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S116: Commissioning for outcomes

EXPO: Pop-up university session

Paul & John

Tuesday 4th March 2014

Room 1

Who are we?

Dr Paul Husselbee

(Clinical lead, NHS

Southend CCG)

Dr Paul Husselbee

(Clinical lead, NHS

Southend CCG)

John Stewart

(Director Outcomes

Framework, NHS

England)

John Stewart

(Director Outcomes

Framework, NHS

England)

Co Chairs: NHS CA Quality Working GroupCo Chairs: NHS CA Quality Working Group

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‘Come together’ in the next hour

Ensuring high

quality care for all

– now and for future

generations

Ensuring high

quality care for all

– now and for future

generations

Outcomes-

based approach

Outcomes-

based approach

Your input! Insights,

challenges, ideas…

Your input! Insights,

challenges, ideas…

1

2

1. Commissioners 1. Commissioners

2. Providers 2. Providers

3. Community & Vol. sector3. Community & Vol. sector

Who do we

have in the

room today ?

4. Patient / Public (inc rep bodies)4. Patient / Public (inc rep bodies)

5. Private sector5. Private sector

6. Other6. Other

OUR SURVEY SAYS…

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Your role for the next hour: sit in Paul’s seat and ‘Drive

my car’

‘Imagine’ you are now a chair of ‘anytown’ ccg…

Older demographic

High prevalence of LTCs

Higher levels of deprivation

A CCG economy…A CCG economy… …forecast to go bust over next 5 years …forecast to go bust over next 5 years

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…you lead a CCG board planning meeting: ‘Help!’

It starts badly…It starts badly… …and gets worse!…and gets worse!

Local providers have each written

to the CCG requiring more funding

to keep their services going

‘Save our local hospital’

campaigners storm the meeting

…start again with a free ‘ticket to ride’

So what are you

going to do now?!!!

We will return to

this scenario later!

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Good commissioners tell us to always keep it simple: What are you trying to achieve?

‘We can work it out’

1. More doctors & nurses1. More doctors & nurses

2. A magic pill that solves all 2. A magic pill that solves all

3. Clinically effective care3. Clinically effective care

What do the public really

want from their NHS?

(You can vote for two)

4. A hospital within 10miles4. A hospital within 10miles

5. A safe and positive experience5. A safe and positive experience

6. Their money back6. Their money back

OUR SURVEY SAYS…

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‘Please Please me’: High quality care for all

Prevents

premature mortality

Prevents

premature mortality

Enhances your

Quality of lifeEnhances your

Quality of life

Helps you recoverfollowing ill health or

injury

Helps you recoverfollowing ill health or

injury

Provides a positive

Experience as

possible

Provides a positive

Experience as

possible

Safe: protects

you from avoidable

harm

Safe: protects

you from avoidable

harm

Person-centred carePerson-centred care

1. Run out of money1. Run out of money

2. Ageing population 2. Ageing population

3. Lack of personal responsibility3. Lack of personal responsibility

What’s the biggest

challenge facing the NHS

over the next 5 years?

(Vote for only one)

4. Decline of public trust in NHS4. Decline of public trust in NHS

5. Politicians / media5. Politicians / media

6. Others?….6. Others?….

OUR SURVEY SAYS…

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A real challenge ‘when I’m 64’ (+1)

Increasing demand

on resources

Increasing demand

on resources

Tight fiscal

environment

Tight fiscal

environment

Rising public

expectations

Rising public

expectations

View from the 211 Clinical

Commissioning Groups

View from the 211 Clinical

Commissioning Groups

Not just the ‘money (that’s what I want)’

Incremental changeIncremental change Transformational changeTransformational change

Can we deliver better for less through…Can we deliver better for less through…

‘We want a better diabetes service’: shift

resources to this priority

‘We want a better diabetes service’: shift

resources to this priority

‘We want to enhance quality of life for people

with LTC’: open up resources for this priority

‘We want to enhance quality of life for people

with LTC’: open up resources for this priority

Hospital

introduces new

consultant led

service

GPs introduce

targeted testing

A better diabetes service for the

public

Personal

budgets to

spend on own

care

Enhanced quality of life for people

with LTCs

Lead providers

partner with

local services to

provide whole

care solutions

Local

communities

co-designing &

co-producing

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Ok, so what can we all learn from good commissioners?

‘How do you do it?’

OUR SURVEY SAYS…

1. Being clear about the goal1. Being clear about the goal

2. Being results-driven 2. Being results-driven

3. Able to think long term3. Able to think long term

What makes a good

commissioner?

(You can vote for more

than one)

4. Brings all the key players together4. Brings all the key players together

5. Open to new ideas & innovation5. Open to new ideas & innovation

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Be clear: ‘Shout!’ for the patientcommission more OUTPUTS?commission more OUTPUTS? commission better OUTCOMES?commission better OUTCOMES?

Drugs available on the NHS

Number of hip operations

Number of acute hospital

beds

Reduce waiting times

Number of trained doctors

and nurses

Preventing premature mortality

Enhancing quality of life for those

with LTC

Helping people to recover quickly

Ensuring patients experience of

care is as positive as possible

Ensuring patients care is as safe

and risk free as possible

OR

Focus on results: Patients ‘glad all over’

An outcomes-based approach means

focusing less on what is done for patients,

and more on the results of what is done

An outcomes-based approach means

focusing less on what is done for patients,

and more on the results of what is done

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Be ambitious: For the future, not ‘yesterday’

An outcomes-based approach

means setting challenging and

stretching goals to achieve for our

patients over the medium – longer

term

An outcomes-based approach

means setting challenging and

stretching goals to achieve for our

patients over the medium – longer

term

Be strategic: ‘Hello Goodbye’

An outcomes-based

approach means getting the

right people working

together focused on meeting

the needs of the patient,

regardless of traditional

organisational boundaries

An outcomes-based

approach means getting the

right people working

together focused on meeting

the needs of the patient,

regardless of traditional

organisational boundaries

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Think innovative: ‘The Hippy Hippy Shake’

An outcomes-based approach means being

open to new ideas, new innovations and new

ways of delivering better outcomes for patients

An outcomes-based approach means being

open to new ideas, new innovations and new

ways of delivering better outcomes for patients

‘Hey jude’, can you now bring an outcomes based approach in

your planning meeting?

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‘Let it be’ that we return to our scenario then…

So what are you

going to do now?!!!

…’I wanna hold your hand’ and plan for the future

Be clear Focus on results Be ambitious Be strategic Think innovative

Are you

interested in

outputs or

outcomes?

What does high

quality care look

and feel like for

the public?

Where do you

want to get to

over the medium

to longer term?

Who do we need

to work with to

achieve

improvements?

How can we

challenge the

status quo and

be open to new

ideas?

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1. Prevents premature mortality1. Prevents premature mortality

2. Enhances quality of life2. Enhances quality of life

3. Recovery from ill health or injury3. Recovery from ill health or injury

We now have the outcomes, but

where do you want to allocate

your money …you decide!

(Vote for your number 1 priority)

4. Positive patient experience 4. Positive patient experience

5. Patient safety5. Patient safety

The ‘Penny lane’ round…

‘Got to get you into my life’

How are we putting

commissioning for outcomes and high quality care at the

heart of the new commissioning system?

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OUR SURVEY SAYS…

1. YES1. YES

2. NO2. NO

3. NOT SURE3. NOT SURE

Are you are aware of the ‘ask’ in

the NHS planning guidance for

all 211 CCGs, together with their

area teams to set 5 year

ambitions to improve outcomes?

The planning guidance has now set out our clear commitment to an outcomes based approach –

‘revolution’?

For the first time, commissioners are being asked to plan on a five

year trajectory, to enable the NHS to capitalise on opportunities for

transformational change and improvement

All 211 CCGs, together with their NHS England Area teams, are being

asked to jointly set levels of ambition against seven overarching

outcome measures. The seven outcome measures are deliberately

broad so as to drive improvement for all CCG local populations.

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Preventing people from dying prematurely

(‘Run for your life’)

Enhancing quality of life for people with Long Term Conditions

Helping people to recover from episodes of ill health or following

injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and

protecting them from avoidable harm

1: Securing additional years of life for the people of England

with treatable mental and physical health conditions

2: Improving the health related quality of life of the 15

million+ people with one or more long-term condition,

including mental health conditions

3: Reducing the amount of time people spend avoidably in

hospital through better and more integrated care in the

community, outside of hospital.

4: Increasing the proportion of older people living

independently at home following discharge from hospital

5: Increasing the number of people having a positive

experience of hospital care

6: Increasing the number of people with mental and

physical health conditions having a positive experience of

care outside hospital, in general practice and in the

community

7: Making significant progress towards eliminating

avoidable deaths in our hospitals caused by problems in

care

Further information & ‘thank you girl’

Visit: http://www.england.nhs.uk/ourwork/sop/plan-sup-tools/

The NHS Commissioning Assembly Quality Working Group have produced a short

‘how to’ guide for local commissioners on setting 5-year ambitions to improve

outcomes

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For Discussion…

1. Reflections from those currently setting 5-year outcome ambitions

2. The biggest barriers to an Outcomes-based approach

3. How can NHS England / the Quality Working Group support local

commissioners to tackle these barriers