1. Reverse Commissioning An Effective Process to Engage BME Communities
Dr Vivienne Lyfar-Cissé MBA
Transitional Lead
NHS BME Network

2. Background 2004 Launch of Brighton BME Network
2007 Launch of South East Coast (SEC) BME Network
2008 SEC Race Equality Service Review

6. Background contd:- 2009 Inaugural BME Conference
2010 Launch of NHS BME Network Conference
2011 1st Anniversary Conference

7. NHS BME Network
Vision
“to be an independent and effective voice for BME staff, patients, service users and carers to ensure the NHS delivers on its statutory duties regarding race equality”

8. 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

9. 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

10. 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

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

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

13. 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

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

15. 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)

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

17. 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.

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

19. 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.

20. Ethnic Health Inequalities
General Statements
1. The incidence of CHD and diabetes is higher than average in ethnic minority groups
2. Asians are more likely than others to have worse reported health and also have long-term illness
3. Ethnic differentials in the incidence of mental health are well reported
4. Generally people from ethnic minorities have lower levels of satisfaction with health services
5. Etc Etc Etc

21. Ethnic Health Inequalities
Mental Health - Count me in census 2010
Since the inception of the Delivering Race Equality
Programme in 2005 three of the twelve goals have not
altered materially as follows:

22. Admission rates remain higher than average among some minority ethnic groups, especially Black and White./Black Mixed groups for whom rates were two or more times higher than average in 2010 (six times higher than average for the other Black group). In contrast admission rates have consistently been lower than average among the Indian and Chinese groups and about average in the Pakistani and Bangladeshi groups

23. Detention rates have almost consistently being higher than average among the Black, White/Black Caribbean Mixed and Other White groups. The rates for being placed on a CTO were higher among the South Asian and Black groups.
Although there have been annual fluctuations in seclusion rates, they have been higher than average for the Black White/Black Mixed and Other White groups, in at least three of the six censuses

24. 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

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

26. NHS Commissioning Board

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

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

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

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

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

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

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

35. Does the Evidence Exist???
Generally
Ethnic monitoring has been a legal requirement for many years

36. Specifically (Mental Health)
Mental Health Minimum Data Set (MHMDS) –the statutory data set submitted by the providers of specialist mental health services in England to the National Mental Health Development Unit (NMHDU). The data provided covers information concerning the following:

37. Individual patients
Services provided to those admitted to hospital
Community Treatment Orders
The Outcome of Care

38. Diabetes Department Inpatient Data Total Number of Patients = 775
Total Number of Patients = 775
Total Number of BME Patients = 61

39. Diabetes Department cont’d
Outpatient Data
Total Number of Patients = 7526
Total Number of BME Patients = 976

40. Diabetes Department cont’d
Percentage of Inpatient and Outpatient Data compared

41. 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.

42. The NHS Outcomes Framework 2011/12
Duty of quality 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
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
tariff
CQUIN
QOF 5
Commissioning/Contracting NHS Commissioning Board – certain specialist services and primary care GP consortia – all other healthcare services 6

43. 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?

44. What is Reverse Commissioning?
Reverse Commissioning is an effective process to engage BME communities to ensure their health needs are addressed by the NHS

45. Why Reverse Commissioning?
Reverse Commissioning is necessary because the existing commissioning process has failed to
(i) identify the needs of BME communities
(ii) effectively engage with BME communities and
(iii) reduce/eliminate ethnic health inequalities.

46. 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.

47. 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

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

49. Discussion How can we best deliver on the 4Es model?
Health Professionals
Engage
Educate
Enlighten
Enhance service delivery
BME Communities
Enable
Expert
Empower
Enhance patient experience

50. The Big Move 1st Anniversary Conference
Date: Friday 16 September 2011
Time: Hours
Venue: London Hilton Park Lane

51. Thank you