must be timely Data quality must be improved and be consistent across the country National information standards must be set and adhered to

12. A culture of open information, active responsibility and challenge to ensure patient safety is priority To make aggregate data available in a standard format to allow intermediaries to analyse and present it to patients Information Sharing

13. Providers would have clear contractual obligations, with sanctions, in relation to accuracy and timeliness of data Commissioners and providers would have to use agreed technical and data standards to promote compatibility between different systems More information about commissioning of healthcare will also improve public accountability. Information about services will be published on a commissioner basis where possible Commissioning

14. Outer North East London PCT Cluster Developed with Health Analytics, PCT-hosted 200 practices – 6 CCGs Data imported from 7 GP systems including EMIS and SystmOne NHS North of Tyne PCT Cluster In-house development with GP practice involvement from day 1 111 practices – 5 CCGs with 86 practices to follow Best Practice Examples

15. West Midlands Healthcare Commissioning Service All PCTs and about 500 practices (circa 50%) In-house development with third party tools such as BUPA Health Dialog South Central SHA Third party solution Used by all PCTs in South Central SHA Best Practice Examples

16. Commissioning Support COMMISSIONING DEVELOPMENT PROGRAMME Jill Peters Commissioning Support Design Department of Health

17. What is Commissioning Support? Setting the scene 'Commissioning support' is the support that CCGs will buy in or share with other organisations to help them carry out their commissioning functions. It does not include those things that CCGs will inevitably decide to do themselves. It is likely to be shared or bought from other CCGs, from commissioning support services, local authorities and commercial and voluntary sector bodies. “Good commissioning support will help CCGs and the NHSCB to concentrate better on the clinical and locally sensitive aspects of commissioning, and make the best use of the resources available for improving healthcare.”

18. Health Needs Assessment Developing Joint Strategic Needs Assessment (JSNA), building on collected data to forecast local health needs and identify gaps in service provision. Back office – core functions such as finance, IT systems and support, legal services, and HR that underpin the successful running of the organisation Business intelligence Information collection and analysis (eg patient activity and costs, clinical outcomes, patient experience), including using data warehouses and hubs etc. Support for redesign Developing clinical specifications and pathway design, service reviews, performance monitoring and demand management. Clinical Commissioning Groups - bringing clinical leadership, vision and accountability – have the freedom to decide whether to Communications and PPE Engaging with key stakeholders and patients, including local consultations, media/press handling and social marketing. Build/do Procurement and market management (agreeing contracts) Identifying best value providers to respond to service needs. Formal contract management, tendering and negotiation. Provider Management (monitoring contracts) Good practice provider management tools and techniques to ensure fulfilment of agreed contracts, service level standards and key performance indicators. Share Developing our approach A taxonomy for commissioning support functions CCGs are uniquely placed to deliver the clinical elements of commissioning but will be able to build, buy or share support to help deliver their functions: Buy

19. Setting the scene Why is it so difficult? Equity and Excellence: Liberating the NHS said that CCGs would have the freedom to decide which commissioning activities they do themselves and which they choose to buy in from external organisations, including local authorities, private and voluntary sector bodies. Over time a more competitive market will develop for supplying some of these services. • To establish commissioning support we need to: • Manage the transition between systems • Develop commissioning support which is fit for purpose ie that will support CCGs to deliver the new clinical model of commissioning • Retain staff • Deliver new models of support which will be affordable within running costs • Look at the right scale for delivering functions • The vision for commissioning support is • A vibrant, dynamic and innovative sector • Customer focused and flexible support that will help consortia to go the extra mile • An attractive sector where talented staff can develop real expertise and skills and have rewarding career paths

20. Developing Commissioning SupportTowards service excellence Key messages: From 1 April 2013 CCGs will be able to choose their commissioning support from wherever they like From 2013 the NHS CB will host some commissioning support to the point where it is ready to be spun off or floated out (no later than 2016) A number of services should be provided at scale to maximise economies of scale and expertise Clear timetable for the change process

21. The vision for commissioning support Developing our approach • A vibrant, dynamic and innovative service sector, which provides customer focused support and choice to CCGs and the NHSCB and helps them to go the extra mile, by supporting the local focus on improving outcomes and increasing value (outcomes per healthcare pound spent) on behalf of their population. • Commissioning support must enable CCGs to harness techniques, thinking and ways of working from other sectors in order to allow them to deliver best value, timely and evidence based commissioning decisions. In this respect commissioning support will feel different to the present approaches. It will support working differently and will enable those taking commissioning decisions to do so with accuracy and acuity by operating against best practice standards. • Commissioning support will be an attractive sector for talented staff who will be able to develop expertise and skills as they innovate and have rewarding careers.

22. Choosing commissioning support Commissioning support is likely to be drawn from a number of different service sectors: • "End-to-end", or “one stop”, commissioning support: Currently only PCTs provide the full range of services . End to end support is likely to be shared by a number of CCGs and can support, for example negotiations with major healthcare providers and commonality of services linked to clinical networks. These services will be delivered directly to CCGs and are also likely to secure specific products and scale services from other commissioning support providers. They are likely to be built on medium to long-term arrangements. • Specific products and/ or services: These activities are currently delivered by a range of providers. Products and services might be used directly by CCGs, or may be part of a wider end-to-end commissioning support service for individual or groups of CCGs. • Business support: Many activities simply support the running of organisations. Some must always be carried out by the organisation itself; others, particularly those that are highly transactional, such as paying staff, managing IT equipment may be carried out by external providers or shared with other organisations. • Commissioning Support for scale services: These are services that should be delivered for larger populations or for a large number of organisations. These functions are discussed later. • Niche services: Usually service specific support, often provided by eg voluntary organisations These activities will be able to support CCGs or the NHSCB in carrying out their statutory responsibilities.

23. Commissioning vs commissioning support This is different from the business of PCTs … • Help undertake day to day activities so allowing CCGs freedomto focus on clinical aspects • Ensure CCGs have the right information to make decisions • Provide focussed support/ SME to each stage of commissioning • Deliver efficient support service to minimise running costs • Help commissioners to innovate Commissioning • Overall accountability for commissioning (andspecifically the decision making) • Clinically led • Utilising clinical insight • Real understanding of health needs and health care Improved Quality & Outcomes/£ = value Commissioning Support

24. NHS CB role in hosting commissioning support • The NHSCB is likely to host some commissioning support functions from 2013 to no later than 2016 as 'safety net' to ensure that there are effective services available to support CCGs until they are able to procure support; • Only those services that are business viable • All hosted functions assessed against clear, open and transparent criteria by October 2012; • Where NHS commissioning support services are hosted by CCGs, then these will also be assured using the same criteria to make sure that CCGs are not taking on unacceptable risk. • From April 2013, CCGs will need to prepare to secure their commissioning support through formal procurement. • Prior to April 2013, emerging CCGs and staff in PCT Clusters will be expected to form shadow arrangements with shadow contracts and terms.

25. Commissioning support services to be delivered at scale The evidence base has shown that it makes sense to bring some functions together to generate considerable economies of scale in terms of: Quality - as volume of output increases, the quality of service increases, driven by staff being able specialise and develop high levels of expertise and greater investment in processes to support effective working. Scope – sharing knowledge between services means that bringing services together is more efficient than having multiple suppliers delivering individual services. Cost - unit costs fall as volume increases as a result of skilled staff being able to apply their skills over a greater volume of output Unit cost Volume

26. Developing our approach: making decisions about scale • Evidence and current practice allows us to estimate some of the optimal scale arrangements for some functions. Some illustrative examples to support local discussions could include: National (do once) AQP accreditation Single finance and accounting system Comparative service information and some collection Data storage and warehousing At some scale Population segmentation Procurement Standard pricing and tariffs Communications and engagement Clinical networks linked to patient groups Some aspects of medicines management* Contract negotiation Cluster level (250k-1m population) Market assessment Social marketing and market research Some aspects of local IT systems and support* Clinical leadership Local service redesign CCG (in-house) Governance Expertise to secure the best support *Some functions have aspects which need to be carried out across all levels, for example medicines management or IT. The purpose of the diagram is to help inform local discussions about which aspects of these it makes sense to carry out at any particular level. [T1]

27. Developing our approach: making decisions about scale Business intelligence services : Building on some of the excellent NHS and more commercial services that already exist across the country we will consider ways to use capacity and specialist skills more effectively whilst ensuring that customers’ needs are being met. Significant local intelligence will be required in order to take standardly good scale products and to interpret them in ways which will enhance local work. This is likely to be a network arrangement, with many staff located at all levels in the system. We have identified four function sets that we believe should be delivered at scale: Major clinical procurement: The commissioning support stocktake exercise[1] identified gaps in the capacity and capability of current contracting and procurement services. While local knowledge and clinical expertise are important, specialist skills, including the use of standardised tools to support ensuring processes are legally compliant, can be provided at scale and procurements can benefit from the support and input of an expert team. Back office functions: Work is ongoing to consider the potential for a single financial and ledger system across the whole of the commissioning architecture. It is also likely that other back office functions such as IT, estates management, HR and payroll may also benefit from a minimum specification or standard that CCGs could use to contract with the existing wide range of NHS and commercial supplier. We do not envisage a single national function for these services, but rather that a coordinated approach will be taken. Communicationsand engagement: Communications and engagement are critical commissioning support functions, some elements need to be delivered locally to be most effective. However, some aspects of these services could be organised and delivered at a national or sub-national level in order to deliver significant advantages to customers in financial and quality terms.

28. Transformation - to develop commissioning support EFFECTIVE COMMISSIONING SUPPORT FOR CCGS TO IMPROVE OUTCOMES

29. Learning Network Supporting accelerated development of commissioning support within areas recognised as leading the field Humber and North Yorkshire and York Greater Manchester Testing discrete parts of commissioning support and business models East Midlands and Nottinghamshire Staffordshire East London and City Herefordshire Outer North East London Sharing learning amongst developing commissioning support organisations Sussex South East Coast Quality Observatory

30. Work Groups – 3 Groups / 30 minutes ALL Current Activity What plans are being developed for supporting future information needs of commissioners? Group 1 Challenges What issues need to be addressed? How can the system be improved? Group 2 What is working well What best practice should be standardised? What are the features of a successful Informatics service for commissioners? Group 3 Involvement How can we support you? What involvement is needed going forward? Time allowing, please do answer the questions of other groups! All answers on ‘post-its’ please, to be placed on corresponding flipcharts Any general points to be ‘parked’