Transcript Presentation heading - Communication Matters

How will the DfE report shape the
future of specialised AAC provision?

Backdrop –
Audience with widely different understanding of
structure of national commissioning.
 Understanding a very new situation that is not fully
formed as yet.

Overview of National arrangements
 Overview of Regional and local arrangement
 Overview of Clinical Reference Group (CRG)
 AAC sub group of CRG
 (Local) Area Teams (AT’s)
 Relationship of DfE report to CRG and AT’s
 The way forward.
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 Complex
situation.
 There is some repetition for clarity.
 Presentation is a combination of NHS England
and DfE AAC project
 Answer as many questions as possible today.
 Any questions that can not be answered
today will be addressed by NHS England
(Rachel O’Connor and Carolyn Young and
posted on the Communication Matters web
site.
Overview of NHS Commissioning Board
The NHS Commissioning Board will:
1. commission primary care health services
2. commission specialised prescribed services, armed forces, offender
health and highly specialised services.
3. be nationally accountable for the outcomes achieved by the NHS, and
provide leadership for the new commissioning system.
Specialised services will account for over £11.8bn – or 10% - of the entire
NHS budget from 2013-14
What will this mean from 2013?
The NHS CB will deliver high quality specialised services:
 Nationally: setting the priorities to ensure consistency across
specialised services
 Regionally: ensuring consistency locally and delivering national
strategic direction
 Locally: contract management and managing local relationships
through 10 Area Teams
Nationally
The Operations Directorate and Medical Directorate will be responsible for
specialised commissioning within the NHS CB, the core functions will:
 ensure consistency and set the national direction
 develop clinical and patient-led national clinical strategies and
commissioning products - through 75 Clinical Reference Groups organised in 5
national Programmes of Care
 co-ordinate the transition to a single function
 prioritise what will be commissioned and determine the criteria/standards
 be the source of expert advice to the NHS CB and other stakeholders on
specialised commissioning
Regionally
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Dual national and regional role - turning ‘strategy to reality’
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Support and advice to Area Teams on contract negotiations and
provider relationships
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Provide support and advice on clinical service areas through
Programme of Care Leads & Clinical Reference Groups
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Act as the regional link to the Strategic Clinical Networks and
Clinical Senates
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Ensure diffusion of innovation and good practice
Locally
Ten Areas Teams will:
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contract and performance management of activity, products, implementation
and compliance of service specifications
hold a single NHS CB contract with providers in their area for all specialised
services (including Highly Specialised)
be responsible for oversight of time-limited derogation from the national
service specifications where required by local services
All Area Teams will:
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lead on local delivery of national standards and policies and contracting
be the hub for local knowledge ensuring local expertise on services, and
strong relationships with local stakeholders
deliver integration in patient pathways with CCGs and other commissioning
bodies
ensure local engagement and communication with Clinical Senates,
Strategic Clinical Networks, Operational Delivery Networks and providers
Background
Specialised Services Clinical Reference Groups (CRGs)
have been established to cover the full range of specialised
services defined within the Specialised Services National
Definition Set (SSNDS) portfolio.
CRGs aim to ensure clinical and patient led
development and delivery of commissioning products
for the national commissioning of prescribed services by
NHS England. The CRGs will be the key delivery
mechanism for the development and assurance of
specialised services contracts products during 2013/14
required for 2014/15 contracts and beyond.
Each CRG has an identified ‘core’ set of products to
develop in 2013/14 with a defined timeline for completion
CRG Roles and Responsibilities
In summary generic role
 Provide expert advice and guidance to develop and shape
products.
Communication with wider professional groups and senates
you represent.
Actively participate in the development and completion of
specialised services contracts products during 2013/14
within the agreed timeline, ready for 2014/15 contract
inclusion.
Work with the team in horizon scanning, identifying and
short-listing potential innovations within the relevant service
area, utilising a predefined prioritisation matrix.
Presentation to SCI APPG 20th March 2013
Work Programme 2013/14
In April/May 2013 Clinical Reference Groups are developing their
work programme for 13/14.
Areas will include:
 core: commissioning 'product' development (service
specifications, tariff, innovation)
 strategic: network implementation
 legacy: on-going projects in development or planned in previous
Specialised Commissioning Group structure.
Trauma Programme of Care Board will consider resources required,
prioritise areas for year one completion and assign project leads
(i.e. CRG, local area teams, Regional PoC Leads)
Useful Links
• Web link for specialised commissioning and key
documents
http://www.england.nhs.uk/resources/spec-commresources/
http://www.england.nhs.uk/ourwork/d-com/specserv/crg/
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Clive Thursfield (Chair)
Clinical Scientist

Sally Chan
Speech and Language Therapist / College of Speech and
Language Therapy
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Judith De Ste Croix
Speech and Language Therapist

Anna Reeves
Teacher

Gary Derwent
Occupational Therapist

Cathy Harris
Speech Therapist / Communication Matters
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Cumbria, Northumberland, Tyne and Wear
South Yorkshire and Bassetlaw
Cheshire, Warrington and Wirral
East Anglia
Leicestershire and Lincolnshire
Birmingham and the Black Country
Bristol, North Somerset, Somerset and South
Gloucestershire
Wessex
Surrey and Sussex
London
Starting point - previous Specialised Services National Definition Sets
(SSNDS) and consideration of four factors below
‘Prescribed’ specialised services are those services which have been
‘tested’ against the four factors in the Health and Social Care Act
2012 as suitable for commissioning by the NHS CB.
The four factors are:
• The number of individuals who require the provision of the service
or facility;
• The cost of providing the service of facility;
• The number of persons able to provide the service or facility; and
• The financial implications for Clinical Commissioning Groups (CCGs) if
they were required to arrange for the provision of the service or
facility
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This service is commissioned by the NHS CB because:
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the number of patients requiring the services is small
(about one patient registered at each GP practice
requires access to the service);
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the cost of the service is high because of the
specialist equipment involved;
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the number of doctors and other expert staff trained
to deliver the service is small; and
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the cost of treating some patients is high, placing a
potential financial risk on individual CCGs.
The NHS Commissioning Board (NHS CB) commissions services for
patients that require specialist assessment for AAC :
 Where there is a severe/complex communication difficulty
associated with a range of physical and/or cognitive, learning and
sensory deficits.
 Where goals are achieved by the input of a multi-disciplinary team
to include speech and language therapists, clinical scientists,
occupational therapists and education professionals (as a minimum),
with specific competencies and access to a wide range of specialist
equipment.
 Where individuals require multiple assistive technologies, integrated
into a single means of access and functionality (for example
communication, environmental control, computer access and/or
powered wheelchair control)
 Where communication solutions are dependent upon special
engineering and adaptation.
Clinical Commissioning Groups (CCGs) commission AAC aids for those
patients who do not meet the criteria for specialist AAC aids.
Scope
Prescribed
Services approved
by ministers in
September 2011
Specification
Developed Mar –Nov 12
Consultation-Dec 12-Jan
13
Information
Rules
Aug – Nov 2012
The DfE report and AAC subgroup are aware of challenges
with the identification of activity for specialised AAC.
• Mix of providers both NHS and Non-NHS.
• Complex ways of defining what is specialist and different
currencies / ways of contracting or lack of them.
• Producing fine detailed descriptions to distinguish specialist
and non specialist provision, equipment types (person not
aid).
• Variations in historically commissioning responsibility (NHS
(local and regional), Education, private, charitable funding.
• Application of IR may not have identified baselines from
the education sector activity
2013/14 is a preparatory year as
national commissioning /
prescribed services mature.
 Further
work to understand any ‘convergence’
impacts from specialist AAC going from locally
commissioned to consistently nationally
commissioned.
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Convergence Impacts to review include;
 Review of actual baseline compared to national
suggested baselines
 Consider growth, un-meet need, technological
advances, demographic changes
 Provider landscape
 Implementation impact of specification.
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Working with Area Teams to gather
information on baselines and the 13/14
identified providers by IR.
– Based on historical activity
In quarters 1 and 2 working with Area
Teams to review any convergence gaps,
if there is a financial gap, then referred
to CPAG.
The DfE AAC report will be a key
document in providing information and
data to pool with existing data sources.
 ATs
will receive feedback from providers as
to the current level of compliance with the
service specification.
 On-going iteration of service specification for
next year- core and developmental standards
and outcome measures.
 Regions and Area Teams Work towards
compliance with specification and review of
providers.
 Development of further products; CQUIN,
Productivity, further information coding
improvements.
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CRG will utilise the whole of the DfE report and
consider areas that may need including in the work
programme that are relevant to the scope of the
services that the CRG covers- core product and
strategic work.
 CRG
will now work to review the baseline
and any convergence impacts.
 this
will be working with DfE
mapping data to compare with
other information streams and
estimation of need and financial
impacts.

Meeting between Rachel O’Connor , Carolyn
Young and Chair of AAC sub group being
arranged.
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Seeking clarification as to the Providers which
the AAC Scope applies to, who have identified
this with their local area team through the IR
exercise.
This information has been requested by Rachel
O’Connor to inform the future work of the CRG
Contact details of all AT’s will be available in
the next week.
Initial meeting to look at the DfE mapping data
being arranged.
CRG will review the report, and ensure it is
considered as part of the work programme for
13/14 .