Trust Board 15 September 2010 Item 9 WEST MIDLANDS COLLABORATIVE COMMISSIONING PROGRAMME- NHS CONTINUING HEALTHCARE Sandra Brennan. Director of Clinical Development and Lead Executive Nurse Recommendation The PCT Board is asked to note the work being undertaken to reduce cost and raise the quality of Continuing Health Care. The Board are asked to support the collaborative commissioning approach being taken across NHSWM. Introduction In 2009, the PCTs across the West Midlands decided to initiate a programme of work to identify and subsequently implement initiatives to enhance collaborative commissioning for Continuing Healthcare services. The initial report completed in December 2009 by Deloitte identified opportunities for collaboratively commissioning with input and agreement from local CHC commissioners. A number of these initiatives were subsequently approved by the steering board for immediate implementation which is the objective of the current project. The collaborative commissioning programme for NHS Continuing Healthcare was tendered in February 2010 and Deloitte were awarded the consultancy contract for all 5 initiatives. Rob Bacon, Chief Executive of Sandwell, is the programme sponsor and leads on behalf of all of the PCTs in the West Midlands. Lynne Archer is the Project Manager leading the Collaborative Commissioning Programme for NHS Continuing Healthcare, Mental Health & Learning Disabilities. The project steering board meets on a six weekly basis, the members of the steering board are: Robert Bacon, Chief Executive, Sandwell PCT - Chair Sue Roberts, Director of Partnerships and Service Developments, Dudley PCT. John Wicks, Director of Commissioning, South Staffordshire PCT. Sandra Rote, Director of Nursing, Worcestershire PCT. Gillian Entwistle, Director of Finance, Warwickshire PCT. Jenny Belza, Director of Commissioning, BENPCT. Corrine Taylor, Corporate Governance lead, NHS West Midlands. Page 1 of 5
Active engagement of the Local authorities has been a focus for the project team in all initiatives of this project, however the ADASS regional lead for CHC has stepped down and we are awaiting a replacement to be nominated. The following diagram outlines the initiatives presented to the Steering Board at the end of 2009 for their consideration and approval. Approval was granted by PCT Chief Executives to immediately commence implementation of the initiatives in the green boxes. The initiatives have been split into enablers and collaborative commissioning. The enablers will build the foundation for longer term market management and system change. CHC Project: initiatives approved for implementation Enablers Collaborative commissioning CCP01: Common care groups and spend / supply data set CCP02: Regional patient choice and resource allocations policy CCP03: Eligibility assessment and appeals process review CCP04: Demand forecasting tool: Scoping and implementation planning CCP05: Procurement of Nursing home Framework Agreement (for Physically Frail, Mental Health and Physical Disabilities) Remaining Framework Agreement implementations, e.g: Nursing Home (Learning Disabilities, Palliative, ABI) Homecare Contract information management system (scoping) Further Competitions Further Competitions Approved for immediate implementation to follow in subsequent stages (subject to approval) At all stages of the each initiative PCT CHC commissioners and other relevant PCT colleagues were involved and consulted on through a series of workshops, conference calls and regional events. 1. Initiatives completed. CCP01 Common Care groups and spend / supply data set. The project team validated care groups, diagnostic classifications and data fields used by each PCT. A number of various options were presented to commissioners to agree a standard common set of care groups and data fields. CCP02- Regional Patient Choice and Resource Policy The principles of the Policy: Page 2 of 5
Consistency Consistent care packages decisions against as regionally developed policy that is within legal boundaries. Transparency Common and shared understanding of PCT obligations in relation to patient choice, resource allocation and other relevant areas. Accountability Robust policy against which to defend care packages decisions if required. Quality Equitable access to consistent quality of care. Financial Control Improved financial management as PCTs are able to make robust care package decisions which can be clinically or financially driven. All PCT policies on NHS CHC were collected by the project team, the project team drafted a number of policies based on PCT (from within the West Midlands and other area) policies, the national framework for NHS Continuing Healthcare and NHS Funded Care, relevant case law and legal advice. A number of workshops were set up with commissioners and nursing representatives and an agreed policy was produced. A public communication document outlining the main issues of the policy was also completed and agreed with commissioners and service user groups. As part of the implementation plan the Patient choice and resource allocation policy should have been tabled and agreed at PCT board level. CCP03 - Eligibility assessment and appeals process reviews and recommendations for implementation Within this programme the outcomes were to standardise the eligibility assessment process for CHC, including the review process and appeals management process across the West Midlands. The project team reviewed all current processes within PCTs and best practice processes, the objectives were: Establish a view of current PCT practices against national guidelines. Build an understanding on the challenges experienced in the process. Identify areas of best practice. Develop an understanding of the SHA role in the process, along with any requirements of the PCTs. Identify PCT performance against key metrics. Develop a best practice approach to eligibility assessment and appeals management. To include approach to process, people involved, training required, documentation utilised and frameworks adhered to. Page 3 of 5
The best practice eligibility and appeals process has been established and implementation will begin through the lead cluster arrangements making best use of the resources available at present due to the pressures around management cost savings. 2. Initiatives underway CCP04- Demand Forecasting tool Demand for CHC has risen since the implementation of the National Framework for CHC in 2007; PCTs are facing challenges around controlling the budgets. The aim of this initiative is to improve the continuing healthcare demand planning process within the region. The key outcomes will include: Forecasted CHC patient numbers by care group. Indicative total costs of care. A mechanism to support budgeting and commissioning decisions. Facilitation of accurate benchmarking between PCTs in terms of their patients and cost forecasts. Improved accuracy of patient forecasts by bringing PCTs up to a common standard in terms of methodology and data. This is an ongoing piece of work with a completion date in mid August 2010. CCP05- West Midlands Nursing Home Framework Agreement. The most significant initiative of the whole project is the Nursing Home Framework Agreement tender, covering the care groups of physically disabled, physically frail and mental health under and over the age of 65. Once implemented, this framework will be the only mechanism (unless exceptional circumstances) by which PCTs (or equivalent commissioning authorities) will make placements against these care groups. Work on the framework agreement started in April 2010 with a market engagement exercise where all identified priority providers (380 providers) were contacted by the project team. The project team also attended local PCT and local authority nursing home provider forums and held a number of provider events to explain the process and purpose of the tendering exercise. The project team, legal team, local authority representatives, clinical nursing representatives and commissioners developed the pre-qualifying questionnaire (PQQ), notices, evaluation criteria, Invitation to Tender documentation (ITT), contract schedules and Page 4 of 5
the framework agreement. All of the aforementioned documentation was also signed off by the project board members. The PQQ was released on the 28 th May 2010 through the Bravo e-procurement system, the PQQ closed on the 16 th July 2010 with 186 providers submitting PQQs covering 512 sites. At present the project team and legal team are evaluating the responses to the PQQ and those providers who have been successful will be invited to tender. The ITT will be advertised on the 18 th August 2010 and will close on the 24 th September 2010. The overall completion date for the framework agreement and signed contract documentation in place will be the 12 th November 2010. CONTEXT AND IMPLICATIONS Process The paper has been provided by the CHC Collaborative commissioning steering group Monitoring Reporting will be via NHS Worcestershire finance / CHC meetings Review At CHC collaborative commissioning steering group Equality and Diversity implications Equality and Human Rights impact assessment undertaken by steering group Patient and Public involvement None Financial consequences Costs to fund Deloittes to undertake work funded by all PCTs. Anticipated to produce saving against CHC budgets Legal consequences None Health inequalities Will ensure equal access to CHC across the SHA Healthcare standards/ PCT aims Page 5 of 5