Post on 24-Dec-2015
transcript
Eleanor Davies Associate Director Joint Mental Health Commissioning Lewisham Clinical Commissioning Group and London Borough of Lewisham
Commissioning post the Health and Social Care
Act, 2012
The Health and Social Care Bill puts clinicians at the centre of commissioning, frees up providers to innovate, empowers patients and gives a new focus to public health.
Arguably the most radical shake up of the NHS since its inception and unequivocally the most extensive reorganisation of the structure of the NHS to date
The Health and Social Care Act in a nutshell
Rising demand and treatment costs Need for improvement State of the public finances
Case for change
Clinically led commissioning Provider regulation to support innovative
services Greater voice for patients New focus for public health Greater accountability locally and nationally Streamlined armslength bodies
Key legislative changes
The focus of new commissioning system is Accountability and Outcomes
Clinical Commissioning Groups (CCGs) are the new statutory (accountable) bodies for most commissioning - Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are abolished
NHS England holds CCGs to account and is accountable for other commissioning (e.g. Primary Care and specialist services)
Various other national bodies are being developed as well as Public Health moving to Local Authorities and Public Health England
CCGs will have £25 per head of population to spend on their organisations (we call this commissioning support)
CCGs have to balance how they spend this – In house staff / purchased from a CSS / shared
The new NHS commissioning system
What’s happening in London…
Camden
7
Hillingdon
Harrow
Brent
Ealing
Hounslow
Central London
Barnet
Enfield
Haringey
Islington
Richmond
Merton
Croydon
Wandsworth
Kingston
Bromley
Bexley
Greenwich
South-wark
Lambeth
NewhamTower
Hamlets
City & Hackney
Havering
Redbridge
Waltham Forest
Sutton
Wave 1 – 3 CCGsWave 2 – 15
CCGsWave 3 – 11 CCGs
Wave 4 – 3 CCGs
Barking &Dagenham
Hammersmith & Fulham
West London Commissioning
Lewisham
Camden
There are 32 emerging CCGs in London, who will need to demonstrate they have robust commissioning support in place
What type of organisation is a Commissioning Support Unit?
• The 2013 NHS will be genuinely different– CCGs will be small, light,
clinical commissioning organisations
– CSUs will be vital to getting CCGs up and running and critical to the success of the commissioning system overall
– Hosted by NHS England – 23 CSUs in England, 3 in
London– CSUs are funded by CCG
income and by income from other customers
CCG
NHS Englan
d
CSUServices
Account-ability
Three CSUs are taking shape in London
North West London
South London
North Central and East London
• SLCSU is developed from CCG views
• SLCSU is designed to give CCGs benefit of local services and the benefits of working at a larger scale to centralise expertise
• £30m+ organisation, c300 staff, all 12 CCGs will purchase core services
The South London CSU Story so far
• Well prepared for the transition
– Started on 1st April
– First board meetings taking place
Development of South London Clinical Commissioning Groups
Stressful! People are applying for new jobs or their old ones £20 billion of NHS efficiency savings required
nationally. Large LA budget reductions In Lewisham GPs are increasingly becoming more on
board with changing referral patterns. Less lone operators, more group think and peer pressure.
There is still the tendency to think like providers rather than commissioners…
What’s it really like….
2 posts transferring to the CCG. One part funded by the LA
c.£90m budget Covering:
Adult Mental Health – for health and social care IAPT service NHS Specialist services NHS Forensic services Mental Health of Older Adults – for health and social care Dementia services – for health and social care Adult Mental Health Voluntary sector – for health and
social care £4.5m health savings and £600k LA savings required from
2011/12 – 2013/14. More savings to come….
Lewisham Joint Mental Health Commissioning
The scale of efficiency savings make it imperative to do things differently – real radical change is required
E.g. Closed a two 16 bedded specialist Continuing Healthcare
Unit and reinvested £1.6m of recurring money into our Dementia pathway with £370k taken as QIPP
Commissioned a 3 month Forensic triage model which has diverted 75% of people away from Medium Secure Units and saved £1.3m to commissioning budgets
Commissioned a support planning and brokerage service to support people to use their Individual Budgets
Commissioned local secondary care ASD and ADHD diagnosis and treatment clinics rather than using specialist services
Some positives to savings!
Lobbying CCGs and Health and Wellbeing Boards Support commissioners in their role – not just GPs Identify gaps in provision Share best practice Share evidenced based practice Give ideas for efficiency savings – support whole
system transformation Improve public awareness and engagement Influence big decision makers
How can the you influence the health and social care agenda