Transcript Document

Towards
informed and innovative
commissioning
Commissioning Workshop
for Library & Knowledge Services
October 2013
[email protected]
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Commissioning defined
Context
Evidence-based commissioning
Understanding the customer
Best value
How can librarians evolve to meet the need?
Sue Lacey Bryant
The library as a platform for change
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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
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
Shift in approach to commissioning
20th Century
21stCentury
• Care closer to home
• Transformation; innovation;
whole system; redesign
• Hospital centred
• Challenges met by growth
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Clinician-centred
Benefits of treatment
Quality improvement
Focus on individual
Patient compliance; public &
patient engagement
• High carbon usage
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Patient-centred
Prevention; risk stratification
Reduce waste; increase value
Population perspective
Patient as co-producer
• Low carbon usage
Sue Lacey Bryant
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
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
Sue Lacey Bryant
19 CSUs; 105 CCGs; 27 Area Teams
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 vs 24.6 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
Platform for change
• Harsh financial climate:
find £20 billion efficiency
savings by 2015
• Berwick report:
give patients quality care
every time
Sue Lacey Bryant
Pressures
• Unprecedented demand
• Ageing population
– more complex health needs
– Increasing demand
• Patient involvement
– No decision about me without me
Sue Lacey Bryant
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
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
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
Sue Lacey Bryant
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.
Emmanouil Gkeredakis & ClaudiaRoginski:
The need for clarity in evidence based commissioning. HSJ 23 May 2011
Sue Lacey Bryant
A plurality of evidence
HSJ 26 May 2011 p23-25
Sue Lacey Bryant
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 Emmanouil Gkeredakis; Claudia Roginski:
The need for clarity in evidence based commissioning. HSJ 23 May 2011
Sue Lacey Bryant
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
The value of library and knowledge
services to QIPP
David Nicholson. HSJ. 10 Sept 2009
Sue Lacey Bryant
“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
4. Understanding the customer
Information services & products for commissioners
Sue Lacey Bryant
What do commissioners ask?
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How have others done it?
Data on outcomes?
Benchmarking
Data and models to support development of
specifications
• Key performance indicators?
• Summaries
Sue Lacey Bryant
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
“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
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
5. Best value
Benefits – Cost
Sue Lacey Bryant
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
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
Targeted alerting services
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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
A bang for the buck
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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
What does good look like?
Performance area
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KPI
Timeliness
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Search reports to be delivered by…
Availability &
Responsiveness
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Routine queries to be dealt within….
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Priority queries to be dealt with
within …
Client Satisfaction
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Use baseline client survey to develop
Value for Money
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Incorporate planned efficiency of
back office functions into delivery of
service
Meeting clearly defined standards
Quality.
Q- 
Is this the sum of the
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parts? Impact?
Performance
score
Delivery of added value
Sue Lacey Bryant
Benefits
• Benefits:
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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
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
Actions speak louder than words
3 actions from this session inc. the presentation
and your group discussion
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Sue Lacey Bryant
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
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
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
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