whole system pathways and commissioning as a dynamic approach

42
Project alford’s Health Investment For Tomorrow Project alford’s Health Investment For Tomorrow SHIFT Project – Salford’s Health Investment For Tomorrow Whole system pathways and commissioning as a dynamic approach Janet Roberts, Sylvain Laxade, Janelle Homes, Richard Freeman

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Page 1: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

SHIFT Project –

Salford’s Health

Investment For

TomorrowWhole system pathways and

commissioning as a dynamic

approachJanet Roberts, Sylvain Laxade, Janelle Homes, Richard Freeman

Page 2: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

What we are going to coverWhat we are going to cover

• Making it Real

• What have we done?

• Were there problems?

• What are we doing now?

• How will we make change stick?

Page 3: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Where have we come from Where have we come from and what have we done?and what have we done?

Page 4: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

History of the ProjectHistory of the Project

• Strategic Outline Case

• Initial hospital focus

• Victorian ward blocks

• Salford’s health status

• Other organisations

• LIFT

Page 5: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Features of the new systemsFeatures of the new systems

• Integration of health and social care

• Planned or elective care

• Unplanned or emergency care

• New intermediate level services

• New ways of managing out patients and

chronic diseases

Page 6: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

How services will change…..How services will change…..

Acute

Intermediate

Primary / community

Old = organisational focus New = Pathway focus

10 20

Page 7: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Service Design GroupsService Design Groups

Emergency

Elective Chronic Disease

Management

Diagnostic & Therapies

Intermediate Care

ElderlyPrimary

Care

Childrens Interface

Group

Page 8: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

User / public involvementUser / public involvement

• Early principle of project

• Public consultation

• Patient focus

• Get it right!

• Requirement for planning services

• Methodologies

Page 9: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Care Pathways & Service RedesignCare Pathways & Service Redesign

• Integrated Care Pathways are one way of implementing protocols. They express locally agreed, multidisciplinary practice, based on guidelines and evidence, where available, for a specific patient group.They form all or part of the clinical record, document the care given and facilitate evaluation of outcomes for quality improvement purposes (Modernisation Agency, 2002)

• The first stage of an Integrated Care Pathway development relates to the provision or mapping of the patient’s journey, what is to happen , where, when and by whom.This is often referred to as the ‘High Level Care Pathways’ (Modernisation Agency 2002)

Page 10: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Accessing the detailAccessing the detail

• Identified a range of

diseases / patient

presentations &

services

• Clinical leads

• Events - Energise

Page 11: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Getting StartedGetting Started

• Clear methodology for the redesign processClear methodology for the redesign process• Identification of the key stakeholdersIdentification of the key stakeholders• Selection of case types based on pre set criteriaSelection of case types based on pre set criteria• Development of a project planDevelopment of a project plan• Inclusion and exclusion criteriaInclusion and exclusion criteria• Strategies for managing the redesign processStrategies for managing the redesign process• Reporting mechanismsReporting mechanisms

Page 12: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

A Sample Project PlanA Sample Project Plan

• Part 1: Part 1: Process Map of current patient’s journey and SWOT analysis against NHS PAF

• Part 2:Part 2: Process Map of future journey, Key proposals and the resource implications

• Part 3: Part 3: Potential Opportunities and Health Impact- access, outcomes, efficiency, effectiveness, patient’s experience. Key protocols and guidelines supporting the new journey

• Part 4: Part 4: Health and Social interventions and goals along the patient’s journey and manpower/skill mix identification

Page 13: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Outline Template for Pathways TIME

Primary

Prevention Early

Detection Assessment Primary Care

Management Intermediate

Treatment Secondary

Care Management

Tertiary Intermediate Recovery

Continuing Care/ Follow

up

WHO

WHAT

WHERE

HEALTH WHEN

WHO

WHAT

WHERE

SOCIAL WHEN

WHO

WHAT

WHERE

O T H E R

AGE NC Y

WHEN

Page 14: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Primary Care Model A&E

Model

Emergency Model

Theatre Model

Specialty Model

Intermediate Care Model

Chronic Disease Model

OBC Model

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 15: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 16: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

INDEPENDENCE DEPENDENCE DEPENDENCE INDEPENDENCESEMI - DEPENDENCE

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Dependence Continuum

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 17: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Management Systems• Systems of planning, finance, quality control, etc.

• Scheduling, access, outcomes, user experience, efficiency, effectiveness

INDEPENDENCE DEPENDENCE DEPENDENCE INDEPENDENCESEMI - DEPENDENCE

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Dependence Continuum

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 18: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Procurement• Commissioning, LDPs

• Modernisation Development Agenda

Management Systems• Systems of planning, finance, quality control, etc.

• Scheduling, access, outcomes, user experience, efficiency, effectiveness

INDEPENDENCE DEPENDENCE DEPENDENCE INDEPENDENCESEMI - DEPENDENCE

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Dependence Continuum

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 19: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Technology Development• PACS – Remote Health Management – ICRS – telemedicine & telemonitoring- Diagnostics & Lab

Procurement• Commissioning, LDPs

• Modernisation & Development Agenda

Management Systems• Systems of planning, finance, quality control, etc.

• Scheduling, access, outcomes, user experience, efficiency, effectiveness

INDEPENDENCE DEPENDENCE DEPENDENCE INDEPENDENCESEMI - DEPENDENCE

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Dependence Continuum

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 20: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Human Resource Management

• Recruiting, rewarding, retaining

• New roles, new ways of working, whole system working

Technology Development• Integrated patient record, PACS – Remote Health

• Management – ICRS – telemedicine & telemonitoring

Procurement• Commissioning, LDPs

• Modernisation Development Agenda

Management Systems• Systems of planning, finance, quality control, etc.

• Scheduling, access, outcomes, user experience, efficiency, effectiveness

INDEPENDENCE DEPENDENCE DEPENDENCE INDEPENDENCESEMI - DEPENDENCE

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Dependence Continuum

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 21: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Health Care Infrastructure

Human Resource Management

• Recruiting, rewarding, retaining

• New roles, new ways of working, whole system working

Technology Development• Integrated patient record, PACS – Remote Health

• Management – ICRS – telemedicine & telemonitoring

• SHIFT / LIFT / Health & Social Care Partnership

Procurement• Commissioning, LDPs

• Modernisation Development Agenda

Management Systems• Systems of planning, finance, quality control, etc.

• Scheduling, access, outcomes, user experience, efficiency, effectiveness

Social Services City Council Life Events Life Event & Life Cycle

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Care Continuu

m

OBC Model

Social Model

Support Activities

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive advantage, creating and sustaining superior performance – the value

system

Page 22: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Health Care Infrastructure

Human Resource Management

• Recruiting, rewarding, retaining

• New roles, new ways of working, whole system working

Technology Development• Integrated patient record, PACS – Remote Health

• Management – ICRS – telemedicine & telemonitoring

• SHIFT / LIFT / Health & Social Care Partnership

Procurement• Commissioning, LDPs

• Modernisation Development Agenda

Management Systems• Systems of planning, finance, quality control, etc.

• Scheduling, access, outcomes, user experience, efficiency, effectiveness

INDEPENDENCE DEPENDENCE DEPENDENCE INDEPENDENCESEMI - DEPENDENCE

Primary prevention

- Osteoporosis

- Falls managementEarly recognition

- call for help

- initial management

Primary Care Model A&E

Model

Emergency Model

Emergency model management

72hr stay

Operation time according to condition

Recovery

Theatre Model

Specialty Model

Specialty bed

Length of stay < 6 days

Intermediate Care Model

Intermediate Care

e.g. virtual, transitional, therapy beds

Chronic Disease Model

Secondary prevention & chronic disease management

A&E management

RCP guidelines

Fast track

Quality &

Cost

-

effective care

Acce

ss Effi

ciency

Patie

nt / U

ser

Experie

nce

Outco

mes E

ffectiv

eness

Equity

Care Continuu

m

OBC Model

Dependence Continuum

Support Activities

Laxade S: Creating and sustaining superior performance in health care - an adapted model of M E Porter: Competitive

advantage, creating and sustaining superior performance – the value system

Page 23: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

START Patient consults General Practitioner

GP assesses needs

Hernia diagnosed / suspected

GP sends referral letter to hospital

Consultant triages patient and informs appointments

Hospital sends appointment to patient

Initial outpatient consultation. Consent given. Patient put on

waiting list

Hospital pre-operative assessment

… six, nine, twelve months later

Patient attends Day Case Unit - Operation - Home on

day of surgery unless clinically contra indicated

Review in outpatient 4-6 weeks later, discharge to

GP. Audit completedEND

YES

Refer to appropriate agency

NO

Page 24: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

START

• Patient consults GP with hernia

• GP assesses condition and suitability for day case hernia according to anaesthetic and surgical protocol

• Investigations and test if necessary

• GP books patient into Day Case Unit operating list via direct booking on line according to the patients preference

• GP emails referral letter and Day Case suitability pro forma to hospital- Consent in principle

• Patient attends Day Case Unit Seen by Surgeon and Anaesthetist

• Written consent

• Operation if appropriate and fit- Same day discharge

• Review appointment with GP / a Nurse in Primary Care

• On line audit form completed and emailed to hospital

END

Page 25: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Goal achieved

GP level. Patient presents

with hip pain

GP assessmen

t using joint

protocol

Serious pathology suspected

Refer to orthopaedic consultant

immediately

END

Refer to appropriate

agency

END

Hip problem suspected

NOYES

YES

Refer to PCT Central Booking System for

physio triage. Commence pain

management

Triage in primary /

secondary care

Patient <50 years Vascular necrosis

suspected,significant hip pain

Refer to orthopaedic

surgeonIdentify cause Treat

accordingly

Patient appropriate for

surgery

P1

Refer to orthopaedic consultant

Outpatient appointment

within 4 weeks

Listed for surgery via

booking system

Outpatient appointment via central booking

system

PC Stage 1 Pre-operative assessment

within 2/52 of listing

New Zealand score. Priority assessment/

Health Management Hip assessment. Wish

for surgery

YES

MDT assessmen

t Goal setting

Identify address All home

alterations/ modifications

Surgical consent

Back to primary care for goal management

Admit on day of surgery, subject to anaesthetic

criteria. Surgery 3/12

NO

Hospitalisation. Length of stay 3/5

days unless clinically indicated

Hospitalisation goals achieved

Discharge home6 weeks review ? P Care

12 weeks reviewYES

NO

YES2nd pre-op

assessment + Anaesthetic assessment

Treat as P3

Page 26: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Intermediate Care needed

YESIdentify

package of care

setting, etc.

Options

Transitional home/

Intermediate Care/ Hospital Intermediate

Care

Goals met

1 year review Indefinite review via THR system

DischargeGo to review system Chronic

D Mang

END

Outcome of New Zealand Hip Score

Patient improving

Review management

Treat as P3

Priority classification. Care for all

Refer to community

physio and OT via booking

system

Pain management according to

pain guidelines

Review New Zealand hip

score in primary care 3/12

P3

Manage according to P2

Refer to Orthopaedic Surgeon

Continue P3 programme

Outpatient physio GP

managementReview 3 to 6 months

Pain management

if required

New Zealand Score P3

P2

NO

P3

P1

P2

Remain at P2 Continue programme

Review in 3/12

Refer to Orthopaedic

Surgeon

P1Surgical

management

DISCHARGE Review system

END

Page 27: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Future underpinning of Elective CareFuture underpinning of Elective Care

Application of the 72 hour principleAn amalgam of service models as identified in OBCFocus on length of Stay underpinned by outcomes and coordinationUse of a range Intermediate Care facilitiesDependence on IM&TSupported by new roles and functionsHigh S Care acuity and turnover leading to quicker access Redefinition of purpose of Secondary and Primary CareClinical Governance across whole systemPost-op review in Primary Care Linked to Social Services and City Council Life Event Model

Page 28: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Planned Care…………….Planned Care…………….

Key Change Principles emerging from the Redesign

Primary Prevention and Early Detection StrategyManagement in Primary Care via Joint Protocol Development and Clinical NetworkInformal access to Surgeons and Physicians if requiredReferral according to pre set criteria via Central Booking SystemNot all Patents need to go to OutpatientInvestigations and Diagnostics in Primary Care prior to referralSurgery in an appropriate location based on Risk criteriaPre-op location based on Anaesthetic RiskAdmission on day of Surgery

Page 29: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Integrating the Redesign into the Integrating the Redesign into the Commissioning ProcessCommissioning Process

The Logical StepsThe Logical StepsProcess map of current serviceProcess map of current serviceSWOT Analysis/NHS PAFSWOT Analysis/NHS PAFFuture DesignFuture DesignResource Implications and Economic ModelResource Implications and Economic ModelClinical Governance - Guidelines/ProtocolsClinical Governance - Guidelines/ProtocolsMedicine Management CommitteeMedicine Management CommitteeProfessional Executive CommitteeProfessional Executive CommitteeIntegration into LDPs/Financial FlowsIntegration into LDPs/Financial FlowsDirectorate’s agendaDirectorate’s agendaMonitoring by ExceptionMonitoring by Exception

Page 30: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Resource ImplicationsResource Implications

• PeoplePeople• TimeTime• User InvolvementUser Involvement• SupportSupport• PlanningPlanning• Specific Needs client / patient groupsSpecific Needs client / patient groups

Page 31: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

BarriersBarriers

• Time » Right people – right time» Short term delivery targets v long term improvements

• Culture» Bureaucracy & Institutional loyalties» Adversarial approach between primary & secondary care» Silo thinking & working» Risk aversion» Professional & inter professional tension & rivalry» Limited ownership locally of overall strategy

• People» Resistance to change – suspicion, fatigue, cynicism, apathy» Self preservation, empire building» Fear – involving patients & carers

• Information» Lack of good quality / whole system information & data» Lack of shared information

Page 32: Whole system pathways and commissioning as a dynamic approach

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alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Overcoming barriersOvercoming barriers

• Skills– Energiser– Barometer– Programme Manager– Facilitator– Translator– Communicator

Page 33: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Strengths of the processStrengths of the process

• Relationship changes• Energy & Enthusiasm• Mutual understanding and agreements• Communication & networking

Page 34: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

What are we doing now? What are we doing now? How will How will we make the change stick?we make the change stick?

• Created SHIFT vision, service principles and sample

care pathways

• Directorate / service level planning

• Core organisational focus

• Early wins

• Tier 2 / Collaboratives / NSFs / etc.

Page 35: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

The challenge for The challenge for commissioningcommissioning

How can commissioning makeservice redesign work?

Page 36: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

How can commissioning help?How can commissioning help?

• Costs & activity• Financial flows• Local Delivery Plans• Ongoing quality & activity monitoring

Page 37: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Pathways & commissioningPathways & commissioning

• Translate pathways into separate elements with:– Costs– Locations– Expected activity– Quality measures– Quantified impact on existing services

• This will be the basis for commissioning redesigned services

Page 38: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Financial flowsFinancial flows

• Payments linked to activity• National tariff price for each HRG• Full cost implications of activity changes• Regime is still developing• Issue of currency & tariff for:

– Mental health services– Community services

Page 39: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Using financial flowsUsing financial flows

Financial flows means• Moving activity at full cost• Patient choice is reflected in payments

But…• Need to develop mechanisms for pathways to

cross between primary & secondary care

Page 40: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Local Delivery PlanningLocal Delivery Planning

• Sets out actions to meet key deliverables• Prioritisation process for schemes

So…• Actions arising from service design must be

reflected in the LDP• Service design resource requirement must be

subject to appropriate scrutiny and prioritisation

Page 41: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow

Ongoing monitoringOngoing monitoring

• Develop mechanisms and indicators to monitor:– Quality of service provided– Activity delivered– Access to services

• The above will be required for each part of the pathway

Page 42: Whole system pathways and commissioning as a dynamic approach

Project

alford’s HHealth IInvestment FFor TTomorrow

Project

alford’s HHealth IInvestment FFor TTomorrow