Commissioning Iain Marley

Commissioning Officer – Children Commissioning Systems Development – South South Tees Clinical Commissioning Group

….and today, I’m….

The “Acceptable Face” of NHS Tees

Context – the overall picture

• 42 major contracts across NHS Tees • Majority are nationally mandated standard contracts: – NHS Standard Acute Contract - NTHFT, STHFT, Nuffield, Ramsay etc – NHS Standard Community Contract - North Tees Community Provider, MRCCS, Assura Sexual Health, Hospices etc – NHS Standard Mental Health Contract - TEWV, Alliance, MIND etc.

• Total Contract Budget of £856m • Over 200 providers • QIPP Challenge

QIPP Challenge: 2012/2013

Middlesbrough Redcar & Cleveland Total Tees Acute Services

- Planned Care - Urgent Care

Prescribing Estate and “Other” Total

£469,000 £2,000,000 £1,375,000 £1,536,000 £5,380,000 £2,000,000 £5,434,000 £1,242,000 £2,469,000

£3,269,000

£7,434,000

£10,557,000

£2,617,000

£5,031,000

£420,000 £1,956,000

£2,946,000

£9,096,000 £14,476,000

£21,803,000

Contract Negotiation Constraints

• 12/13 Affordability versus Forecast Outturn activity/cost • SHA/DH expectations – Operating Framework requirements must be negotiated in to contracts – Deadlines for contract signature • FAILURE TO AGREE WITH PROVIDERS WILL RESULT IN NOT HAVING A SIGNED

CONTRACT AND CCGS AFFECTED WON’T ACHIEVE AUTHORISATION

• Clinicians views are not necessarily the organisation’s views • Payment by Results (PBR) – It is in the Foundation Trusts (FTs) interests to grow their business – Commissioners are immediately on the back foot once a patient enters “the system” – “Patient Pinball” • FTs will exploit Primary Care’s inability to manage demand • “It is what it is” – a negotiation: we don’t get everything we want!

Contract Negotiation Constraints

• Delayed publication of Operating Framework and Standard National Contracts • Lack of evidence based, clinically credible proposals resisted as unsafe/high risk to FTs • New services/changes to pathways – “Pilot Vs. Procurement” • Overall impact of Commissioning Intentions: – Don’t do anything which may increase overall costs – Consider system wide impacts on other stakeholders, e.g. Social Care

Timetable

Meanwhile, back in the land of Clinical Commissioning…

• NHS Hartlepool and Stockton on Tees

Clinical Commissioning Group

– Hartlepool CCG – Stockton-On-Tees CCG • South Tees Clinical Commissioning Group – Middlesbrough CCG – Redcar and Cleveland CCG – Greater Eston CCG

Clinical Commissioning Agenda

• Still in process of formation – Structures – Leadership – Priorities • Heavy Authorisation Process • Wide Agenda – CAMHS IS part of it – we do have clinical engagement!

CAMHS Priorities

• Earlier intervention in CYPs Emotional Health and Well-being • Shifting resources upstream through 2 priorities: – CAMHS service transformation (TEWV CAMHS contract – changing the core service to deliver accessible, community based services) – Developing Tier 1 and 2 services • Co-ordinating commissioning across Tees • Developing/increasing the capacity of the broader delivery system – schools, VCOs

Progress to date

• Strategic CAMHS Stakeholder Group – meets monthly - LA rep, GPs, Head Teacher and VSO rep – increased commitment to CYP’s MH • Strategic Tees-wide Plan - response to NST review, needs assessment - mapping of ‘tier 2’ services • TEWV CAMHS Performance dashboard - using new Info management system in TEWV • Service transformation funding agreed….

• BOND – capacity building in early intervention MH third sector services

Aims

• Aim to drive down T3 referrals - increase earlier intervention, and increase capacity within other services through consultation, training and shared, co-ordinated pathways • Potential non-recurring - £0.5m – fund increased activity and development at tier 2 – embed workforce plan for sustaining new service model – manage risk/existing demand at tier 3/4 • £200k ring-fenced for third sector sub contracting – to extend good practice in pathway development and increase access for vulnerable groups

Why now?

• Funding window – speedy action required • NHS capacity to drive change through

commissioning

• Financial climate – mitigate impact of early intervention cuts • BOND – building interest and momentum – Schools – interest in funding services – Improving quality of VCS/alternative providers – Identifying and sharing models of good practice

Next steps…

• Strengthen LA/NHS commissioning – co-ordinating/joint commissioning for LAC, VSO etc – commissioning with/by schools for early intervention support in schools • Develop outcomes framework - for CYPs MH services Tier 1 – 3 – as a basis for commissioning • Develop core TEWV offer/spec • Commission training programme from CAMHS for T1 and 2 service providers as part of service transformation