Post on 01-Apr-2015
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
Performance Regimes
Financial pressures
Organisational complexity
Changing leadership
Financial complexity
Less hindrance to integrate than 2010?
Source: NHS/Confed Where Next for Health and Social Care Integration, June 2010
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
‘A wider service offer’
Citizen purchased care – state resources
Citizen purchased care – own resources
Enablement
Prevention
Support and information 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?
Source: Rosen et al (forthcoming)
Operationalising integration
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!
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