A single commissioning model for the organ donation and transplantation pathway – what are the pros and cons? Keith Rigg

‘Commissioning is the planning and purchasing of NHS services to meet the health needs of a local population.’ ‘Commissioning is the process of planning, agreeing and monitoring services.‘ ‘Securing the highest quality healthcare services to meet the identified needs of a population within available resources.’

Commissioning ≠ Funding

What is the current model? What might a single commissioning model look like? What are the pros and cons? What is the likelihood?

What is the current model?

Organ Donation Organ Retrieval commissioned by NHSBT as the OPO Funded by grant in aid from four UK health departments Transplantation Kidney – commissioned and funded by specialised commissioning in each UK country Other organs – commissioned by specialised commissioning in England & Scotland as appropriate; funded by specialised commissioning in recipient country of origin

Patient and organ Post-op care Organ retrieval Process by Retrieval Team 1.Tissue typing 2.Liaison with national database 3.DBD – clinical management on ventilator 4.SN-OD overall co-ordination SN-OD liaises With family/ Coroner, alerts team and observes due process Clinician Alerts SN-OD Retrieval Team arrive Retrieval Team called Organ(s) retrieved Organ(s) transported to Receiving centre Organ(s) transplanted into recipient(s) Direct Funding Via NHSBT Contract with NHSBT Contract With NHSBT NHS England Generic Patient Pathway – Organ Donation After Circulatory Death (DCD) or Brain Death (DBD) Patient pathway Commissioning pathway Consent is given

What is the current model? Organ Donation Organ Retrieval commissioned by NHSBT as the OPO Funded by grant in aid from four UK health departments Transplantation Kidney – commissioned and funded by specialised commissioning in each UK country Other organs – commissioned by specialised commissioning in England & Scotland as appropriate; funded by specialised commissioning in recipient country of origin

What might a single commissioning model look like?

Provisos Which parts of the organ donation pathway would be included within the commissioning by a single body? Commissioning model would depend on host organisation Funding from four health departments and four specialised commissioners A single organisation commissioning organ donation and transplantation across UK

What are the pros and cons?

Pros Single point of contact for whole organ donation and transplant pathway Commissioners would have a greater understanding of the synergies of the pathway Potential for lighter touch outcome based commissioning Savings realised could be reinvested elsewhere in the pathway

Cons Increases in funding would have to be negotiated with up to four health departments and four specialised commissioners. Risk that overspend in one part of the pathway mean savings have to be made in another part of the pathway Willingness of any one organisation to take on this role on behalf of four countries Potential disconnect with wider NHS

Options NHSBT commissions organ donation and transplantation across the UK NHS England (or other commissioner) commissions OD&T on behalf of other three specialised commissioners Co-commissioning by NHSBT and NHS England (or other commissioner) New organisation commissions OD&T OD&T commissioned separately in each UK country

What is the likelihood?

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How can synergies be improved? Quarterly NHSBT/NHSE meetings Closer links between NHSBT and relevant CRGs – Service specifications and other commissioning products – Centre specific reports – Peer review Shared approach to TOT 2020 and LD2020 strategies