Dr Nick Harding's second presentation at "SWB Connect", an event held in West Bromwich, 28th June 2012.

1. Sandwell and West Birmingham CCG
Our approach to commissioning
Dr Nick Harding
MBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)
26th June 2012
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2. Our health priorities
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3. Our health needs
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4. Our health needs
Health without boundaries - November 2011 4

5. A wide range of services available to
commission from
Complex range of providers for
healthcare:
Hospitals
Heart of England (3 hospitals),
University Hospitals Birmingham, Sandwell West
Birmingham, Birmingham Children’s Hospital, Royal
Orthopaedic, Birmingham Women’s Hospital and
Birmingham Dental Hospital
Birmingham
Specialist
Birmingham and Solihull Mental Health Trust
Community
Birmingham Community Healthcare
Acute & Urgent
West Midlands Ambulance Service; Range of
urgent care, walk-in and other providers – Assura,
Care UK etc
Third Sector – a wide range of provision e.g.
over 40+ alcohol/drug dependency services
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6. RCRH Comms and Engagement
Chair and
RCRH Partnership Board Rep
Birmingham Birmingham
Black
Sandwell and City Council and Solihull
Country NHS Black Sandwell
Cluster Country Metropolitan West NHS Cluster
(Sandwell Partnership Borough Birmingham (Heart of
PCT) (NHS) Trust Council Hospitals Trust Birmingham
tPCT)
Birmingham Birmingham
Community and Solihull
Healthcare NHS Mental Health
Trust Trust (BSMHT)
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7. Our strategic priorities
► Instigate – intervening early to prevent problems before
they occur
► Integrate – putting the patient at the centre of their care
► Innovate – changing the way we do things to deliver more
with less
► Improve – focusing on the quality and safety of services in
all parts of the system
► Influence – playing a full role in local partnerships,
affecting the determinants of health
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8. Our plans are to:
► Increase the capacity and capability of primary care, using it as
a foundation for system change
► Focus on the frail elderly, supporting independence and dignity
in old age
► Accelerate the Right Care Right Here programme - providing
care in the community and treating hospitals as specialist
providers
► Treat mental ill health and promote wellbeing, viewing good
mental health as a precondition to better physical health
► Work in partnership to improve maternity and early years,
giving every child the best start in life
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10. Our quality priorities
Our priority How we monitor this
Safety Population health is improving
Effectiveness Treatments are effective
Population is satisfied with their
Patient experience
treatments
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11. Continuously improving quality
Build feedback and
Annual
improvement into
Quality and
annual commissioning
Safety Plan
intentions
Monitor effective delivery of quality and safe care through :
information at Quality & Safety Committee,
Local Commissioning Groups feedback
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12. How we will ensure high quality in
Primary Care
► We want to be able to use information in a way that continuously
improves services – as close to ‘real time’ as possible
► Our plan is to use same data as before – but in a smarter, more
user friendly way so you can react more quickly to feedback – we
can control this
► Reflected in improvements in GP dashboard
► National GP quality dashboard
► If we get the information reporting right at practice level, this will
make the job easier and create a more accurate bigger picture
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14. Getting the best out of services - diabetes
Patients
•Regular follow up
•Easy physical
access
•Close to home
SWB CCG
•Managed care •Patients
•Professional opinion managed safely
•Costs covered •Upstream
interventions
•Value for money
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15. End of life – from pilot to rollout 2012/13
►Award winning pilot with experience-led commissioning
– patients driving the process
Range of events to inform strategy development
e.g. Planning Alternative Tomorrows with Hope (PATH)
stakeholder event (55) to agree shared vision for end of life care;
review of all existing strategies, documentation and initiatives;
public health and service cost data and statistics pulled together;
two experience co-design events held with third sector; one to
one filmed interviews with front line professionals, managers and
people living with dying and carers transcribed by University of
Oxford for emerging themes
►Strategy co-created with patients, carers and stakeholders
►Our strategy:
“in three years time, 90% of people will
die in a place they choose.”
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16. End of life –CCG rollout 2012/13
5 improvement workstreams have been established February
2012 supported by 2 underpinning foundation programmes:
► Theme 1 Tell my story – helping people to articulate
end of life to be
► Theme 2 Hospice everywhere
► Theme 3 24:7 coordinated care
► Theme 4 Keeping carers well
► Theme 5 Compassionate communities – changing the
culture towards dying
Programme team established with wide range of clinicians,
commissioners, carers, third sector delivering the workstreams to
achieve improvements – with shared ownership.
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17. Maternity and Children’s Strategic Model of Care
Experienced clinical group developed vision for Maternity and
Newborn Services – October 2009:
►120,000 women aged 15 to 44 in catchment area
►Share epidemiological and economic characteristics such as high
levels of deprivation
►Issues: High levels of still births and infant mortality compared to
England and Wales average
►Strong evidence impact quality maternity services can make to
improve health and well being of teenagers and their babies
increasing number of children on path to success
►Teenage pregnancy is a key issue in Sandwell and West
Birmingham
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18. So who will overview new world
Commissioners: Providers
National
NHS Commissioning Provider • Support &
Board Development develop
Authority
• Set maximum
prices
• Maintain
Overview and Monitor continuity of
Scrutiny care
Committees
• Quality
CQC • Safety
HealthWatch
Any Willing Provider
Foundation Trusts
Private Sector
3rd Sector
Primary Care 18

19. The RATAR model
• Access to a Referral, Assessment, Treatment,
Advice and Recovery model through a single
point.
• Provision of Care Closer to Home
• A service based on outcomes with patients,
families and carers at the heart
• Integrated Care Pathways
• Collaborative Care
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20. • The CCG will have as a priority the ongoing
commissioning and further development of
mental health and well being services.
• Developments will focus on an integrated
mental health service and the development of
Primary Care mental health and wellbeing in
the community to meet the needs of the
population.
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21. Some successes already
► Reduction in A&E attendance by 6%
► Promotion of effective medicines management
► Good examples of GPs working together
► Defining agreed patient experience standards
► End of life pilot - being rolled out across CCG
► Dermatology – reductions in hospital attendances
► Improved access – radiography available in community
► Award winning patient consultation processes
► Approval to go for first wave authorisation…
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22. How we currently invest in secondary
healthcare
Provider BSOL Sandwell Total
£000's £000's £000’s
SWBH 77,936 157,260 235196
BSMHT 23,724 1,443 25,167
BCPFT 230 33,915 34,145
Birmingham 634 5,065 5,699
Children’s
SCHS 8,804 34,553 43,357
BCHS 27,409 3,628 31,037
TOTAL 374,601
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23. How we work with other CCGs
► Leadership /advice – clinical senate?
► Clinical leads for commissioning for contracts?
► Nominated contract leads – how this will work:
“hosted by a CCG but ensuring those CCGs with
‘significant interests’ are represented around the
discussion table’ e.g. urgent care, BCHC
► Health and Well-being boards – shared strategy for
city
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24. Quality Priorities 2012/13
• Developed draft CCG Quality and Safety Plan – out for
consultation to members (issue 2) www.swbcg.link ]
• Putting quality into all our contracts – ensuring we are
commissioning for quality e.g. alcohol CQUIN
• Monitoring delivery of quality and safety through
Quality and Safety Committee and formal Clinical
Quality Reviews (e.g. meetings, reviewing
incidents/never events, visits)
• Provider development
• Primary Care development
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25. Thank you
► Have learned a great deal already and much
to build on
► Remain committed to what its all
about….patients and quality of care
► Committed to working with the third sector,
patients, carers to develop together the best
healthcare Questions?
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27. 12 months on…
 Shared vision and strategy - We have an integrated
plan which has involved all health and local authority
partners
 Shared way of working through the Compact - for
shared leadership across the NHS and local authorities
 Resources - Good progress has been made - a
coordinated structure was established pooling the
resources of four PCTs
 Results so far - Delivery is good - moving from forecast
£50.5m deficit to £2m planned surplus; key quality and
performance targets achieved
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28. Integrated Plan
 Greater push on transformation and delivering
improvements
 Greater emphasis on quality and improving
primary care
 Supporting development of future organisations
 More integrated working
→ specialised service pathways and joined up services
→ Councils working with health on care for older people
 Financial planning - Still heading off increasing
financial pressures for years ahead
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29. Brief
• Support the Frail Elderly Programme
Signed off by CEO Compact
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30. Patient/Clinician Journey
Dr S Mr/s D
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31. A constitution – why?
Clear and comprehensive constitutions – to ensure effective
structures, strong governance systems and good relationships
with practices.
►Describes our statutory responsibilities as a commissioning body
►Set out who and how you can be a member, how to leave
►Our internal structures
►Our Elections and appointment processes, and removal from office
►How we can demonstrate transparency in how our decisions are taken
►Accountability to our patients, the wider local community, local council
and health and well being board
►Engagement with our membership, the wider profession
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32. The journey to authorisation
► Approval to go for first wave authorisation
► What we need to demonstrate:
→ Examples of how member practices are involved in decision
making within the CCG/LCG
→ How we work together - constitution
→ Election process – competency and
representation
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33. New NHS Parliament
Key:
Accountability Department of
Funding Health
Right Care Right
Here partnership
NHS Commissioning Monitor CQC
Board Licensing
Providers
SWB CCG Contracts
BSMHT, BCP, BCHC,
SWBH
Partnership
Local Authorities
Other providers BCH,
Local HealthWatch BWH, ROH, DGH, RW,
SWB, WM, and I/C.
Birmingham HealthWatch
Patients & Public
Sandwell HealthWatch 33

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