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Towards informed and innovative commissioning, Workshop for LKS October 2013

Towards informed and innovative commissioning, Workshop for LKS October 2013



The background to commissioning and how library and knowledge services can support commissioners.

The background to commissioning and how library and knowledge services can support commissioners.



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  • This session will include some opportunities for personal reflection and goal setting.  
  • Where can knowledge have the most impact? How can we improve business performance by building know-how?How can we share and spread good practice & embed lessons learned?What do we need in the way of information products and services?See also ; Platform for Change: The Educational Policy Statement of the Medical Library Association, The Medical Library Association, 1992 http://www.mlanet.org/education/platform/
  • Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ In the UK, life expectancy has been rising and infant mortality has been falling since the NHS was established. Both figures compare favourably with other nations.
  • Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ In the UK, life expectancy has been rising and infant mortality has been falling since the NHS was established. Both figures compare favourably with other nations.
  • CCGs are managing c60% of the total NHS budgetResponsible for commissioning the majority of health services, including emergency care, elective hospital care, maternity services, and community and mental health servicesAlready flagged their responsibility towards the integration of health and social careIn 2015/16 the average CCG will have c3% of its allocation, c£10m taken out of its budget to pay for the government’s planned £3.8bn fund for the integration of health and social care, according to NHS EnglandAnd noting general election 7th May 2015
  • 2010 study by the Commonwealth Fund – 7 industrialised countries Australia, Canada, Germany, Netherlands, New Zealand, UK and USA
  • Effectively flat real terms funding for the next four years; against backdrop of wider economic recessionNever let a good crisis go to waste; Take the opportunity to do things you think you could not do before“The Burning Platform” Explosion the Piper Alpha oil-drilling platform in the North Sea in 1988One of the survivors,a superintendent on the rig, jumped 15 stories from the platform to the water – where he knew he could only survive for 20 mins. Why? “It was either jump or fry.” He chose possible death over certain death; the price of staying on the platform was too high.
  • Deloitte: 350 m consultations pa [2001] ... 433m [2035]Within next few years, 3m people will have 3 LTCs. By 2020, no. people with dementia alone will exceed 1m.The rich world is ageing; more people living longer - at 2030 22% of the people on the planet 65+; Elderly people who are chronically unwell rather than seriously ill can be maintained with nursing rather than medical care in their own homes. “No decision about me, without me”
  • Demand continues to rise, especially for unplanned and emergency care; rise in levels of chronic conditions and obesity In areas with severalhospitals within 30 mins driving distancewe might expect to see some reconfiguration of health services to offer patients the very best specialist care where availableBetter drugs and improved surgical techniques, along with the advent of day surgery, have meant good after-care, rather than medical intervention, is what increasingly determines a full recoveryA whole year's care by a GP costs about one tenth of a day in hospital. Dealing with the duplication and fragmentation that occurs in care that crosses provider and budgetary boundariesUsing data to illuminate unexplained / inappropriate variation to drive up quality. “No decision about me without me”
  • Primary care itself a success 15m inpatient admissions to NHS hospitals in England [Health &Social information centre,2011] 350 m consultations pa [Deloitte,2001]British Social Attitudes survey 2012: public satisfaction with the NHSSatisfaction with GP services traditionally high – slight decline in recent years – 74% in 2012 (80% 2009).In new landscape, policy places GPs at the centre of success and sustainability
  • All of the four elements of the cycle are sequential and of equal importance. Different elements may operate at the same time; does not operate in isolation; informed by the previous stage and drives subsequent stages of the cycle.Essentially this commissioning cycle should drive purchasing and contracting activities and be open to influence from all stakeholders via ongoing engagement activities to secure the delivery of community objectives.Value for MoneyBest Valuehttp://www.val.org.uk/page/commissioning-basics#cycle Voluntary Action Leeds
  • Emmanouil Gkeredakis, Claudia RoginskiThe need for clarity in evidence based commissioningHSJ, 23 May, 2011http://www.hsj.co.uk/resource-centre/best-practice/the-need-for-clarity-in-evidence-based-commissioning/5030129.article#.UlMNucdwb48
  • The evidence base Need different forms of evidence- clinical and non-clinicalPlurality rather than hierarchy of evidence - different types of evidence is needed to work together
  • Consider the different forms of evidence needed for different commissioning tasks in the early stagesValue plurality of evidence (from both authoritative bodies and local commissioning knowledge)Be proactive and pay attention to the timing for using a piece of evidenceIdentify, facilitate and balance contributions from different experts, understand who will be affected by decisions of redesigning services; involve all groups actively and early onCreate meaningful interfaces between different tasks and different stakeholdersScrutinise the merits of redesign decisions in terms not only of high clinical standards but also of workable commissioning arrangementsAsk advice from people who might already have gone through the challenges you face, e.g., setting up a new service, or conducting a complex procurement. They can be a valuable source of information  
  • Linda CoxLibrarians are “pollinators” – Prof Paul Glazsiouhttp://www.qualitymk.nhs.uk/default-ContentID-3011.htm
  • Working in an increasingly cash-strapped system
  • In undertaking our risk assessment process became evident that the CCG must undertake a substantial amount of work on developing service specifications for each of the functions inc:Defining what the service will deliver; Understanding what ‘good performance’ looks like; Developing a range of KPIs, metrics, targets and thresholds; Agreeing reporting processes, including frequency of reporting; Confirming contractual penalties.
  • Feel the heatInformed by a Preliminary Brief for commissioning support hub, Milton Keynes CCG, Nov 2011
  • What is already in place? For the library/information service represented around the table - list the services and products you consider most relevant to commissioners that are already available/being provided
  • A time of enormous change in the NHSAre we a profession in Transition at a time when both medical/health education, and the NHS, and indeed the wider landscape of health and social care in the UK, is in a state of change? Concept of Evolution - Develop gradually, esp. from a simple to a more complex formDevelop over successive generations, esp. as a result of natural selection.
  • Carl-Ardy Dubois and Debbie Singh. From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management. Human Resources for Health 2009, 7:87 http://www.human-resources-health.com/content/7/1/87
  • So this is the challenge for us today –

Towards informed and innovative commissioning, Workshop for LKS October 2013 Towards informed and innovative commissioning, Workshop for LKS October 2013 Presentation Transcript

  • Towards informed and innovative commissioning Commissioning Workshop for Library & Knowledge Services October 2013 sue.lacey-bryant@nhs.net
  • 1. 2. 3. 4. 5. 6. Commissioning defined Context Evidence-based commissioning Understanding the customer Best value How can librarians evolve to meet the need? Sue Lacey Bryant
  • The library as a platform for change • • • • Health is a knowledge- based industry Health is a people based industry What more can librarians do to help? “What more can I do to help?” Sue Lacey Bryant
  • 1. Commissioning defined “the process of allocating public resources to achieve the greatest gains in health within a defined population” Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/ Sue Lacey Bryant
  • Shift in approach to commissioning 20th Century 21stCentury • Care closer to home • Transformation; innovation; whole system; redesign • Hospital centred • Challenges met by growth • • • • • Clinician-centred Benefits of treatment Quality improvement Focus on individual Patient compliance; public & patient engagement • High carbon usage • • • • • Patient-centred Prevention; risk stratification Reduce waste; increase value Population perspective Patient as co-producer • Low carbon usage Sue Lacey Bryant
  • 2. Context: key facts The NHS in England: • Deals with over ? patients every 36 hours • Serves ? people • Employs ? staff • Budget of ? £ Billion • Av. CCG is commissioning care for ? people; • Av. CCG has been allocated ? £m in 2013-14  Life expectancy rising  Infant mortality falling Sue Lacey Bryant
  • Key facts The NHS in England: • Deals with over 1m patients every 36 hours • Serves 53m people • Employs 1.35m staff • Budget of £95.6 billion • Av. CCG is commissioning care for 226,000 people; • Av. CCG has been allocated c £300m in 2013-14  Life expectancy rising  Infant mortality falling Sue Lacey Bryant
  • Sue Lacey Bryant
  • 19 CSUs; 105 CCGs; 27 Area Teams
  • Where in the world are we? • NHS ranked 2ndafter Holland • 2nd patient equality & safety • Scored highly on access • Best system in terms of efficiency, effective care and cost-related problems 2010 : NHS cost £2,021 per person in UK - less than half than the £4,926 per head in US • 2nd to last for 'long, healthy, productive lives‘ • Bottom for life expectancy of patients at age 60 22.5 yrs vs 24.6 in Australia • Much higher death rates from conditions amenable to medical care. In 2003 rates were 25% 50% higher than Canada and Australia Sue Lacey Bryant
  • Platform for change • Harsh financial climate: find £20 billion efficiency savings by 2015 • Berwick report: give patients quality care every time Sue Lacey Bryant
  • Pressures • Unprecedented demand • Ageing population – more complex health needs – Increasing demand • Patient involvement – No decision about me without me Sue Lacey Bryant
  • Priorities • Stemming the increase in emergency admissions • Service reconfiguration; making the shift from hospital to community care; seamless care • Addressing inappropriate variations in clinical practice; clinical safety and quality • Improving Public Health; reducing inequalities Sue Lacey Bryant
  • Primary care at the helm • GPs manage the lion’s share of NHS medical work • High level of patient confidence and satisfaction • One year's care by a GP costs c1/10th of a day in hospital • CCGs responsible for £65 billion of the £95b commissioning budget • Increasing choice and service integration Sue Lacey Bryant
  • 3. Evidence-based commissioning “the process of allocating public resources to achieve the greatest gains in health within a defined population” Simon Lenton: Introduction to developing and commissioning pathways www.networks.nhs.uk/ Sue Lacey Bryant
  • Sue Lacey Bryant
  • Evidence based commissioning Redesigning services in the NHS can be an incredibly complex task, with differential demands for information and evidence originating from the nature of the task itself Emerging research suggests that, for redesigning and commissioning or recommissioning services, equal attention may need to be paid to both clinical and non-clinical evidence. Emmanouil Gkeredakis & ClaudiaRoginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011 Sue Lacey Bryant
  • A plurality of evidence HSJ 26 May 2011 p23-25 Sue Lacey Bryant
  • Top Tips for gathering evidence • Consider the different forms of evidence needed for different tasks • Value plurality of evidence (from authoritative bodies & local knowledge) • Be proactive • Ask advice from people who have already tackled the challenge Derived from Emmanouil Gkeredakis; Claudia Roginski: The need for clarity in evidence based commissioning. HSJ 23 May 2011 Sue Lacey Bryant
  • Pressing need for innovation “We need to radically transform the way we deliver services. Innovation is the only way we can meet these challenges” “Put simply, we must make innovation a priority. We know that the NHS can spread new ideas at pace and scale when it puts its mind to it, and we need to do more of this.” “ Innovation ... needs to be replicable – and replicated – across similar settings. So innovation is as much about applying an idea, service or product in a new context, or in a new organisation, as it is about creating something entirely new. Copying is good.” Sue Lacey Bryant
  • The value of library and knowledge services to QIPP David Nicholson. HSJ. 10 Sept 2009 Sue Lacey Bryant
  • “What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making. We need to look at how information links together to get a holistic picture of the situation.” Dr Shahid Ali, GP and Clinical Lead, Patients and Intelligence Directorate, NCB
  • 4. Understanding the customer Information services & products for commissioners Sue Lacey Bryant
  • What do commissioners ask? • • • • How have others done it? Data on outcomes? Benchmarking Data and models to support development of specifications • Key performance indicators? • Summaries Sue Lacey Bryant
  • Examples - Evidence searches • Impacting on hospital use (re)admission, Outpatient Dept, A&E, community care • GPs in A&E departments • Has anyone charged for DNAs? • Outcomes of MSK services • Service specifications inc. Community cardiology, MSK, Urgent Care • What self care tools will we need to support our new MSK Clinical Assessment & Triage services? • Predictive modelling tools • Return on Investment in telehealth/telecare • Why are our antenatal admissions so high? • Self management, decision aids • Outcomes based contracting Sue Lacey Bryant
  • “Anne carried out three targeted data searches for me to support the CCG’s three Local Priorities in its Integrated Commissioning Plan (ICP). Rather than merely searching for relevant articles, Anne reflected on the problem areas, searched for evidence of a range of successful interventions achieved elsewhere and provided a new measurable solutions for the CCG to adopt. This saved me time in developing the ICP and added real value and a new angle of approach.” Tim Deeprose: Interim Director of Commissioning, NHS Milton Keynes CCG, July 2013 Sue Lacey Bryant
  • What sources do commissioners value? Survey n=300 Very/quite important • Local public health intelligence • Expert advice • Examples of best practice • Local policies • Guidelines • Government pubns • Benchmarking • Cost effectiveness Not important/did not use • General published literature • Professional association guidance • Management studies • Academic research • Management consultants HSJ 26 May 2011 p23-25 Sue Lacey Bryant
  • 5. Best value Benefits – Cost Sue Lacey Bryant
  • Core offer into CCGs & CSUs? Generic/At scale offer • Horizon scanning • Tailored and targeted dissemination of evidence, by stakeholder group • Concise summaries of key policy documents • Intranet/web knowledge zone • Aligned with the strategic objectives of the organisation Sue Lacey Bryant
  • Core offer into CCGs & CSUs? Specialised services – for individuals ; for teams • Investigative research and enquiry service covering clinical & cost effectiveness; best practice”; models of service • Producing Easily read, synthesised reports ie. retrieve, select, appraise, summarise • SDI to key personnel - by profile • Supporting pathway review & service redesign • Information skills training Sue Lacey Bryant
  • Targeted alerting services • • • • • • • • Client focus; ensuring insights into CCG agenda national policy drivers transforming pathways QIPP challenge; financial balance supporting service redesign; models of delivery promoting best evidence promoting tools and resources sharing best practice to drive innovation and enable transformation Sue Lacey Bryant
  • A bang for the buck • • • • • • • • Work to strengths: what are we really good at? Collaborate to improve products & services? Efficiency: at-scale delivery of back office Understand which functions can routinely be delivered remotely? Which require engagement? Use strengths in networking to enhance impact Help to overcome silo mentalities Raise our expectations; demonstrate impact Quality = clarity and standards Reflect on service specifications and KPIs Sue Lacey Bryant
  • What does good look like? Performance score Performance area KPI Timeliness Search reports to be delivered by… Availability & Responsiveness Routine queries to be dealt within…. Client Satisfaction Use baseline client survey to develop Value for Money Incorporate planned efficiency of back office functions into delivery of service Meeting clearly defined standards Quality. QIs this the sum of the parts? Impact? Priority queries to be dealt with within … Delivery of added value Sue Lacey Bryant
  • Benefits • Benefits: o o o o o o Cost effective; Time effective Expertise in sourcing, selecting, summarising Knowledge of resources Rapid response option Build a knowledge resource • High quality service to support both strategy & operations • Scale up across the potential customer base Sue Lacey Bryant
  • Criteria by which to assess CSS  Alignment: demonstrable commitment to achieving CCG objectives inc. high quality care  Responsive: to the individual priorities of our CCG and the population on behalf of which we commission  Agile: flexibility to support changing demands on CCG  Cost effective: value for money; added value  Innovation: sharing best practice; „lift & shift‟ where practical  Business focus: robust arrangements to support multiple clients Sue Lacey Bryant
  • Actions speak louder than words 3 actions from this session inc. the presentation and your group discussion 1. 2. 3. Sue Lacey Bryant
  • 6. How can health librarians evolve to meet the need? Source: A visualização da imagem anterior desperta para a leitura do artigo: "Evolving Web, evolving librarian" de Amy and Robert Favini balcaodebiblioteca.blogspot.com Sue Lacey Bryant
  • Enhancing the role of librarians Role enhancement involves expanding a group of workers' skills so they can assume a wider and higher range of responsibilities through innovative and non-traditional roles Sue Lacey Bryant
  • Positioning librarians as catalysts for improvement • Aligning with NHS priorities • Bringing research, education and practice closer together • Spreading innovation • Multidisciplinary working • Changing skill mix: role substitution, role enlargement & enhancement Sue Lacey Bryant
  • Towards informed and innovative commissioning “Libraries will get you through times of no money better than money will get you through times of no libraries” Anne Herbert, writer. b1952 Sue Lacey Bryant