London Ambulance Commissioning. Pre-hospital Care Neil Kennett-Brown, Director of LAS Commissioning
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1 London Ambulance Commissioning Pre-hospital Care Neil Kennett-Brown, Director of LAS Commissioning
2 Outline What is commissioning Commissioning arrangements Improving pre-hospital care Commissioning Intentions 2013/14
3
4 What is commissioning? The act of committing finite resources to evidence-based interventions, with the aim of improving health, reducing inequalities and enhancing patient experience. Aim: Better health and well-being for all Better care for all Better value for all Trade offs for investment/disinvestment - Geography, disease, prevention, demography
5 What is commissioning really? Conscience stewardship, quality assurance, public protection Brain resource allocation, service design, planning Eyes and Ears patient experience, receiving and analysing information back to brain and conscience (Smith & Mays, 2005) Not Arms and Legs doing and delivering
6 Commissioning Arrangements Treasury London s 32 Clinical Commissioning Groups Department of Health National Commissioning Board Policy, Commissioning Mandate Specialised GPs, Dentists -Planning and securing health services and improving health of the local population, lead NHS locally services covered include - Commissioning Support Units 3 North West, South, North Central & East Ambulance Services Hospitals Mental Health Community Services
7 Pre-hospital Care
8 Commissioner Questions: 1. Why call 999? - Preventable? - Sign of other system failure? 2. Was service safe & efficient? -Shared understanding of risk -Benchmarking efficiency 3. What happened afterwards? -Good for person? -Did the system work well?
9 Recent initiatives Increase Hear & Treat (& refer) To NHS Direct Resolving within LAS Falls & Diabetes Referrals back to primary care Mental Health protocols Alcohol Alcohol Recovery Centre (Soho) Health promotion Frequent Callers/Organisations
10 Appropriate Care Pathway (ACP) lessons learnt Strong Collaboration with key Partners eg Provider, LAS and Commissioner / clear validation process required Referral Pathway (written Provider to Provider agreement between the LAS & Local Service Provider) critical Keep it simple e.g Co-located UCC exclusion criteria Understanding of Governance, roles and responsibilities Alignment to other key priorities, QIPP, Hospital turnaround, Winter Pressure Management
11 Commissioning Intentions 2013/14
12 Commissioning Cycle ensuring we get what we specify: quality, patient experience, effectiveness, efficiency The Commissioning Cycle Needs Analysis understanding needs & services, identifying gaps, population based not service specific Commissioning Intentions set each year, working across with all commissioners - KPIs, CQUIN - Financial Monitoring Contracting Safe and effective patient care Procurement & Service Delivery Strategy & Planning - what services best fill the gaps? How do we develop/procure
13 Commissioning Intentions What are they? The commissioning intentions are developed annually to signal to the LAS our commissioning principles and areas for potential change in the next financial year. The commissioning intentions provide the background and context which informs the decision-making process. Key areas covered: Quality, Innovation, Productivity & Prevention requirements Financial context, including DH guidance Key service developments Contractual performance requirements CQUIN (clinical quality incentive scheme)
14 Commissioning Intentions DH Mandate Regional Priorities & Existing Strategy Public / Patients Clinical Commissioning Group CIs including urgent care strategies/qipp Joint Capacity Modelling NCB Performance Framework Commissioning Intentions LAS Strategy & 12/13 Performance Contracting Intentions 2013/14 Contract
15 Commissioning Intentions Headlines Patients feedback (via Patients Forum) End of Life Care integrated planning Dementia Care - training of staff, referring on Greater involvement of public & patient experience Involvement of staff to review care pathway outcomes integrated care Mental Health sectioned patients experience/delays Note: Further feedback requested this evening from Foundation Trust Members (29 th Nov 12)
16 Commissioning Intentions Headlines Clinical Commissioning Groups Commissioning Intentions & urgent care strategies Integrated Care planning Urgent Care linking back to primary care Quality, Productivity & Prevention plans: - Self-care - Increase Hear & Treat; See & Treat; See, Treat & Refer - Ensure appropriate Emergency Department attendances - Tackling demand - Frequent callers/locations
17 Commissioning Intentions Headlines Nationally Category A performance (Red 1 and Red 2) Upper Quartile performance for Ambulance Quality Indicators Stroke, Cardiac etc Priorities from mandate - Dementia & elderly care - Long term conditions - Integrated Care planning - Mental Health on same footing as physical health - Positive experience of care Financial context following DH/NCB guidance
18 Commissioning Intentions Headlines Regionally Link with 111 & - Special Patient Notes & Coordinate my Care - Direct transfer of 111 calls to and from LAS - Use of Directory of Service & NHS Pathways LAS to play key role in integrated system - e.g. pressure surges Hospital reconfigurations - Fewer specialist sites cancer, cardiac arrhythmia - Use of local Urgent Care Centres
19 Commissioning Intentions Headlines LAS Performance over past 12 months Successful Olympic & Paralympic Games Successful implementation of new CAD Quality indicator improvement, including 30% cardiac arrest survival Whole system triggers & escalation now in place Lack of resilience currently (fluctuations in performance) Use of the Demand Management Plan & delays for lower categorisation of patients Staff - Engagement & satisfaction - Training compliance
20 Commissioning Intentions Headlines Capacity Modelling Significant opportunities to improve triage Significant operational efficiencies possible Staffing needs to align with demand Demand pressures predicted (e.g. 111), impacting on resourcing
21 Commissioning Intentions Summary Collaboration & Integration with wider system 111 & NHS Pathways Local QIPP schemes and pathways to reduce ED attendance Integrated care plans Ambulance turnaround improvement Address findings from Capacity Modelling Dementia focus Deliver within financial guidance Support for hospital configurations Note: Further feedback requested this evening from Foundation Trust Members (29 th Nov 12)
22 Commissioning Intentions Headlines Patients feedback (via Patients Forum) End of Life Care integrated planning Dementia Care - training of staff, referring on Greater involvement of public & patient experience Involvement of staff to review care pathway outcomes integrated care Mental Health sectioned patients experience/delays Note: Further feedback requested this evening from Foundation Trust Members (29 th Nov 12)
23 Any Questions?
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