Towards informed and innovative commissioning

1. Towards informed and innovative commissioning Commissioning Workshop for Library & Knowledge Services October 2013 sue.lacey-bryant@nhs.net

2. Commissioning defined • Context • Evidence-based commissioning • Understanding the customer • Best value • How can librarians evolve to meet the need? Sue Lacey Bryant

3. The library as a platform for change • Health is a knowledge- based industry • Health is a people based industry • What more can librarians do to help? • “What more can I do to help?” Sue Lacey Bryant

4. 1. Commissioning defined “the process of allocating public resources to achieve the greatest gains in health within a defined population” Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/ Sue Lacey Bryant

5. Shift in approach to commissioning 20th Century 21stCentury Care closer to home Transformation; innovation; whole system; redesign Patient-centred Prevention; risk stratification Reduce waste; increase value Population perspective Patient as co-producer Low carbon usage • Hospital centred • Challenges met by growth • Clinician-centred • Benefits of treatment • Quality improvement • Focus on individual • Patient compliance; public & patient engagement • High carbon usage Sue Lacey Bryant

6. 2. Context: key facts The NHS in England: • Deals with over ? patients every 36 hours • Serves ? people • Employs ? staff • Budget of ? £ Billion • Av. CCG is commissioning care for ? people; • Av. CCG has been allocated ? £m in 2013-14 • Life expectancy rising • Infant mortality falling Sue Lacey Bryant

7. Key facts The NHS in England: • Deals with over 1m patients every 36 hours • Serves 53m people • Employs 1.35m staff • Budget of £95.6 billion • Av. CCG is commissioning care for 226,000 people; • Av. CCG has been allocated c £300m in 2013-14 • Life expectancy rising • Infant mortality falling Sue Lacey Bryant

8. Sue Lacey Bryant

9. 19 CSUs; 105 CCGs; 27 Area Teams

11. Where in the world are we? • NHS ranked 2ndafter Holland • 2nd patient equality & safety • Scored highly on access • Best system in terms of efficiency, effective care and cost-related problems 2010 : NHS cost £2,021 per person in UK - less than half than the £4,926 per head in US • 2nd to last for 'long, healthy, productive lives‘ • Bottom for life expectancy of patients at age 60 22.5 yrs vs24.6 in Australia • Much higher death rates from conditions amenable to medical care. In 2003 rates were 25% - 50% higher than Canada and Australia Sue Lacey Bryant

12. Platform for change • Harsh financial climate: find £20 billion efficiency savings by 2015 • Berwick report: give patients quality care every time Sue Lacey Bryant

13. Pressures • Unprecedented demand • Ageing population • more complex health needs • Increasing demand • Patient involvement • No decision about me without me Sue Lacey Bryant

14. Priorities • Stemming the increase in emergency admissions • Service reconfiguration; making the shift from hospital to community care; seamless care • Addressing inappropriate variations in clinical practice; clinical safety and quality • Improving Public Health; reducing inequalities Sue Lacey Bryant

15. Primary care at the helm • GPs manage the lion’s share of NHS medical work • High level of patient confidence and satisfaction • One year's care by a GP costs c1/10th of a day in hospital • CCGs responsible for £65 billion of the £95b commissioning budget • Increasing choice and service integration Sue Lacey Bryant

16. 3. Evidence-based commissioning “the process of allocating public resources to achieve the greatest gains in health within a defined population” Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/ Sue Lacey Bryant

17. Sue Lacey Bryant

18. Evidence based commissioning Redesigning services in the NHS can be an incredibly complex task, with differential demands for information and evidence originating from the nature of the task itself Emerging research suggests that, for redesigning and commissioning or recommissioning services, equal attention may need to be paid to both clinical and non-clinical evidence. EmmanouilGkeredakis & ClaudiaRoginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011 Sue Lacey Bryant

19. A plurality of evidence HSJ 26 May 2011 p23-25 Sue Lacey Bryant

20. Top Tips for gathering evidence • Consider the different forms of evidence needed for different tasks • Value plurality of evidence (from authoritative bodies & local knowledge) • Be proactive • Ask advice from people who have already tackled the challenge • Derived from EmmanouilGkeredakis; Claudia Roginski: • The need for clarity in evidence based commissioning. HSJ 23 May 2011 Sue Lacey Bryant

21. Pressing need for innovation “We need to radically transform the way we deliver services. Innovation is the only way we can meet these challenges” “Put simply, we must make innovation a priority. We know that the NHS can spread new ideas at pace and scale when it puts its mind to it, and we need to do more of this.” “ Innovation ... needs to be replicable – and replicated – across similar settings. So innovation is as much about applying an idea, service or product in a new context, or in a new organisation, as it is about creating something entirely new. Copying is good.” Sue Lacey Bryant

22. The value of library and knowledge services to QIPP David Nicholson. HSJ. 10 Sept 2009 Sue Lacey Bryant

23. “What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making. We need to look at how information links together to get a holistic picture of the situation.” Dr Shahid Ali, GP and Clinical Lead, Patients and Intelligence Directorate, NCB

24. 4. Understanding the customer Information services & products for commissioners Sue Lacey Bryant

25. What do commissioners ask? • How have others done it? • Data on outcomes? • Benchmarking • Data and models to support development of specifications • Key performance indicators? • Summaries Sue Lacey Bryant

26. Examples - Evidence searches • Impacting on hospital use (re)admission, Outpatient Dept, A&E, community care • GPs in A&E departments • Has anyone charged for DNAs? • Outcomes of MSK services • Service specifications inc. Community cardiology, MSK, Urgent Care • What self care tools will we need to support our new MSK Clinical Assessment & Triage services? • Predictive modelling tools • Return on Investment in telehealth/telecare • Why are our antenatal admissions so high? • Self management, decision aids • Outcomes based contracting Sue Lacey Bryant

27. “Anne carried out three targeted data searches for me to support the CCG’s three Local Priorities in its Integrated Commissioning Plan (ICP).   Rather than merely searching for relevant articles, Anne reflected on the problem areas, searched for evidence of a range of successful interventions achieved elsewhere and provided a new measurable solutions for the CCG to adopt.  This saved me time in developing the ICP and added real value and a new angle of approach.” Tim Deeprose: Interim Director of Commissioning, NHS Milton Keynes CCG, July 2013 Sue Lacey Bryant

28. What sources do commissioners value?Survey n=300 Very/quite important • Local public health intelligence • Expert advice • Examples of best practice • Local policies • Guidelines • Government pubns • Benchmarking • Cost effectiveness Not important/did not use • General published literature • Professional association guidance • Management studies • Academic research • Management consultants HSJ 26 May 2011 p23-25 Sue Lacey Bryant

29. 5. Best value Benefits – Cost Sue Lacey Bryant

30. Core offer into CCGs & CSUs? Generic/At scale offer • Horizon scanning • Tailored and targeted dissemination of evidence, by stakeholder group • Concise summaries of key policy documents • Intranet/web knowledge zone • Aligned with the strategic objectives of the organisation Sue Lacey Bryant

31. Core offer into CCGs & CSUs? Specialised services – for individuals ; for teams • Investigative research and enquiry service covering clinical & cost effectiveness; best practice”; models of service • Producing Easily read, synthesised reports ie. retrieve, select, appraise, summarise • SDI to key personnel - by profile • Supporting pathway review & service redesign • Information skills training Sue Lacey Bryant

32. Targeted alerting services • Client focus; ensuring insights into CCG agenda • national policy drivers • transforming pathways • QIPP challenge; financial balance • supporting service redesign; models of delivery • promoting best evidence • promoting tools and resources • sharing best practice to drive innovation and enable transformation Sue Lacey Bryant

33. A bang for the buck • Work to strengths: what are we really good at? • Collaborate to improve products & services? • Efficiency: at-scale delivery of back office • Understand which functions can routinely be delivered remotely? Which require engagement? • Use strengths in networking to enhance impact • Help to overcome silo mentalities • Raise our expectations; demonstrate impact • Quality = clarity and standards Reflect on service specifications and KPIs Sue Lacey Bryant

34. What does good look like? Sue Lacey Bryant

35. Benefits • Benefits: • Cost effective; • Time effective • Expertise in sourcing, selecting, summarising • Knowledge of resources • Rapid response option • Build a knowledge resource • High quality service to support both strategy & operations • Scale up across the potential customer base Sue Lacey Bryant

36. Criteria by which to assess CSS • Alignment: demonstrable commitment to achieving CCG objectives inc. high quality care • Responsive: to the individual priorities of our CCG and the population on behalf of which we commission • Agile: flexibility to support changing demands on CCG • Cost effective: value for money; added value • Innovation: sharing best practice; ‘lift & shift’ where practical • Business focus: robust arrangements to support multiple clients Sue Lacey Bryant

38. Actions speak louder than words 3 actions from this session inc. the presentation and your group discussion 1. 2. 3. Sue Lacey Bryant

39. 6. How can health librarians evolve to meet the need? Source: A visualização da imagem anterior desperta para a leitura do artigo: "Evolving Web, evolving librarian" de Amy and Robert Favini balcaodebiblioteca.blogspot.com Sue Lacey Bryant

40. Enhancing the role of librarians Role enhancement involves expanding a group of workers' skills so they can assume a wider and higher range of responsibilities through innovative and non-traditional roles Sue Lacey Bryant

41. Positioning librarians as catalysts for improvement • Aligning with NHS priorities • Bringing research, education and practice closer together • Spreading innovation • Multidisciplinary working • Changing skill mix: role substitution, role enlargement & enhancement Sue Lacey Bryant

42. Towards informed and innovative commissioning “Libraries will get you through times of no money better than money will get you through times of no libraries” Anne Herbert, writer. b1952 Sue Lacey Bryant