Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Collaborative Commissioning and
Devolution for Specialised Services
Alison Tonge –Regional Director of Specialised
Commissioning (North)

2. Specialised commissioning overview
• NHS England directly commissions specialised serviceswith a value of
approximately £14bn.
• Ministers are responsible for deciding which specialised services should be
commissioned directly by NHS England rather than by CCGs, based on
advice from the PrescribedSpecialised ServicesAdvisory Group (PSSAG), a
multi-disciplinary Department of Health Committee.
• 145 services are currently prescribedas specialised.
• Around 60 of these are highly specialised(including services for people with
very rare diseases).
2

3. What are Specialised ServicesHighlyspecialised
• Rare conditions
• Very low patient
numbers
• Very few hospitals
• Examples:
• Heart and lung
transplantation
• Treatment of rare
eye conditions Specialised
services(1)
• Episodic
specialised
services
• Examples:
• Paediatric and
Neonatal
Intensive care
• Severe burn care
• Specialisedcancer
surgery
Specialised
services(2)
• ‘Pathway’
specialised
services
• Long term
conditions
• Examples:
• Kidney care
• Mental health
• Cardiac care
• Cancer services

4. We commission with providers for all three
levels of services National
services
Regional services
Health economy services

6. Trauma 0%
16%
36%
16%
28%
4%
Group of CCGs
Health Economy
Sub-region
Region
National
TBC

7. Collaborative
commissioning
Strategy and
service reviews
Newmodels
Removingbarriersto
Placebased accountability for
Wholesystemand pathways
Clear visionon direction
Prioritisedservice areas for
New model of delivery
TransformedCommissioning
Enable newdeliverymodel forspecialised
Based on a specialisednetworkwith
Lead providerand peer partners
In-built‘rightcare models’drivingsustainability
TransformedDelivery
Place Based Alignment !

8. Why is change needed in specialised services?
Too many
providers
Too much
variation in
quality and
outcomes
Some
hospitals don't
have enough
specialist staff
Some
Providers are
not seeing
enough
patients
Move towards
7 day working
Some
providers are
not meeting
core quality
standards
Lack of
integrated
commissioning

9. Specialised Services Commissioning Development
what can we do better together
Champion the
CHANGE in
quality needed
Measure it !
Contract
together
Manage
providers
together
CRG’sand
POCB’sto
advise on
whole pathway
Improving –
commissioning
for value
evidence
Lead service
reviews to
create
sustainability
Create pathway
supportsthat
are unavoidable
Needs
assessment
integrated
Single set of
priorities for
‘place’ and
intentions

10. National Direction and Progress
Principles
• Place based commissioning –
specialised within a whole system
• Transformation of specialised
services – consolidation , new care
models and networks
• CCG’s collaboration in health
economies, region to enable greater
influence on specialised services
plans and priorities
• CCG’s to see overall budget for the
specialised portfolio for the
population but influence this through
two main collaborative structures
Progress
• Collaborative commissioning groups
established in 10 regions
• Priorities have been identified to
work on
• National program board – co-
chaired Dr N Harding, R Jeavons
• Two services to transfer to CCG’s
this year – Neurology OP and
Wheelchairs
• Morbid obesity surgery to transfer
16-17 , Renal review

11. Priorities
• Mostfrequentprioritiesin the collaboratives
• CAMHS
• Morbid Obesity
• Renal
• Vascular
• Cancer surgery
• Radiotherapy
• Spinal surgery
• Complexand neuro rehabilitation
• Neonatal
• HIV networks

12. Complex Rehabilitation Example
North West
Provision
IntegratedNetwork
Tier 3 (community and
LA)
Tier 2 (DGH’s)
Tier 1 (tertiary hub)
Commissioning
integratedcommissioningmodel
CCG, NHS E, LA
Single commissioning
specificationandmodel
Contract(?) money
Stimulatedpartnership through
Clear process,resource,new
Governance,capacity
UsedSCN’s /clinical networks
Case forchange – point prevalence,
National standards,across continuum!
Single commissioner lead
Close working

13. Phase 2 – Enabling place based leadership
Governance and Transformation
• Enable CCG’s to take more ownership of
– Redesign and service change of specialised services
– New care models and pathways
– Transformation initiatives

14. • Health economy level
• Ownership of transformation
• Service change decisions owned locally
• Legal framework to enable this within NHSEngland scheme
of delegation
• Enable pooled budgets and lead contracting
Governance
• Specialised within a broader program
• Coherent strategy – based on service bundles
• Integration of specialised commissioning on systemdesign
• Initiatives undertaken with CCG leadership and sponsorship
• Knowledge and opportunities shared from national team to
support improvement
Transformation

15. Specialised Commissioning within the
context of Devolution Manchester
Gina Lawrence – Chief Operating Officer, NHS TraffordCCG

16. • Governance
• Principles
• Scope
• Commissioning
• Service Transformation
• Provision

17. Governance

18. Principles
Specialised Commissioning Principles:
• To co-design and work together - both between commissioners (Greater Manchester and
NHS England) and with providers;
• To design services that are best for patients (not organisations);
• To set clinical standards that at least meet current specifications and also anticipate the future
needs of patients;
• For Greater Manchester to be “outward facing” in seeking optimum standards – to ensure
national standards, best practice and equity of access and quality are “in built” to locally
owned clinical standards
• To have cognisance of co-location and co-dependencies
• To anticipate future developments in technology and innovation;
• To build on previous successful commissioning approaches namely the commissioning of a
single service through a lead provider;
• To design optimal arrangements that recognise key inter linkages between services;
• To optimise estate utilisation and minimise further infrastructure investment.

19. Scope
All 200 service specifications were considered and have been divided
into 3 groups as below:
• Group 1
1. Highly specialised services
2. Small number of patients
3. One/two centres in the Country
4. Input from National Team
– To be managed by NW Specialised Commissioning with input by
National Team
– AGG to have oversight of budgets/activity/performance/quality issues
Example – Bone Cancer Services

20. Scope continued
• Group 2
1. More appropriate to be commissioned on a wider than GM footprint
2. Profile means difficult to split service
3. Large net importer from other areas
– To be managed jointly by Devo Manc with other NW CCG’s under the
guidance of the NW Spec Comm Team
– AGG under Devo Manc would offer high level input
– These services have an opportunity in future to move into full
commissioning within Devo Manc
Example – Bone Marrow Services

21. Scope continued
• Group 3
1. These services are considered discrete
2. Inter-dependency
3. Work on a GM footprint
4. Population base of 3 million people
– Services can sit within a GM construct
– Services within this group will be considered for early transformation
Example – Vascular Services

22. Scope continuedSoftware tools used to prioritise and group services

23. Scope continued
Software tools used to prioritise and group services

24. Commissioning
• Services will need to be Co-commissionedwith NHSE due to legislation
• Possible for full Devolution in the future
How might GM Commission the Service
• GM Devolution Centre Team
• Align services to the 12 GM CCG’s
• Led by a single CCG

25. Service Transformation
• Testing the approach during 2015/16
• OG/Urology cancer prioritised
• Baseline review of finances/risks/current pathway
• Development of clinical standard by clinical teams across GM
• Work with GM provider to develop thinking around provider models
• Test commissioning model

26. Provision
• Vanguard Models – Cancer
• Single Service
• Prime Vendor
• Integration
• New ways of collaboration under Devo Manc

27. Any Questions