World Class Commissioning

1. World Class Commissioning Sarah Crawley CEO ISE

2. Introduction • What is the current status of the third sector in Commissioning? • What is so different about World Class Commissioning? • The opportunities for the third sector?

3. What does third sector involvementcurrently look like? • Evaluation of National Programme for Third Sector Commissioning (Feb 08) reports • 46% of respondents were already receiving funding for the delivery of a public service BUT • Less than 20% thought that commissioners understood the contribution the third sector could make • Only 27% thought the compact had been helpful in improving working relationships • Third Sector organisations often reported that their contributions were marginalised in practice

4. Policy tells us: Gov Depts told - buy from3rd sector • Social and health care - will be characterised by wellbeing, independence, self directed support, joint commissioning for outcomes. • It is likely that services will have to be drastically reconfigured, given changing needs/ public expectations of services; personalisation and demographic changes. • In theory, all stakeholders would benefit from creating and sustaining a successful market that ensures genuine choice, quality and innovative supply. • The aim is then that: Commissioners manage and develop provider markets to meet local need in a competitive, but fair way. Commissioning is the ‘engine room’ of system reform.

5. Report of 3rd Sector Commissioning Task Force

6. Commissioning Framework for Health and Wellbeing

7. Commissioning for Health andWell Being • Third Sector mentioned 26 times! • Requirement to establish Provider forum • Need to stimulate market • Commissioning process must engage third sector

8. What’s different about WorldClass Commissioning? • Focus on Health Outcomes and Inequalities • Defines what good commissioning looks like • Professionalises commissioning • Has rigour of a national programme • Has an evidence base?

9. Locally lead the NHS Work with community partners Engage with public and patients Collaborate with clinicians Manage knowledge and assess needs Prioritise investment Stimulate the market Promote improvement and innovation Secure procurement skills Manage the local health care system Make sound financial investments Competencies

10. Competency 2 – Work collaborativelywith community partners to commissionservices which optimise health gains • “PCTs should not commission services in isolation. In addition to commissioning healthcare services, they will need to consider the wider determinants of health and the role of other partners in improving the health outcomes of their local population. Partners include local government , healthcare providers, third sector organisations and clinical partners. Working collaboratively with partners, PCTs will stimulate innovation, efficiency and better service design”

11. Competency 3 – Proactively build continuousand meaningful engagement with the public andpatients to shape services and improve health • “PCTs are responsible through the commissioning process for investing public funds on behalf of their patients and communities. PCTs will have to engage the public in a variety of ways, openly and honestly. They will need to be proactive in seeing the views and experiences of the public, patients, their carers and other stakeholders, especially those least able to act as advocates for themselves.”

12. Competency 7 – Effectively stimulate the marketto meet demand and secure required clinical and health and wellbeing outcomes • “PCTs will need to have a range of responsive providers that they can choose from. Employing their knowledge of future priorities, PCTs will use their investment power to influence improvement choice and service design through new or existing providers, effectively shaping their market. This will include building upon local social capital and encouraging provision via third sector organisations.”

13. Joint strategic needs assessment • a process that identifies current and future health and wellbeing needs in light of existing services, informs future service planning taking into account evidence of effectiveness.  • identifies 'the big picture' in terms of the health and wellbeing needs and inequalities of a local population. • is an essential tool for commissioners to inform service planning and commissioning strategies. For the purpose of JSNA, a clear distinction should be made between individual and population need. • examines aggregated assessment of need and should not be used for identifying need at the individual level. • is a tool to identify groups where needs are not being met and that are experiencing poor outcomes.'

14. JSNA will be underpinned by: • - partnership working; JSNA will be undertaken by Directors of Public Health, Adult Social Services and Children's Services working in collaboration with Directors of Commissioning • - community engagement: actively engaging with communities, patients, service users, carers, and providers including the third and private sectors to develop a full understanding of needs, with a particular focus on the views of vulnerable groups- evidence of effectiveness: identifying relevant best practice, innovation and research to inform how needs will best be met. • 'JSNA is a continuous process. All should engage with each other throughout and refine their analyses as part of this ongoing process.'

15. What does this mean for the 3rd sector? • Opportunities !!!!

16. Lots of toolkits to support us! = healthy organisations Large contracts = partnership working New ways of working Evidence base Impact measurement Risk management Good financial management Social enterprise? Mergers Accountability Competition Quality Contract management Harder for small orgs to gain access to contracts What does this mean for 3rd sector

17. What do we need to be doing? 1. Marketing and awareness raising, commissioners understand existing contribution 2. State the barriers and incentives – and then find ways to solve the issues 3. Define the risks of not engaging more with the third sector – understand your value 4. Adding value – 3rd sector and service provision 5. Adding value – 3rd sector and commissioning process

18. Explain risks of not engaging with the third sector • Breach of Compact • Lack of diversity of supply • Lack of reach • NHS – system management, rules of Competition, Co-Operation and Choice • Social capital not developed • World class commissioning – competences, outcomes

19. In the future the 3rd sector should provide.. • A wide range of diagnostic services • Rehab, falls, some beds etc • Appropriate access • Culturally sensitive services • 7 day a week service ….. • Assessment units, Primary Care, Enhanced Primary Care, Support teams, Integrated Social care, Chiropody, …..

20. Real Opportunities! • Tariff for community services – targeting hard to reach • Older peoples services [changing demographics] • Individualised budgets [direct payments] • Need for ‘Innovative’ approaches

21. ise Rubicon House Ravenhurst Street Camp Hill Birmingham B12 0HD 0121 771 1411 info@i-se.co.uk www.i-se.co.uk