Strategic Commissioning

What was the issue you were addressing or working on?

The purpose of the strategic commissioning plan is to set out the Highland approach to commissioning services for older people between 2014-2019 in terms of quantified quality, volume, value and location, and to set out how this is to be achieved.

NHS Highland currently spends around £500m per annum on providing or delivering adult care services, with around half of this on older people. The challenge for this plan is to ensure that this resource is used to achieve the outcomes based on what people have told us they need and our understanding of what would meet these needs. The plan also needs to move us away from traditional ways of thinking about meeting people’s needs in terms of beds and buildings and towards a greater emphasis on early intervention and anticipatory support. In achieving this shift, it is intended that a more vibrant and energised care market will be created; maximising potential for self directed support and creating opportunities for greater choice and innovation for how people’s needs can be met.

What you did?

“There must be nothing about us without us”.  The Strategic Commissioning Plan for Highland has been developed through a co-productive approach by NHS Highland and its commissioning partners – and has involved a cross sector Project Team, with the developing work overseen by the wide range of representation round the Adult Services Commissioning Group.  It is therefore not NHS Highland’s plan, but a jointly owned plan for Highland.  Crucial to the development of the plan and setting the priorities for the future, has been the inclusion of service users and their carers, as well as input from providers and their representatives and these key stakeholders have been included as partners at every level and stage of the plan’s development.  This first Plan focuses on services for older people over the next five year period (2014-2019).  Our approach is an evolving process and more detailed direction for both older people and other population groups will be produced over 2014-2015.

An Adult Services Commissioning Group has been established. The Group is jointly chaired by the Chief Operating Officer (NHS Highland) and the local Chair for Scottish Care.  The Group reports to the Health and Social Care Committee (sub committee of Board); its membership is spread (as equitably as possible) across NHS; Third; Independent Sectors and Service users and carers.

This group was set up to drive strategic commissioning across the whole integrated Adult Care budget (circa £0.5m) rather than being limited to the Change Fund (£3.9m)

The group has unfettered access to finance; performance and health intelligence information.

The group has made progress in moving from a traditional bidding (from Change Fund) and procurement (NHS design spec in isolation and sectors tender) approach, to some new models of collaboration. (eg. on recruitment; tariff and zoning for care at home)

The group also wrote the strategic commission plan, introducing ideas around commissioning for quality and some bold ideas about investment/disinvestment.

The following are the key priority areas to be delivered through this plan:

  • Ensure the best available evidence is used for making decisions
  • Increase transparency on price and quality
  • Pay for value
  • Enhance quality, efficiency and capacity of care at a local level
  • Increase dignity and quality of care for seriously/terminally ill patients
  • Focus on prevention
  • Build the foundation of a sustainable health and social care system across all sectors

What were the outcomes - benefits or otherwise?

The principal benefit has been to move from a traditional purchaser/provider relationship to a co-productive commissioning approach.  Key issue is that the journey to this point has been challenging and required a shift (by all parties) from often adversarial approaches.  But it’s early days

Contacts - to find out more

Simon Steer, Head of Strategic Commissioning