Peter Hay, President, Association of Directors of Adult Social Services (ADASS), looks at the role of integrated commissioning in the new health economy.

1. Making Links with GPs – Influencing
Commissioning in the new Health
Economy
Kings Fund, Health and Wellbeing Board
Summit 14th July 2011
Peter Hay, Strategic Director, Birmingham
City Council, ADASS President

2. Context
• Two systems
• Forces against integration?
• What good looks like
• How we might get there

3. Context
• Largest user (2/3rd of hospital beds)
• 167,000 NHS hospital beds
• 18,255 care homes provide 459,448 beds
• 40% growth in public spending on older people to 1.7%
of GDP by 2029/30
• The funding gap between care and health “needs to
change”
• 152 care systems, 250 consortia

4. Two nations divided by a common
language?

5. Joint/integrated commissioning
• Not same market
• …nor commissioning skills
• …nor approach to market development
• …nor use of personalisation
• …nor acknowledgement of the above
• …and experience of integration is mixed

6. Less hindrance to integrate than
2010?
Source: NHS/Confed Where Next for Health and Social Care Integration, June 2010
Performance Regimes
Financial pressures
Organisational complexity
Changing leadership
Financial complexity

7. Good looks like
• Joint goals
• Very closely knit and highly connected networks of
professionals
• Mutual sense of long term obligation
• High degrees of mutual trust
• Joint arrangements are core business and are operational
and strategic
• Shared or single management arrangements
• Macro and micro joint commissioning
(Source; Rosen, Nuffield after Glenning)

8. A new model of care
and public health
Citizen purchased care Citizen purchased
– state resources care – own resources
Enablement
Prevention
Support and information offer
‘A wider service offer’
MEANS

9. So Commissioning…
• Will promote resilience in people and communities
• Develop risk and return on investment in prevention
(and public health?)
• Create relationships about evolving practice and best
performance in enablement
• Shape markets through information
• Assist individual budgets where necessary / shown by
citizen statement

10. Resilience in Communities
• Spend/influence?
• What measures?
• How might we hold
universal offers to
account?
• Is starting now the
beginnings of a new
public health relationship
with place?

11. So Commissioners will…
• Understand money – from investors to spend
• Consumer information – and intelligence
• Prioritise provider relationships – who matters?
• Work within a fast changing dynamic environment
where the adaptive might survive?

12. Operationalising integration
Source: Rosen et al (forthcoming)

13. So…
• The “architecture” locally needs to support known
models of what good looks like
• Sort out common language
• Agree common models
• Clarity of purpose with the urgency of focus on people
and outcome

14. Conclusions
• Integrated commissioning, easy to say,
tough to deliver
• In developing the structures, pay attention to
the ways of working
• Size of the prize!

16. ADASS Business Unit
Local Government House
Smith Square
London SW1P 3HZ
Tel: 020 7072 7433
Fax: 020 7863 9133
EMAIL: team@adass.org.uk WEB: www.adass.org.uk