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Alcohol Commissioning - The role of Public Health - A view from Tower Hamlets Chris Lovitt- AD Public Health Rachael Sadegh- DAAT Joint Commissioning Manager Knowledge, Insight and Action Commissioning & Public Health 1 Overview 1. Local work on developing a strengthened Public Health role in commissioning 2. Developing a framework for commissioning 3. Prioritising areas for engagement 4. Reality 2 Strengthening local commissioning •Developing an Inner London Health Intelligence Unit - strengthen acute commissioning City and Hackney, Newham and Tower Hamlets Supported by McKinsey's interviews, research & workshops •Develop model of commissioning •Identified 6 priority areas •Focus action on priority areas to further strengthen commissioning 3 KEY PUBLIC HEALTH/ HEALTH INTELLIGENCES ACTIVITIES THAT TAKE PLACE ALONG THE COMMISSIONING PROCESS – A B Health needs assessment and strategic planning C Condition management & influencing health behaviours D Specification, contracting and procurement Performance, contract and quality management E Informatics F Public & Clinical & Partner Engagement A B • Assess needs and prioritise • Care pathway design • Condition prevention and management • Condition and risk monitoring • Patient engagement • Strategic planning C • Define contract specifications • Contract & procure • Market Management D • Quality and performance • Claims management and coding review • Treatment cost management E,F • Informatics • Public and clinical engagement 4 SIX AREAS FOR FOCUS ALONG THE COMMISSIONING PROCESS A B Health needs assessment and strategic planning C Condition management and influencing health behaviours x Priority area D Specification, contracting and procurement Performance, contract and quality management E Informatics F Public and Clinical and Partner Engagement A 1 • Assess needs and prioritise: Data driven assessment of the health needs of the population leading to agreed commissioning priorities that will improve health outcomes 2 • Care pathway design: Use clinical knowledge and experience and evidence base to develop pathways and ensure joined up approach across service lines and a common currency across London 3 • Strategic planning: Work with key strategic partners to agree commissioning priorities that will improve health outcomes; plan resource allocation over long term, map desired service configuration and provider market B 4 • Condition prevention and management: Identification and Management of high-risk groups with pro-active engagement, targeted interventions and health promotion campaigns and evidence of effectiveness • Condition and risk monitoring: Trends analysis and anticipation of predispositions to disease states by individual • Patient engagement : Effective patient registration, capturing transient populations; ensure patients understand available services and quality to inform choice; Facilitate and respond to feedback and work to improve patient experience C 5 • Define contract specifications : Specify delivery target, outcome and quality metrics in contracts; prepare tender specifications • Contract and procure: Run open and fair procurement processes, negotiate contracts and appointing high quality providers with best valuefor-money • Market Management: Ensure competitive market, and an adequate number and diversity of providers to meet London’s healthcare needs; Monitor and manage service delivery networks 6 D E,F • Quality and performance: Track and regulate performance and compliance against contracts. Monitor quality indicators; adjust or terminate contract where necessary • Informatics: Ensure effective data storage, management and availability to support commissioning • Public and clinical • Claims management engagement: and coding review: Build effective channels of Review and validate invoices; Check for clinical communication with the public coding errors in handling and clinicians to of patient episode; understand Negotiate disagreements opinion on with providers services and optimal care • Pharmaceutical/ pathways treatment cost management: Analyse activity, intervention costs and effectiveness; Create incentives for GPs and monitor compliance 5 REALITY • Health needs assessments • Integrating data from multiple local & national sources • Annual Report • NAO report • Integration with other healthy lifestyle activity • Capacity modelling • Commissioning Intentions Support •Audit of A&E alcohol related admissions • Implementation of new projects & evidence reviews • Patient pathway mapping • Valuation and outcome monitoring • Social marketing • Training • Research and publications • Representation at meetings 6 Action • • • • • • • • Overview & scrutiny review of young people & alcohol Alcohol LES Retender of Enhanced Community Alcohol Service Alcohol Social Marketing A&E diversion intervention Forthcoming alcohol NST Support visit Young People Alcohol Health Improvement Officer Alcohol Public Health Strategist 7 Knowledge, Insight and Action Commissioning & Public Health 8 Conclusion Public Health & Commissioning Together providing: Knowledge Insight Action 9 Some resources A • Assess needs and prioritise: Data driven assessment of the health needs of the population leading to agreed commissioning priorities that will improve health outcomes • http://www.empho.org.uk/Themes/ alcohol/alcohol4.aspx • http://www.alcohollearningcentre.o rg.uk/Topics/Browse/Data/ • http://www.homeoffice.gov.uk/rds/ pdfs2/dpr6.pdf • Care pathway design: Use clinical knowledge and experience and evidence base to develop pathways and ensure joined up approach across service lines and a common currency across London • http://www.alcohollearningcentre.o rg.uk/Topics/Browse/PrimaryCare/ ?parent=4608&child=4618 • http://www.sussedprofessionals.n et/node/441 • Strategic planning: Work with key strategic partners to agree commissioning priorities that will improve health outcomes; plan resource allocation over long term, map desired service configuration and provider market http://www.nao.org.uk/publications/0 708/reducing_alcohol_harm.aspx B • Condition prevention and management: Identification and Management of high-risk groups with pro-active engagement, targeted interventions and health promotion campaigns and evidence of effectiveness • Use tools such as SASQ, FAST, AUDIT C, AUDIT PC Use of tools such as SASQ, FAST, AUDIT C, AUDIT PC • Role of Primary Care http://www.emphasisnetwork.o rg.uk/events/alcoholnov2008 /presentations/donlavoie.ppt • Condition and risk monitoring: Trends analysis and anticipation of predispositions to disease states by individual • Patient engagement : Effective patient registration, capturing transient populations; ensure patients understand available services and quality to inform choice; Facilitate and respond to feedback and work to improve patient experience C • Define contract specifications : Specify delivery target, outcome and quality metrics in contracts; prepare tender specifications • Contract and procure: Run open and fair procurement processes, negotiate contracts and appointing high quality providers with best valuefor-money • Market Management: Ensure competitive market, and an adequate number and diversity of providers to meet London’s healthcare needs; Monitor and manage service delivery networks D E,F • Quality and performance: Track and regulate performance and compliance against contracts. Monitor quality indicators; adjust or terminate contract where necessary • Informatics: Ensure effective data storage, management and availability to support commissioning • Public and clinical • Claims management engagement: and coding review: Build effective channels of Review and validate invoices; Check for clinical communication with the public coding errors in handling and clinicians to of patient episode; understand Negotiate disagreements opinion on with providers services and optimal care • Pharmaceutical cost pathways management: Analyse prescribing activity, drug costs and effectiveness; Create incentives for GPs and monitor compliance