Gill Herbert, Consultancy & Development Ltd1 Domiciliary Care Workshop Waterfront Place, Chelmsford 11 October 2007

Commissioning Framework for Health & Well-being Consultation Document Dept of Health, 6 th March 2007 Gill Herbert, Consultancy & Development Ltd. March 2007

Gill Herbert, Consultancy & Development Ltd3 Key outcomes Best possible health and well-being outcomes Best possible health and well-being outcomes Best health and social care provision Best health and social care provision Achieve this within best use of available resources Achieve this within best use of available resources

Gill Herbert, Consultancy & Development Ltd4 Vision Enablement Enablement Seamless transition between services Seamless transition between services Quality, Efficiency & Value Quality, Efficiency & Value Wider range of providers & provision that is more innovative Wider range of providers & provision that is more innovative Commissioning at practice & individual level Commissioning at practice & individual level Focus on outputs & outcomes Focus on outputs & outcomes

Gill Herbert, Consultancy & Development Ltd5 Voice Easier for people to provide feed-back Easier for people to provide feed-back Effective advocacy & complaints procedures Effective advocacy & complaints procedures Innovative methods for involving local population – IDeA led Innovative methods for involving local population – IDeA led LINKs for engagement LINKs for engagement Advocacy approaches – 3 rd Sector driven Advocacy approaches – 3 rd Sector driven

Gill Herbert, Consultancy & Development Ltd6 Needs assessment Local area agreements Local area agreements Director of Public Health, Director of Public Health, Director of Adult Social Services, Director of Adult Social Services, Director of Children’s Social Services Director of Children’s Social Services lead on population needs analysis Increased use of actuarial forecasting, market segmentation & cost-benefit analysis – shared between localities Increased use of actuarial forecasting, market segmentation & cost-benefit analysis – shared between localities

Gill Herbert, Consultancy & Development Ltd7 Joined up I.T. and sharing of information Sharing between providers and commissioners Sharing between providers and commissioners Shared data-sets Shared data-sets Sharing of info between front line professionals Sharing of info between front line professionals

Gill Herbert, Consultancy & Development Ltd8 Assuring high quality providers for all services Community based 3 rd Sector may be more effective at advocacy & engagement Community based 3 rd Sector may be more effective at advocacy & engagement Commissioners to develop their providers to do this Commissioners to develop their providers to do this Commissioning for outcomes & outputs Commissioning for outcomes & outputs Better market intelligence and market mapping Better market intelligence and market mapping Ensure active choice for providers Ensure active choice for providers Fair & open procurement Fair & open procurement Distinction between grants & contracts Distinction between grants & contracts

Gill Herbert, Consultancy & Development Ltd9 And… Supplement to tariff to encourage new provision (more paid for new services) Supplement to tariff to encourage new provision (more paid for new services) Guarantees within the contract Guarantees within the contract Reducing capital investment required by provider Reducing capital investment required by provider Pump-priming for primary care providers Pump-priming for primary care providers Unbundling tariffs Unbundling tariffs Registration & monitoring Registration & monitoring

Gill Herbert, Consultancy & Development Ltd10 Developing incentives for comissioning Individual budgets, direct payments, year of care pilots Individual budgets, direct payments, year of care pilots PCTs and practice based commissioners spending NHS funds on non-health interventions & supporting better self-care PCTs and practice based commissioners spending NHS funds on non-health interventions & supporting better self-care Agreement of personalised joint health & social care plans Agreement of personalised joint health & social care plans Establishment of inter-disciplinary teams across health and social care Establishment of inter-disciplinary teams across health and social care Provide more alternatives to hospital admission Provide more alternatives to hospital admission Avoid more expensive interventions Avoid more expensive interventions

Gill Herbert, Consultancy & Development Ltd11 Flexibility in use of NHS funds to include: Purchase of respite care Purchase of respite care Supporting carers of terminally ill people to enable people to die at home Supporting carers of terminally ill people to enable people to die at home Crisis avoidance & intervention Crisis avoidance & intervention Supporting healthy lifestyles Supporting healthy lifestyles Supporting greater independence of people with LTC Supporting greater independence of people with LTC Provision of Citizens Advice, advocacy & return to work advice Provision of Citizens Advice, advocacy & return to work advice Developing practice based multi-disc, mental health resources Developing practice based multi-disc, mental health resources Developing social & practical support for isolated older people Developing social & practical support for isolated older people Anger management for children & young people Anger management for children & young people PCTs to agree appropriateness of funding (for things outside the remit of Local Authorities)

Gill Herbert, Consultancy & Development Ltd12 Incentives Pooled budgets with one lead commissioner Pooled budgets with one lead commissioner Contracts that include improvement in health and well-being whatever else they are for Contracts that include improvement in health and well-being whatever else they are for Improving access Improving access New type of performance framework based on local priorities and on outcomes – to apply across health & social care New type of performance framework based on local priorities and on outcomes – to apply across health & social care