1. How will the DfE report shape the future of specialised AAC provision?

2.  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.

3.  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.

4. 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

5. 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

6. 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

7. Regionally Dual national and regional role - turning ‘strategy to reality’ Support and advice to Area Teams on contract negotiations and provider relationships Provide support and advice on clinical service areas through Programme of Care Leads & Clinical Reference Groups Act as the regional link to the Strategic Clinical Networks and Clinical Senates Ensure diffusion of innovation and good practice

8. Locally Ten Areas Teams will: 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: 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

9. 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

11. 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.

13. Presentation to SCI APPG 20th March 2013

14. 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)

15. Useful Links Web link for specialised commissioning and key documents http://www.england.nhs.uk/resources/spec-comm- resources/ http://www.england.nhs.uk/ourwork/d-com/spec- serv/crg/

16.  Clive Thursfield (Chair) Clinical Scientist  Sally Chan Speech and Language Therapist / College of Speech and Language Therapy  Judith De Ste Croix Speech and Language Therapist  Anna Reeves Teacher  Gary Derwent Occupational Therapist  Cathy Harris Speech Therapist / Communication Matters

17. 1. Cumbria, Northumberland, Tyne and Wear 2. South Yorkshire and Bassetlaw 3. Cheshire, Warrington and Wirral 4. East Anglia 5. Leicestershire and Lincolnshire 6. Birmingham and the Black Country 7. Bristol, North Somerset, Somerset and South Gloucestershire 8. Wessex 9. Surrey and Sussex 10. London

18. 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

19. This service is commissioned by the NHS CB because: the number of patients requiring the services is small (about one patient registered at each GP practice requires access to the service); the cost of the service is high because of the specialist equipment involved; the number of doctors and other expert staff trained to deliver the service is small; and the cost of treating some patients is high, placing a potential financial risk on individual CCGs.

20. 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.

21. Scope Specification Information Rules Prescribed Services approved by ministers in September 2011 Developed Mar –Nov 12 Consultation-Dec 12-Jan 13 Aug – Nov 2012

22. 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

23. 2013/14 is a preparatory year as national commissioning / prescribed services mature.

24.  Further work to understand any ‘convergence’ impacts from specialist AAC going from locally commissioned to consistently nationally commissioned.  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.

25. 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.

26.  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.

27. 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.

28.  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.

29. 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.