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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
Context
• Two systems

• Forces against integration?

• What good looks like

• How we might get there
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
Two nations divided by a common
language?
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
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
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)
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
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
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?
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?
Operationalising integration




  Source: Rosen et al (forthcoming)
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
Conclusions
• Integrated commissioning, easy to say,
  tough to deliver

• In developing the structures, pay attention to
  the ways of working

• Size of the prize!
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

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Peter Hay: Making links with GPs: influencing commissioning

  • 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!
  • 15.
  • 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