1. A Commissioner’s Perspective
Annette Williamson
Programme Lead - Reducing Infant Mortality
Birmingham

2. The Commissioners’ Role
Assess health need
Consider the evidence base
Involve the public and clinicians
Design service specifications
Procure the right services
Stimulate the development of providers
Performance manage, review services

3. Commissioning Cycle

4. Considerations The commissioners are PCTs and Local Authorities
There are national targets around infant mortality
Determinants of risk are both medical and social
Partnership working with wide range of stakeholders is essential for effective commissioning
Practice based commissioning input

5. World Class Commissioning
The NHS Plan 2000: a plan for investment, a plan for reform.
Commissioning a Patient-Led NHS 2005: Shift in focus from spending to investing in health and well-being outcomes.
NHS Next Stage Review – Emphasis on Quality.
A Step Further
Raising Ambitions – New Form of Commissioning
Effective World Class Commissioning - 11 Organisational Competencies
understand the needs of their local population.
steer the local health agenda
main focus – better outcomes – adding life to years and years to life.

7. Determining the Quality of Maternity Services
Development of ‘Clinical Dashboards’ to support clinical teams
Commissioners involve clinician groups in strategic planning and service development to drive improvements in health outcomes
Use of tools and toolkits to measure the quality of care
Use information from tools to inform commissioning

8. CQUIN is one of several mechanisms for improving quality
The Commissioning for Quality and Innovation (CQUIN) framework is part of a package of measures for improving quality set out in the Next Stage Review

10. CQUIN is one of several mechanisms for improving quality
The NSR built upon existing structures to introduce some powerful new ways to improve quality. These include:
Getting the basics right eg Care Quality Commission enforcement powers, Never Events, improving measurement
Strengthening leadership eg National Quality Board, SHA Boards and Medical Directors
Improving accountability eg Quality Accounts, and developing independent quality standards
Supplementing support tools eg NHS Evidence service, Quality Observatories
CQUIN will operate alongside and reinforce these initiatives.
CQUIN will also allow commissioners to demonstrate their World Class Commissioning competencies
CQUIN will act as a vehicle to reinforce the Quality Framework, encouraging all NHS organisations to give a higher regard to quality.

11. New national choice guarantees by Dec 2009
Choice of how to access maternity care
Choice of type of antenatal care
Choice of place of birth
Home
Midwifery unit; freestanding or alongside maternity unit
Maternity team care in maternity unit
Choice of postnatal care
Also said women should have a midwife they know and trust throughout pregnancy & in postnatal period

13. Birmingham 20791 births in 2006/07 2 Foundation and 1 NHS Trust
3 Coordinating Commissioning PCTs
2 Associate PCTs
1 Local Authority
High rates of infant mortality & deprivation
Very diverse population
Variable quality of maternity services
2x less well performing Trusts
1x fair performing Trust

14. What have we done?
Perinatal Institute - data collection and needs assessment
City wide commissioning group
Develop common specification for maternity services
Develop social risk assessment tool
Develop pathways of care for social risk

15. More of what we’ve done Birmingham Health and Wellbeing Partnership
Smoking, breast feeding
Pregnancy Outreach Workers and other interventions for the very deprived, excluded, teenagers etc
Workforce plan to
Address rise in birth rate
Deliver maternity matters choice guarantee
Reduce caseload for community midwives in deprived areas

16. West Midland-wide KPIs
Quality framework for hospital trust contracts including KPIs NICE and other guidance
Booking before 12 weeks (80%)
Antenatal detection of IUGR (60%)
Smoking during pregnancy (below 15%)
Breast feeding at 6-8 weeks (2% pa ^)
Continuity of carer (75% named midwife)

17. Other challenges
Alignment and co-production - previously fragmented effort
Commissioners and providers working together to deliver better safer care
Increasing the availability of obstetricians on labour ward
Meeting antenatal screening standards
Offering choice and improving safety

18. Gaps
Absence of a nationally agreed risk assessment tool for social risk
Absence of any evidence based intervention for obesity in pregnancy
Need to develop cohesive care pathways for social risk across the city
Weak evidence base for reducing infant mortality

19. Thank you
Any questions?