1. Ally Robson Programme Budgeting Manager (Commissioning), NHS North of Tyne & IHS Newcastle University PBMA and Commissioning Mapping Health Expenditure against Outcome Data

2. PBMA PBMA and Commissioning

3. 1.Identify current costs of services against national Programme Budget categories for each PCT 2.Identify key outcome data to assess impact of investment against national Programme Budget Categories for each PCT 3.Map outcome data against current costs and benchmark against Peer Group 4.Use PB work as one source of information to help inform the LDP’s investment and disinvestment decisions PBMA and Commissioning Stage 3 in Detail

4. 5.Make recommendations as to which programme areas represent clear outliers with respect to expenditure and outcomes and which are, thus, worthy of further in-depth investigation

5. 6.Incorporate views of Public engagement events to identify potential areas for prioritisation from patient perspective 7.Incorporate views of PBC Groups events to identify potential areas for prioritisation from PBC perspective 8.Incorporate views of PEC to identify potential areas for prioritisation from PEC perspective PBMA and Commissioning LDP in General

6. PBMA and Commissioning 1.Original financial information extracted from the DH PB returns Financial Data for North Tyneside PCT Collection of Financial Information

7. PBMA and Commissioning 1.All outcome data collected from NCHOD atlas and NCHOD website (including QOF information) 2.Team of Public Health representatives from the three PCTs in the North of Tyne created a list of useful outcomes to be analysed 3.Example of Outcome dataExample of Outcome data Collection of Outcome Data

8. PBMA and Commissioning Boston Matrix Technique 1.Compares expenditure versus outcome 2.Each programme category falls into one of four categories 1.Low spend & poor outcome 2.Low spend & high outcome 3.High spend & high outcome 4.High spend & poor outcome 3.All categories are ‘relative to the individual PCT’s ONS cluster

12. PBMA and Commissioning 5 mile wide, but only 1inch deep What Next?... Now need to concentrate on an inch wide and 5 miles deep How?...

13. PBMA and Commissioning ‘Deep Dive’ Reviews PBMA based service redesign process 5 programme budget categories identified for deep analysis. PB categories were chosen as they were either outliers in expenditure, outcome or both.

14. Process Map Assembly of Health Outcomes Assembly of the Programm e Budget Assembly of a map of current care pathway Is the map accurate? Assembly of Patient Opinion Initiation of the Deep Dive Initial Ideas for Change Inspection by the Project Team on the feasibility of Ideas for change Stored Results Develop Public Criteria Assembly of Detailed Ideas for Change Weight Criteria Assembly of a Ideas for Change priority list Priority service changes proposed to Board Validation of priority list Is there a need to change the priority list? Assembly of updated Ideas for Change priority list No Yes Assembly of a map of desired care pathway Copyright Robson 2007

15. PBMA and Commissioning Evaluating Programme Budgeting Categories for Commissioning Case Study: Diabetes

16. Write & invite a Key Groups Assembly of the Programm e Budget Assembly of stakeholder & service user opinion Aim and Scope of Review Initial options for change Stored Results Develop Criteria (Principles) Assembly of Detailed Ideas for Change Weight Criteria (Mapping) Assembly of a Proposed model of care Model of care submitted to ECT Validation of proposed model of care Is there a need to change the model? Assembly of updated model of care No Yes Pre Event Steering Group / Project Team Follow up Event Community Provider Workshop Workshop Figure 1 Diabetes Service Review Pre Event

17. PBMA and Commissioning Why use a PBMA approach? Impact on: –Health Needs Assessment –Programme Budgeting –Patient and Public Involvement –Engagement –Service Developments Process developed brings together PB, World Class Commissioning, patient focus and evidence into one process

18. PBMA and Commissioning Inputs Deep Dive Outputs Facilitators High level champion Strong Leadership Culture to learn and change Activity aligned with managerial activity Earmarked resources for process Facilitators Real decisions have to be made Culture open to change Integrated budgets Earmarked resources for follow-up Barriers Lack of trust between stakeholders Clinicians not on board No real or perceived authority to change Lack of experience Politics trumps evidence based decisions Barriers No genuine buy-in Too many other demands Politics prevents evaluation Discontinuity of personnel

19. PBMA and Commissioning PB doesn’t give you any answers It just helps you to ask the right questions PBMA is like swimming Some people jump in the deep end Others start off paddling You choose

20. Contributors: Knowledge Transfer Partnership Group Angela Bate, Danny Ruta, Cam Donaldson, Madeleine Murtagh and Lyn Dixon Special Thanks: Jill Mitchell Head of Long Term Care Contact: alistair.robson@ncl.ac.uk PBMA and Commissioning