7NHS BME NetworkVision“to be an independent and effective voice for BME staff, patients, service users and carers to ensure the NHS delivers on its statutory duties regarding race equality”
8What is Commissioning? Several Definitions: The act of committing finite resources to evidence based interventions particularly, but not limited to the health and social sectors with the aim of improving health, reducing inequalities and enhancing patient experienceThe process of specifying, securing and monitoring services to meet the individuals’ needs at a strategic level
9The Commissioning Process The Commissioning Process is driven byand/or dependent on the need to:Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirementsPrioritise investment according to local needs, service requirements and the values of the NHS
10Work collaboratively with community partners to commission services that optimise health gains and reductions in health inequalitiesProactively seek and build continuous and meaningful engagement with the public and patients to shape services and improve health
11Commissioning Cycle1. Assessing needs: through a systematic process, understanding of the health and healthcare needs of the PCTs resident population.
12Commissioning Cycle2. Reviewing services and gap analysis: reviewing the services currently provided and based on the needs, defining gaps (or over provision).
13Commissioning Cycle3. Deciding priorities: given a list of desirable actions using available evidence of cost effectiveness and based on a robust and defensible ethnical framework, prioritise areas for purchase
14Commissioning Cycle4. Risk management: understanding the key health and health care risks facing the PCT and deciding on a strategy to manage it
15Commissioning Cycle5. Strategic options: bring together all the available information into a single strategic commissioning plan that outlines how the PCTs will deliver its core objectives (including those of the SHA and DH)
16Commissioning Cycle6. Contract implementation: put those strategic plans into action through contracting
17Commissioning Cycle7. Provider development (including care pathway re-design and demand management): support provider improvements or introduce new providers to deliver the services required (including setting up demand management systems and designing new care pathways). This includes supporting providers in decommissioning of services where appropriate.
18Commissioning Cycle8. Management provider performance: monitor and manage the performance of providers against their contracts, especially against KPIs.
19QuestionWhy Reverse Commissioning?AnswerThe commissioning process has (in the main) failed to identify the health needs and effectively engage our BME communities. Consequently, ethnic health inequalities remains a major problem for BME people.
20Ethnic Health Inequalities General Statements1. The incidence of CHD and diabetes is higher than average in ethnic minority groups2. Asians are more likely than others to have worse reported health and also have long-term illness3. Ethnic differentials in the incidence of mental health are well reported4. Generally people from ethnic minorities have lower levels of satisfaction with health services5. Etc Etc Etc
21Ethnic Health Inequalities Mental Health - Count me in census 2010Since the inception of the Delivering Race EqualityProgramme in 2005 three of the twelve goals have notaltered materially as follows:
22Admission rates remain higher than average among some minority ethnic groups, especially Black and White./Black Mixed groups for whom rates were two or more times higher than average in 2010 (six times higher than average for the other Black group). In contrast admission rates have consistently been lower than average among the Indian and Chinese groups and about average in the Pakistani and Bangladeshi groups
23Detention rates have almost consistently being higher than average among the Black, White/Black Caribbean Mixed and Other White groups. The rates for being placed on a CTO were higher among the South Asian and Black groups.Although there have been annual fluctuations in seclusion rates, they have been higher than average for the Black White/Black Mixed and Other White groups, in at least three of the six censuses
24Reverse Commissioning Flagship Project Brighton and Sussex University Hospitals NHS TrustEastern Road, Brighton, BN2 5BEDr Vivienne Lyfar-Cissé MBAAssociate Director of Development
25New Structure of the NHS Department of Health (including public health England) – Overall responsibility for health, public health and social care policyDepartment for Communities and Local GovernmentPublic health deliveryNHSSocial CarePublic HealthNHS Commissioning BoardLocal authorities (including health and wellbeing boards)Local Commissioning GroupService deliveryAccountability to patients, service users and the public (underpinned by the regulators and Healthwatch England)Subject to Parliamentary scrutiny
27Remit to commission services to meet the needs of local communities and resources allocated accordingly
28Remit to commission services to meet the needs of local communities and resources allocated accordingly
29x Remit to commission services to meet the needs of local communities and resources allocated accordinglyxLack of evidence
30x Remit to commission services to meet the needs of local communities and resources allocated accordinglyxLack of evidence
31Establish Reverse Commissioning Group 4 Es ModelHealth ProfessionalsEngageEducateEnlightenEnhance service deliveryBME CommunitiesEnableExpertEmpowerEnhance patient experienceEstablish Reverse Commissioning Group
32x Remit to commission services to meet the needs of local communities and resources allocated accordinglyxLack of evidence
33x Remit to commission services to meet the needs of local communities and resources allocated accordinglyHealth promotionEthnic health equalitiesHealth improvementxLack of evidence
35Does the Evidence Exist??? GenerallyEthnic monitoring has been a legal requirement for many years
36Specifically (Mental Health) Mental Health Minimum Data Set (MHMDS) –the statutory data set submitted by the providers of specialist mental health services in England to the National Mental Health Development Unit (NMHDU). The data provided covers information concerning the following:
37Individual patientsServices provided to those admitted to hospitalCommunity Treatment OrdersThe Outcome of Care
38Diabetes Department Inpatient Data Total Number of Patients = 775 Total Number of Patients = 775Total Number of BME Patients = 61
39Diabetes Department cont’d Outpatient DataTotal Number of Patients = 7526Total Number of BME Patients = 976
40Diabetes Department cont’d Percentage of Inpatient and Outpatient Data compared
41The NHS Outcomes Framework 2011/12 The focus of the Framework is on health improvement and itspurpose is threefold:To provide a national level overview of how well the NHS is performing, wherever possible in an international contextTo provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board; andTo act as a catalyst for driving quality improvement and outcome measurement throughout the NHS encouraging change in culture and behaviour, including a renewed focus on tackling inequalities in outcomes.
42The NHS Outcomes Framework 2011/12 Duty of quality1NHS Outcomes FrameworkDomain 1 Preventing people from dying prematurelyDomain 2 Enhancing quality of life for people with long-term conditionsDomain 3 Helping people to recover from episodes of ill health or following injuryDomain 4 Ensuring that people have a positive experience of careDomain 5 Treating and caring for people in a safe environment and protecting them from avoidable harmNICE Quality Standards (building a library of approx 150 over 5 years)2Commissioning Outcomes Framework3Commissioning Guidance4Provide payment mechanismsStandard contracttariffCQUINQOF5Commissioning/Contracting NHS Commissioning Board – certain specialist services and primary care GP consortia – all other healthcare services6
43Page 42-The NHS Outcomes Framework 2011/12 “The Department of Health has made tackling health inequalities a priority and it is also under a legal obligation to promote equality across the equality strands protected in the Equality Act There is therefore both a legal requirement and a principle in designing the NHS Outcomes Framework that its induction will not cause any group to be disadvantaged. We have used the equalities and inequalities breakdowns to assess data availability in order to monitor this commitment. Date collection is more complete for some of the strands than others; for example, there is better coverage (questions are asked as standard and patients provide the information) for age and gender than for religion or belief and sexual orientation”.Our question - What about ethnicity?
44What is Reverse Commissioning? Reverse Commissioning is an effective process to engage BME communities to ensure their health needs are addressed by the NHS
45Why Reverse Commissioning? Reverse Commissioning is necessary because the existing commissioning process has failed to(i) identify the needs of BME communities(ii) effectively engage with BME communities and(iii) reduce/eliminate ethnic health inequalities.
46How Does Reverse Commissioning Work? Reverse Commissioning works by:Using existing data and evidence to identify the needs of BME communitiesBy recognising that Health Professionals needs to be educated and trained to enhance service deliveryRecognising that BME communities need to be empowered to engage with Health ProfessionalsRecognising there is a need to establish lasting partnerships between health professionals and BME service users to effect changeUsing information gained from these partnerships to influence commissioning by Local Clinical Commissioning groups.
47Summary cont’d: What are the Desired Outcomes of Reverse Commissioning? The desired outcomes of reverse commissioning are as follows:Clinical services that meet the needs of BME communitiesEnhanced BME patient experienceEnlightened health professionalsEnhanced clinical service delivery to BME peopleReduction in ethnic health inequalitiesHealth improvement for BME communitiesHealth promotion programmes directed at BME communitiesEffective and lasting partnerships between health professionals and BME services users to effect change
48ConclusionEffective commissioning to meet the needs of BME communities is possible if we apply the correct process
49Discussion How can we best deliver on the 4Es model? Health ProfessionalsEngageEducateEnlightenEnhance service deliveryBME CommunitiesEnableExpertEmpowerEnhance patient experience
50The Big Move 1st Anniversary Conference Date: Friday 16 September 2011Time: HoursVenue: London Hilton Park Lane