Reverse Commissioning An Effective Process to Engage BME Communities Dr Vivienne Lyfar-Cissé MBA Chair NHS BME Network

What 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 experience The process of specifying, securing and monitoring services to meet the individuals’ needs at a strategic level

The Commissioning Process The Commissioning Process is driven by and/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 requirements Prioritise investment according to local needs, service requirements and the values of the NHS

Work collaboratively with community partners to commission services that optimise health gains and reductions in health inequalities Proactively seek and build continuous and meaningful engagement with the public and patients to shape services and improve health

1. Assessing needs: through a systematic process, understanding of the health and healthcare needs of the PCTs resident population. Commissioning Cycle

2. Reviewing services and gap analysis: reviewing the services currently provided and based on the needs, defining gaps (or over provision). Commissioning Cycle

3. 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 Commissioning Cycle

4. Risk management: understanding the key health and health care risks facing the PCT and deciding on a strategy to manage it Commissioning Cycle

5. 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) Commissioning Cycle

6. Contract implementation: put those strategic plans into action through contracting Commissioning Cycle

7. 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. Commissioning Cycle

8. Management provider performance: monitor and manage the performance of providers against their contracts, especially against KPIs. Commissioning Cycle

Question Why Reverse Commissioning? Answer The 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.

Reverse Commissioning Flagship Project Brighton and Sussex University Hospitals NHS Trust Eastern Road, Brighton, BN2 5BE Dr Vivienne Lyfar-Cissé MBA Associate Director of Development

NHSSocial Care Public Health New Structure of the NHS Department of Health (including public health England) – Overall responsibility for health, public health and social care policy Service delivery Accountability to patients, service users and the public (underpinned by the regulators and Healthwatch England) NHS Commissioning Board Public health delivery Department for Communities and Local Government Local authorities (including health and wellbeing boards) Subject to Parliamentary scrutiny Local Commissioning Group

NHS Commissioning Board

Remit to commission services to meet the needs of local communities and resources allocated accordingly

Remit to commission services to meet the needs of local communities and resources allocated accordingly

Remit to commission services to meet the needs of local communities and resources allocated accordingly Lack of evidence x

Remit to commission services to meet the needs of local communities and resources allocated accordingly Lack of evidence x

Health Professionals Engage Educate Enlighten Enhance service delivery BME Communities Enable Expert Empower Enhance patient experience Establish Reverse Commissioning Group 4 Es Model

Remit to commission services to meet the needs of local communities and resources allocated accordingly Lack of evidence x

Remit to commission services to meet the needs of local communities and resources allocated accordingly Lack of evidence x Health improvement Ethnic health equalities Health promotion

The NHS Outcomes Framework 2011/12 The focus of the Framework is on health improvement and its purpose is threefold: To provide a national level overview of how well the NHS is performing, wherever possible in an international context To provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board; and To 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.

The NHS Outcomes Framework 2011/12 1 NHS Outcomes Framework Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term conditions Domain 3 Helping people to recover from episodes of ill health or following injury Domain 4 Ensuring that people have a positive experience of care Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm Duty of quality NICE Quality Standards (building a library of approx 150 over 5 years) 2 Commissioning Outcomes Framework 3 Commissioning Guidance 4 Provide payment mechanisms Standard contract tariffCQUINQOF 5 Commissioning/Contracting NHS Commissioning Board – certain specialist services and primary care GP consortia – all other healthcare services 6

Page 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?

How Does Reverse Commissioning Work? Reverse Commissioning works by: Using existing data and evidence to identify the needs of BME communities By recognising that Health Professionals needs to be educated and trained to enhance service delivery Recognising that BME communities need to be empowered to engage with Health Professionals Recognising there is a need to establish lasting partnerships between health professionals and BME service users to effect change Using information gained from these partnerships to influence commissioning by Local Clinical Commissioning groups.

Summary 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 communities Enhanced BME patient experience Enlightened health professionals Enhanced clinical service delivery to BME people Reduction in ethnic health inequalities Health improvement for BME communities Health promotion programmes directed at BME communities Effective and lasting partnerships between health professionals and BME services users to effect change

Conclusion Effective commissioning to meet the needs of BME communities is possible if we apply the correct process