Commissioning for Value A programme to help CCGs identify value opportunities and improve healthcare for their populations September 2013

2 Commissioning for Value is about identifying priority programmes which offer the best opportunities to improve healthcare for your populations; improving the value that patients receive from their healthcare and improving the value that populations receive from investment in their local health system. Commissioning for Value – September 2013 What is Commissioning for Value? “ Value in any field must be defined around the customer, not the supplier. Value must also be measured by outputs, not inputs. Hence it is patient health results that matter, not the volume of services delivered. But results are achieved at some cost. Therefore, the proper objective is… patient health outcomes relative to the total cost (inputs). Efficiency, then, is subsumed in the concept of value. ” Source: Porter ME. (2008). What is Value in Health Care? Harvard Business School. “ Value in any field must be defined around the customer, not the supplier. Value must also be measured by outputs, not inputs. Hence it is patient health results that matter, not the volume of services delivered. But results are achieved at some cost. Therefore, the proper objective is… patient health outcomes relative to the total cost (inputs). Efficiency, then, is subsumed in the concept of value. ” Source: Porter ME. (2008). What is Value in Health Care? Harvard Business School.

3Commissioning for Value – September 2013 What is Commissioning for Value? In his Dear Colleague letter to the NHS of 10 October – Planning for a sustainable NHS, Sir David Nicholson set out ten key points to support planning for a sustainable NHS. The letter included information about the ‘Commissioning for Value’ packs for CCGs to help you identify where there is greatest opportunity to improve outcomes. Planning for a sustainable NHS The packs aim to help identify real opportunities for improvement of outcomes and to increase value for local populations. The localised information will support discussions about prioritising areas for change, utilising resources and will help you as local leaders make improvements in healthcare quality, outcomes and efficiency. They are also the first product CCGs will receive as part of the new planning round for commissioners - a vital part of NHS England’s ‘Call to Action’ where everyone is being encouraged to take an active part in ensuring a sustainable future for the NHS.

The Commissioning for Value approach begins with a review of indicative data to highlight the top priorities (opportunities) for transformation and improvement. This is achieved using Programme Budgeting Marginal Analysis and Spend and Outcome data to highlight those clinical programmes where the health economy is an outlier and therefore will be most likely to yield the most improvements to clinical pathways and policies. The approach - where to look...using indicative data 4

Commissioning for Value – September QualitySpend Direction of Travel Bespoke Commissioning for Value insights packs CCGs By mid-October, we will deliver bespoke Commissioning for Value packs to all 211 CCGs, with an offer of follow-up events and support. These packs will have triangulated data for the top Programme Budget Categories by spend for your population and will suggest priority programme areas which offer the best value opportunity for service improvements

Commissioning for Value How will using this pack benefit my population? Achieved Turnaround (Warrington CCG - Winner of HSJ Commissioning Organisation of the Year 2012) Financial sustainability (West Cheshire CCG - Winner of HSJ Commissioning Organisation of the Year 2010) Clinically led annual QIPP planning and delivery (Borough of Wigan) Clinical Leaders driving change (Vale of York CCG) Galvanising commissioners in a growing number of health economies (20+ CCGs and growing) CCGs can and are using the “Right Care approach” to shift spend Year 1 – “Came from behind” - Implemented system mid year Year 2 – “Delivered as went along” - Began at year start, achieved by end Year 3 – “Planned ahead” - Began before year start, over-achieved Year 4 – “Ahead of the curve” - 20% of QIPP delivered by start Year 5 – Increased focus on Quality! Achieving financial stability in West Cheshire It’s not just about money - Right Care in West Cheshire led to real quality improvements in just one annual cycle -A&E attends & admissions, Elective & Non- elective activity, OP Firsts and – -Follow-ups – all decreased - Outcomes & Quality – improved - Integration occurred across health sectors and with social care Enabled by, for example : - Medicines administration training to care homes - Personalised care plans (LTC) - Community endoscopy, optometry, ophthalmology, neurology & pain management pathways - MRI Scanner Direct Access

Constant clinical focus on improving quality and outcomes Significant engagement from constituent practices Involvement of the wider clinical community in commissioning Domain 1 A strong clinical and multi- professional focus System-wide strategic planning Evidence based operational planning Effective delivery of the plan Domain 3 Clear and credible planning and delivery CCG is clinically led and properly constituted with the right governance arrangements Delivers statutory functions efficiently, effectively and economically Procures high quality support as required to meet the business needs Domain 4 Robust governance arrangements The use of these packs and the approach described can help CCGs develop the strategic commissioning skills necessary for delivering quality care today and transforming services for tomorrow, as outlined in the following 3 of the 6 assurance domains: How will using this pack help my CCG Development 7

8 understand what the insight packs are telling you about your population health outcomes how to use the insights in the packs to direct your improvement efforts learn from early adopters who have successfully used this approach to deliver results get face to face support in surgeries where your insight packs can be discussed on an individual, CCG basis network with commissioning support services who can help you to move forward The presentation for these events are now online at: To support CCGs in making use of the insight packs, two follow-up events were organised for CCGs and their partners. The events were designed to: Commissioning for Value 2013 Two follow-up events for CCGs…

9 The Right Care website will offers a new Resource Centre to support CCGs including: Online videos and ‘how to’ guides Theme based Webinars Case studies with learning from previous pilots Tried and tested process templates to support taking the approach forward Advice on how to produce level 2 packs locally, within the CCG or working with local intelligence services NHS England will also be publishing further material to help commissioners navigate their way through the planning process, including detailed planning guidance and financial allocations. You will be able to find out more about this in the CCG bulletin and on the NHS England website.NHS England website Commissioning for Value Other resources to help get the most our of Commissioning for Value