1. www.england.nhs.uk Commissioning for Paediatric Surgical Services Commissioner Overview Julia Grace, Regional Programme of Care Lead Accountable Commissioner For: Neonatal Critical Care; Paediatric Critical Care, Paediatric Medicine and Congenital Heart Services 19 th November 2014

2. www.england.nhs.uk Since 1st April 2013..... Commissioning landscape : 212 clinical commissioning groups (CCGs) Local Authorities Public Health England NHS England - direct commissioning responsibility Primary Care Public Health and Screening Armed Forces Health Offender Health Specialised Commissioning

3. www.england.nhs.uk NHS England Board Direct Commissioning Committee Clinical Priorities Advisory Group Specialised Commissioning Oversight Group Women & Children's Programme of Care Board Cancer & Blood Programme of Care Board Internal Medicine Programme of Care Board Mental Health Programme of Care Board Trauma Programme of Care Board CRGs

4. Paediatric Medicine Paediatric Neurosciences Metabolic disorders Paediatric Surgery Specialised Commissioning Oversight Group Paediatric Cancer Services Paediatric Cardiac Services Complex Gynaecology Specialised Maternity Paediatric Intensive Care Medical Genetics Fetal Medicine Internal Medicine Neonatal Critical Care Trauma Blood and Cancer Mental Health Women and Children Multi-system disorder

5. www.england.nhs.uk Commissioning Products  SERVICE SPECIFICATIONS  CLINICAL COMMISSIONING POLICIES  QUALITY DASHBOARDS  CQUINS  QIPP  5 YEAR STRATEGY

6. www.england.nhs.uk Service Specifications SpecificationWork Programme Status Beckwith-Wiedmann Syndrome with Macroglossia Unchanged – Paused until 2015 Bladder ExstrophyFor discussion with Centres Complex Tracheal DiseaseDraft specification to be shared with relevant CRG’s for comment Craniofacial Draft specification being reviewed by RDAG Paediatric Surgery (& surgical pathology, anaesthetics and pain) To be revised in 2015 incorporating Transition and Paediatric Medicine Spec’s – Paused until 2015 Paediatric Surgery – Chronic PainPaused until 2015 Paediatric Surgery – NeonatesAs for Paediatric Surgery – Paused until 2015

7. www.england.nhs.uk Commissioning Products Derogation High level results published on the POC page http://www.england.nhs.uk/wp-content/uploads/2014/10/derogations-women- children-040614.pdf CRG to sense check information Ongoing work with Providers and AT Commissioners – provider derogations completed before 1/4/2015 Commissioner Derogations – working with Providers

8. www.england.nhs.uk QIPP Challenging financial gap for specialised Discussions at CRG level Enhanced Recovery – standardisation of pathways for electives – minimisation of LOS Procedures of limited clinical value – reducing variation Review of specialised procedures before trim point POC QIPP Workshop

9. www.england.nhs.uk Commissioning Products CQUINS Currently in development for 2015/16 Fewer CQUINS Challenge – applicable for all units Stretch Targets Link to QIPP Derogation = non eligibility Commissioner driven

10. www.england.nhs.uk Strategy Commissioning Intentions Published http://www.england.nhs.uk/wp- content/uploads/2014/10/comms-intents-2015-16.pdfhttp://www.england.nhs.uk/wp- content/uploads/2014/10/comms-intents-2015-16.pdf Prices Convergence to most efficient quartile costs No payments above mandatory tariffs Services Moving In and Out Out – Wheelchair services Renal dialysis & morbid obesity (pending) In – Some specialist adult heamatology services

11. www.england.nhs.uk Strategy Co-commissioning – models being developed Prime Contractor Model Opportunities Strategic Service Reviews – Derogation New Prioritisation Process (28/10/14) Clinical Utilisation Reviews Patient in the optimal setting Provider derogations – fully compliant before 1/4/15

12. www.england.nhs.uk Strategy Five Year Forward View Radical Upgrade to Prevention & Public Health Action: Demand, Efficiency and Funding National action on obesity, smoking, alcohol and other major health risks Promote employee health and reduce sickness related unemployment Improved partnerships with voluntary organisations and local communities Shared health and social care budgets

13. www.england.nhs.uk Strategy Five Year Forward View Break down barriers between health care providers, GP, Secondary, Specialists & acute and mental health Integrated out of hospital care : “multispecialty community provider” “primary and acute care systems” Integrated emergency and urgent care More support for frail elderly people in care homes Greater investment in primary care More GP training places Raising the game on health technology Test Bed and Green Field Sites

14. www.england.nhs.uk Still Lots to Do!! NHS England – Organisational Alignment and Capability Programme Consultation on the proposed structures Effective From 1 April 2015 QUESTIONS ?