Planning Commissioning Performance Management Andrew McCormick 14 June 2006

Frederick Douglas If there is no struggle there is no progress... Power concedes nothing without a demand. It never did and it never will

Progress on RPA... Trust Legislation Trust Legislation CE Designate of HSSA CE Designate of HSSA Trust Chairs Trust Chairs Trust CEs – adverts out Trust CEs – adverts out Road shows – 4 so far, positive feedback Road shows – 4 so far, positive feedback Primary Legislation – instructions end June Primary Legislation – instructions end June

Never mind the RPA, wheres the Service...? 12 months is far too long 12 months is far too long 34 weeks from referral to treatment 34 weeks from referral to treatment A&E standards are just not acceptable A&E standards are just not acceptable More chronic disease management is essential – but wont save money More chronic disease management is essential – but wont save money Care for the vulnerable old and young Care for the vulnerable old and young Health and well being, not just services Health and well being, not just services STRUCTURES MUST DELIVER THIS!

The Reform Triangle Choice/ Commissioning Performance Management Funding based on Outcomes

Overarching Themes Leadership Commitment Leadership Commitment Quality Culture Quality Culture Clarity of Focus Clarity of Focus Professional/Physician Engagement Professional/Physician Engagement Empowerment Empowerment Approach to Continuous Improvement Approach to Continuous Improvement Use of Data Use of Data

The New HPSS Distinguishes procurement from provision Distinguishes procurement from provision Works with human nature, not against it Works with human nature, not against it the super-ego and the ego the super-ego and the ego –commissioning based on public sector values the super-ego: comprehensive, local, free and fair the super-ego: comprehensive, local, free and fair –provision based on entrepreneurialism the ego: my organisation, customers and reward the ego: my organisation, customers and reward –an external market fitness for purpose is the only requirement – we do what delivers fitness for purpose is the only requirement – we do what delivers

Performance Management Smaller numbers of core targets – a dashboard Smaller numbers of core targets – a dashboard In the context of standards framework – systematic use of NSFs In the context of standards framework – systematic use of NSFs Mandatory compliance – incentives and sanctions Mandatory compliance – incentives and sanctions Balanced scorecard approach Balanced scorecard approach access, responsiveness, outcomes, financial management, quality access, responsiveness, outcomes, financial management, quality

Performance Management

Payment by Results Marginal costs Marginal costs –minimal impact of doing one more (or less) Full costs Full costs –exaggerated impact of doing one more (or less) Radical mechanism Radical mechanism –..too radical could bankrupt the system Too acute-centric Too acute-centric –could we drive up acute activity at the expense of primary care THE ANSWER IS YES BUT... We create OUR system to address these problems and also...

Commissioning Rules... assessment of the health and social care status of the population assessment of the health and social care status of the population service frameworks service frameworks service realities service realities specific contracts for service provision (single or multiple to be decided) specific contracts for service provision (single or multiple to be decided) monitoring of compliance monitoring of compliance Sanctions Sanctions plurality and choice in providers and enhancing contestability plurality and choice in providers and enhancing contestability

Key Challenges Early start to the new LCGs Early start to the new LCGs Changing the balance of power Changing the balance of power Integration Integration Whole life, whole person Whole life, whole person Balance of regional and local commissioning Balance of regional and local commissioning

Emerging Proposals for Membership 1 x Chief Commissioning Officer for the locality 1 x Chief Commissioning Officer for the locality 5 x professional officers of the Authority including 2 social services representatives and others from public health, nursing and Allied/Community Health representatives 5 x professional officers of the Authority including 2 social services representatives and others from public health, nursing and Allied/Community Health representatives 4 x GPs 4 x GPs 3 x other Independent Contractors 3 x other Independent Contractors

Roles for LCGs Four distinct roles: targeted improvements in the health status and social wellbeing of the population targeted improvements in the health status and social wellbeing of the population Commissioning health, social and care services to meet the populations needs, and strategic targets and standards set by the Department and Authority - CONTESTABILITY Commissioning health, social and care services to meet the populations needs, and strategic targets and standards set by the Department and Authority - CONTESTABILITY Securing the delivery of cost-effective service to meet presenting demand; and Securing the delivery of cost-effective service to meet presenting demand; and Overseeing the development of practice-based commissioning Overseeing the development of practice-based commissioning

Through this we create... Strong centrally driven adherence to targets and standards Strong centrally driven adherence to targets and standards Performance improvements through financial incentives and contestability Performance improvements through financial incentives and contestability Strong local commissioning always looking to make before buying Strong local commissioning always looking to make before buying

…[decision makers] … must be allowed to contest provision and commission from different sources where they believe it to be in the interests of the user. The independent treatment centres; diagnostic centres; … the expertise of both the voluntary sector and the private sector. Then, the money needs to follow these choices. This is the spur for improvement. Tony Blair 6 June 2006