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World Class Commissioning a Guide for Professionals
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Transcript of World Class Commissioning a Guide for Professionals
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Commissioning Supportfor London
Mental HealthWorld Class Commissioning.A quick guide for mental health professionals
August 2009
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Mental Health World Class Commissioning.A quick guide for mental health professionals2
Engagement in commissioning involvesunderstanding and applying:
thepolicyandstrategiccontextofMentalHealthWorld Class Commissioning ( WCC)
howtoinuenceWCCandthedecisionsmadebycommissionersinyourlocality
thepublichealthandevidencebaseforWCCdrivers.
Engaging in commissioning requires the mentalhealth proessional, clinician and practitioner to:
focusontherelationshipsyouhavewithcommissioningcolleaguesandhowtocommunicateclinicalchallenges
understandhow,whenandwheretheabovetwiththecommissioningdecision-makingprocess.
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Mental Health World Class Commissioning.A quick guide for mental health professionals4
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 2009 05
Foreword 03
Who is the guide or? 06
Why read it? 06
What does it cover? 07
Understanding mental health policy 08
Commissioning or mental health 12
World Class Commissioning 13
What are the World Class Commissioning competencies? 14
Why does World Class Commissioning matter to the mental health proessional? 15
The commissioning cycle stage by stage 16
Working better together 21
Useul links 23
Reerences 24
Acknowledgements 25
Contents
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200906
The guide is or clinicians and other mental
health proessionals working along the
mental health care pathway who would
like to learn more about the principles o
World Class Commissioning (WCC) and how
they could be involved in improving services
or users. Mental health commissioning is
relevant to many dierent stakeholders:
people who use services, people who deliverservices, those who monitor perormance
and eectiveness, and the wider public.
This guide has three objectives:
1 awareness to highlight the challenges
aced by commissioners, clinicians, and
other proessionals who are working to
implement strategic commissioning at
local level
2 knowledge to improve understanding
o the commissioning process
3 application to describe how mental
health proessionals can get involved
in commissioning, and how
commissioning colleagues can benet
rom the involvement o mental
health proessionals.
Mental health proessionals have an
important role to play in infuencing
commissioning decisions.
The purpose o this guide is to describe
the basics o WCC and encourage mental
health proessionals to get involved in the
commissioning agenda and work with the
health and social care commissioners intheir area.
The guide explains how mental health
proessionals can:
inuence decisions in partnership
with commissioners
understand the political and perormance-
related incentives that guide the work o
commissioners
improve services, and
build on opportunities to improve
outcomes and quality.
Who is theguide for?
Whyreadit?
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 2009 07
The guide starts with an overview o current
mental health policies, setting the context
or the World Class Commissioning agenda.
It goes on to:
explain what World Class Commissioning
is, and what it demands of those
responsible for commissioning
health services explain the commissioning cycle whereby
commissioners arrive at their decisions
about what services to commission
explain why and how mental health
professionals can and should get involved
in the commissioning process
suggest some prompts that highlight
what professionals can bring to the
commissioning process
explore barriers to professional
involvement in commissioning, and
suggest ways in which professionals
and commissioners can work together
to improve mental health services.
What doesitcover?
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200908
Mental Health World Class Commissioning
operates within the context o a number o
key national policies and guidance.
National Service Framework for MentalHealth (Department o Health, 1999)
The National Service Framework (NSF) for
Mental Health (Department o Health,
1999) prioritised mental health as one othree key health issues requiring investment
and development, alongside coronary
heart disease and cancer. It set out seven
standards, with milestones or achieving
set objectives within its ten-year liespan,
within a national template o evidence-
based services or working age adults with
which local mental health services were
required to comply. These services, covering
mental health promotion, primary mentalhealth care, services or people with severe
mental illness, services or carers, and
interventions to prevent suicide, were to
be provided seamlessly between agencies
and available around the clock. A review
o the implementation o the National
Service Framework, published in 2004,
ound that mental health services had been
successully reshaped according to the NSF,
but there remained areas requiring urther
improvement specically, inpatient care,
services or people with dual diagnosis, social
exclusion o people with mental health
problems, services or ethnic minorities, and
access to psychological therapies.
New Horizons
A new Department o Health strategy, New
Horizons, will replace the NSF towards the
end o 2009. New Horizons is expected
to give more weight than the NSFto theimportance o promoting whole-population
mental health and well-being across the
liespan, while supporting continued
improvement o specialist services or people
with severe and enduring mental health
problems. It will also address the inequalities
that dierent groups in society experience,
both in access to services and in levels o
mental health. It will guide a programme o
action or mental health services rom 2010
and bring together agreed principles andpriorities under one banner, aligning them
with High Quality Care for All(the Darzi
report, see below) and other government
health and social care policies, such as
Putting People First(see page 9).
At the time o going to press, New Horizons
is out or consultation until 15th October
2009. For urther inormation please
go directly to the Department o Health
wesbite: www.dh.gov.uk/en/Healthcare/
Mentalhealth/NewHorizons/index.htm
Delivering Race Equality: an action planfor reform (Department o Health, 2005)
The Delivering Race Equalityaction plan was
published in 2005. It draws on the report
into the death o David Rocky Bennett in
a medium secure unit in Norwich in 1998,
and a growing body o evidence that people
rom black and minority ethnic groups are
disproportionately detained in psychiatric
units, have a poorer experience o mental
health services than their white British
counterparts, and are more likely to be
subject to compulsory treatment. Delivering
Race Equalitysets out a ve year action
plan or achieving equality and tackling
discrimination in mental health services or
all BME people, including people o Irish and
Mediterranean origin and east Europeanmigrants. The action plan comprises three
main building blocks:
Understanding mentalhealthpolicy
http://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htmhttp://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htmhttp://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htmhttp://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htm -
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moreappropriateandresponsiveservices
communityengagement,viacommunity
development workers based in every PCT
betterinformation,includinganew
annual census o mental health patients.
Our Health, Our Care, Our Say:anew direction for community services
(Department o Health, 2006)This document emerged rom an
extensive consultation with the public and
proessionals. It builds on Choosing Health,
the public health White Paper (Department
o Health, 2004), which identied the
improvement o mental well-being as a
priority or health and social care services.
Our Health, Our Care, Our Saysets out how
NHS and social care services should work
together to provide more individualised
health and social care services that better
meet peoples needs and are available closer
to their homes. It states that health andsocial care services should be more fexible
and more personalised to meet the health
and social care needs o individuals, and
should give patients and service users more
control over the treatment they receive.
It gives GPs, primary care trusts and local
authorities more say in how best to plan and
commission services or local communities,
outlines the need or a shit in resources
towards preventive services, and encouragesgreater partnership between statutory
health and social services and the third sector.
Commissioning Framework or Health andWell-being (Department o Health, 2007)
This provides a ramework and practical
suggestions, including resources and
sources or tools, or commissioning or
health and well-being rom 2008/09. It
sets out a number o objectives to help
people stay healthy and independent
and to build stronger communities. These
include giving people choice about care
services, delivering services close to home,
and tackling health inequalities.
Putting People First(Department o Health, 2007)
Putting People Firstis jointly endorsed by
all government departments and many
o the lead voluntary sector organisations
concerned with adult social care. It outlines
the governments vision or a personalised
adult social care system that is designed to
maximise peoples independence, choice
and control over their own lives and care.
Its proposals include a rst stop shop to
provide a universal inormation, advice and
advocacy service or people needing social
care services, and their carers, irrespective
o their eligibility or public unding.
It introduces the Joint Strategic Needs
Assessment, to be conducted together
by NHS providers, local authorities and
PCTs, and combined with other local
needs assessments (i.e. housing) to orm a
Sustainable Community Strategy or the
area. It sets out how these agencies can
identiy and agree, with other stakeholder
organisations, how best to meet local
priority needs, and which agency will do
so, through Local Area Agreements. It alsointroduces personalised budgets or all those
eligible or state-unded social care services.
social care servicesshould be more fexibleand more personalised
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200910
The Local Government and PublicInvolvement in Health Act 2007 (HMSO, 2007)
This Act enacts the 2006 Local Government
White Paper. Among its provisions directly
relating to health and social care, it replaces
the Patient and Public Involvement Forums
(PPIFs) with Local Involvement Networks
(LINks), to provide the patient and public
voice in the planning and delivery o local
health and social care services (PPIFs related
only to health services), and claries and
strengthens the existing duty on NHS bodies
to involve and consult patients and the
public in the planning and provision o
services. It places a specic duty on local
authorities to undertake Joint Strategic
Needs Assessments and to consult with their
local communities. It also requires PCTs, local
authorities and other relevant bodies to co-
operate with each other in the development
and agreement o Local Area Agreements,
which are also given statutory status.
Cross-cutting prioritiesIn addition, the government has identied
a number o key, cross-cutting priorities to
which all public services are expected to
contribute. In mental health and social care,
the most relevant are:
personalisation
socialinclusion.
Personalisation
Personalisation embodies the governments
aim to put people rst in public service
delivery. The stated aim is that people should
be able to live their own lives as they wish,
and should receive high quality, sae health
and social care services that support theirown goals and promote their independence,
well-being, and dignity.
This approach is set out in Putting People
First, which states that every person who
receives support, whether provided by
statutory services or sel-unded, will have
choice and control over the shape o that
support in all care settings. Direct payments
and individual budgets are seen as the
means to deliver this aspiration.
Social exclusion
Social exclusion in relation to adults with
mental health problems is documented
in the Mental Health and Social Exclusion
report, published in 2004 by the Oce o
the Deputy Prime Minister. This highlighted
the lack o employment opportunities,
poverty, poor housing, social isolation,
stigma and exclusion rom community
services experienced by people with severemental health problems.
Government action to tackle social exclusion
is set out in the Public Service Agreement
(PSA) 16 (see overlea or an explanation
o PSAs). PSA 16 ocuses specically on the
needs o our client groups who are seen as
particularly vulnerable to poor lie outcomes
and multiple orms o disadvantage:
youngpeopleleavingcare offendersunderprobationsupervision
peoplereceivingsecondarymental
health services
peoplewithmoderatetosevere
learning disabilities.
PSA 16 has two key aims: to increase the
numbers o people in these groups living
in settled accommodation, and to increase
employment, education and training ratesin these groups. Government departments
signed up to achieving these aims include
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 2009 11
the Department or Work and Pensions,
the Department o Communities and Local
Government, the Ministry o Justice, the
Department o Health, the Department
or Innovation, Universities and Skills, and
the Department or Children, Schools and
Families. This partnership approach will
be refected at local authority and health
service commissioning and delivery level.
Policy into practicePublic Service Agreements (PSAs)
The strategic ramework governing the
delivery o all government policy is provided
by the Comprehensive Spending Review
(CSR) and Public Service Agreements. The
aim is to ensure the relevant government
(national and local) departments work
together to address areas o priority publicservice need, and that public spending
and perormance at local level is careully
monitored to ensure quality o service
provision and value or money.
The CSR sets out the governments public
spending plans. PSAs provide the perormance
management ramework whereby the
government sets out the outcomes expected
to be delivered by public services at nationaland corresponding local levels.
PSAs or the current period (2008/09
2010/11) are set out in the Comprehensive
Spending Review 2007. The PSAs are
grouped under ve main headings:
helppeopleandbusinessescomethroughthe
downturn sooner and stronger, supporting
long-term economic growth and prosperity
fairnessandopportunityforall abetterqualityoflife
strongercommunities
amoresecure,fairandenvironmentally
sustainable world.
Those with specic relevance or mental
health and social care are:
Fairnessandopportunityforall
Address the disadvantage that
individuals experience because o their
gender, race, disability, age, sexual
orientation, religion or belie
Increase the proportion o
socially excluded adults in settled
accommodation and employment,
education or training.
Abetterqualityoflife
Promote better health and
well-being or all
Ensure better care or all.
Each PSA is underpinned by a single delivery
agreement shared across all government
departments concerned. Delivery
agreements are expected to be developed
in consultation with NHS trusts and other
agencies who will be delivering the services,
and with rontline workers.
At local level PSAs are refected in Local Area
Agreements (LAAs) and Local Public ServiceAgreements (LPSAs). Local Area Agreements
may cover one or more local authority
area and set out goals, agreed with all
participating agencies, or service delivery
across a range o public services.
Local Public Service Agreements provide a
ramework through which local authorities
and other local organisations agree targets
or service delivery and improvement withcentral government, and are nancially
rewarded or achieving these targets.
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200912
Commissioning is the process whereby PCTs
and local authorities translate the aspirations
and needs o their local populations into
services that:
deliverthebestpossiblehealthand
well-being outcomes
reduceinequalitiesandpromoteequality
providethebestpossiblehealthandlocal
authority provision
achievethebestuseofavailableresources
Put simply, commissioning is the cyclical
process o planning, developing, monitoring
and reviewing health and social care services.
The role o the mental healthcommissioner
The mental health commissioner is the
executive ocer within a PCT responsible
or taking a lead on assessing local
mental health needs, reviewing service
provision, developing strategic plans
and commissioning services and service
development or the population served
by the PCT, the local authority, and third
sector organisations.
It is important to remember that
commissioners do not work in isolation.PCTs will have a number o commissioners
with lead responsibility or each o the
health specialisms.
Commissioningfor mental health
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World Class Commissioning (WCC) was
launched by the Department o Health in
2008. It is an ambitious programme, based
on best practice in the UK and other health
systems around the world, to transorm the
way in which PCTs ull their commissioning
unction. Its aim is to help PCTs deliver better
services that are more closely matched to
local needs, resulting in better quality ocare, improved health and well-being and
a reduction in health inequalities across the
community.
WCC does this by creating a ramework
through which PCTs can ocus on improving
the health o local people.
There are our key elements to the World
Class Commissioning ramework. Vision - To achieve world class excellence
in delivering health improvement
through commissioning.
Assurance system - To develop
appropriate rameworks or implementing
world class commissioning and ensuring
improved health outcomes.
Competencies - To dene the knowledge,
skills, behaviours and characteristicscommissioners will need to reach world
class status.
Support and development - To develop
tools or commissioners to deliver
improvements, either by sharing
services and costs across localities,
remodelling and expanding internal
resources, or buying in external expertise.
Outcome-based commissioning
Outcome-based commissioning ocuses
not on activities and processes but on
results. It represents a shit away rom
previous practice whereby commissioning
was based on providers meeting contractual
requirements through outputs such as
the number o hours or type o service
to be provided. Outcome-based
commissioning means that providers will
have to demonstrate how their services
will achieve real and tangible benets or
the local population.
The task or commissioners is to dene
what systems and services need to be
in place in order to meet the outcomes
required or their local populations and then
support providers to improve services that
are not working towards those outcomes.
Improvements may be in:
clinicalandcareoutcomes
healthoutcomes
communityoutcomes
World ClassCommissioning
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What are the World ClassCommissioning competencies?
14
There are 11 competencies (or sets o
skills) in which commissioners and PCTs are
expected to demonstrate their prociency.
Below are listed the WCC competencies
with most relevance to mental health
proessionals, and a brie explanation o
what they mean in practice.
Leading the continuous and meaningul
engagement o all clinicians to inorm
strategy and drive quality, service design
and use o resources.
Commissioners are explicitly required to
involve and draw on the knowledge and
experience of frontline practitioners when
researching and making decisions about
commissioning services.
Proactively seeking and building
continuous and meaningul engagement
with the public and patients, to shape
services and improve health.
Commissioners are explicitly required to
consult with and involve service users and
the wider public in reaching their decisions
about local needs and how best to meetthem.
Stimulating the market to meet demand
and secure required clinical and health
and well-being outcomes.
Commissioners are expected to encourage
innovation and look beyond their usual
providers when inviting tenders from
organisations to run services.
Promoting and speciying continuous
improvements in quality and outcomes
through clinical and provider innovation
and confguration.
Commissioners are expected to promote
and support innovative approaches
to clinical care and treatment and the
organisation o services to deliver betterquality and improved outcomes.
The ull list o WCC competencies
can be ound at: www.dh.gov.uk/en/
Managingyourorganisation/Commissioning/
Worldclasscommissioning/Competencies/
index.htm
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/Competencies/index.htm -
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WhydoesWorldClassCommissioningmatter to mental health professionals?
Proessional leadership and involvement
should be an integral part o the
commissioning process. Mental health
proessionals and clinicians work with
their local communities and know about
local needs and shortalls in service
provision. Their knowledge is o paramount
importance or inorming strategic plans and
decision-making during commissioning.
Mental health proessionals and clinicians
are well placed to draw attention to and
advise on issues relating to quality and
eectiveness o services. They can also
oer valuable insights on the eectiveness
o care pathways and the points at which
early interventions can be most successully
implemented.
Clinicians have animportant role toplay in assessinglocal needs and
shaping priorities(World Class Commissioning: vision.
Department o Health, 2007)
Barriers to proessional involvementin World Class Commissioning
There are a number o reasons why
proessionals may not be currently
suciently involved in the commissioning
process. These include pressure on timerom their work commitments, incomplete
understanding o the commissioning process
and its relevance to their clinical and
proessional practice, and concerns that their
contributions may not be valued.
Increased proessional involvement in
strategic planning and service design
is a critical component o World Class
Commissioning and essential in ensuring
clinical excellence.
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Thecommissioningcycle
16
The commissioning cycle is the annual
process by which commissioners are
expected to deliver improved health and
well-being outcomes.
It describes the continuous process whereby
commissioners collect, analyse and use data
to make decisions about spending and
service development. The commissioningcycle also helps commissioners think about
the strategic plans they need to produce,
and when.
Understanding the eight stages o the
commissioning cycle is central to the
successul infuencing o commissioning
decisions. Mental health proessionals
are well-placed to provide important
inormation at a number o points in thecycle. Ultimately, proessional involvement
helps to ensure that commissioning
decisions and resource allocation meet
the needs o people with mental illness,
address actors that negatively aect
mental health, and support well-being.
In addition, the commissioning cycle includes
the development, review and approval o
three urther key plans.
1 The Strategic Commissioning Plan (SCP)
is produced by every PCT and establishes
its direction and priorities or at least the
next ve years. It is developed every three
years and updated annually. The CSP
should be available on your PCTs website.
2 The Operating Plan sets out how the PCT
plans to achieve the health outcomes and
nancial goals set out in the Strategic
Commissioning Plan (SCP). It includes
targets, nancial and activity schedules
and action plans. It is developed annually.
3 The Organisational Development Plan
describes the organisational capabilities
needed to deliver the Strategic
Commissioning Plan, and any capability
gaps and how they will be lled. It is
developed every three years and updated
annually. PCT boards are required to work
with local stakeholders (these include
mental health proessionals) to ensure
these plans are comprehensive and joined
up with local delivery.
PCTs are expected to work with local
stakeholders to ensure these plans are
comprehensive and integrated into local
delivery plans.
The role o the Strategic HealthAuthority (SHA)
Strategic Health Authorities (SHAs)
have a regulatory role in that it is their
responsibility to ensure that all threeplans contain nancially sound options
that are regularly reviewed and lead to
signicant improvements in the health
o local populations.
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The commissioning cycle stage by stage
This section describes the WCC cycle in more detail, and oers suggestions about where and
how mental health proessionals, clinicians and practitioners can maximise their impact at
each stage.
The diagram below explains the commissioning cycle. It is just one example: approaches may
dier rom area to area.
1 Assessing needs
Understandingthehealthcareneedsof the PCT population
Stakeholderengagement Engagingclinicalchampionsand
serviceleaders
2 Reviewing services and
gap analysis
Reviewingservicescurrentlyprovided Deningthegapsorover-provision
3 Risk management
Understandingthekeyhealth
and health care risks Decidingonastrategytomanage risks
4 Deciding priorities
Robustevidencebase Costcomparisons Prioritisingareasforpurchase
5 Strategic planning
Collatingallinformationinoneplan(CSP)
Settingactionpointsfordelivery
including: localcoreobjectives SHAandDHpriorities
8 Managing provider perormance
Managingproviderperformanceandsustainingquality
Monitoringagainstcontractsandkeyperformanceindicators
7 Provider development
Carepathwayre-designanddemand management
Supportingproviderimprovementsorintroducingnewproviders
Supportingprovidersindecommis-sioningofservicesasappropriate
6 Contract implementation
Implementingstrategicplans
throughcontractingwithproviders Allcontractscommissionedto demonstrate clear anddenedoutcomes
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200918
Step 1 Assessing Needs
Commissioners need to build an accurate
picture o the health and health care needs
o the local population. The PCTs website
should include details o the standards,
reviews and commissioning plans o which
mental health proessionals, clinicians and
practitioners need to be aware. The PCTs
annual review will show how well it is
perorming in its commissioning unction
against the WCC ramework. Every PCTs
progress and development needs are assessed
through an annual assurance check.
3 Check your local PCT website or a copyo the World Class Commissioning Report
2009 that gives an outline o your PCTs
progress to date and details or supporting
strategic plans or improving health andwell-being within the local community.
Step 2 Reviewing services and gap analysis
Based on the known needs o each area
within their remit, commissioners need to
review existing services and the extent to
which the services they commission meet
those needs, and identiy any areas o
over-provision or gaps. All PCTs and local
authorities are required by law to produce aJoint Strategic Needs Assessment (JSNA). This
provides the evidence base or the health
and well-being o the local population,
including health, mental health, housing,
education, deprivation levels, economic
activity etc, which will allow decision makers
to identiy areas o need, and how these are
likely to change in the uture. By drawing
together these needs in a single document,
the JSNA enables local agencies to worktogether and co-ordinate planning to ensure
their services meet current and uture needs.
3 Have you seen your local Joint StrategicNeeds Assessment (JSNA)? Ask or a copy
rom your mental health commissioner. Does
it match your understanding o the health
needs o the communities with which you
work? Are there areas o need that the
needs assessment has missed?
Step 3 Risk management
Commissioners need to identiy the main
health and health care risks (ie. unexpected
need or a particular service, an ageing
population that may need services in the
uture) anticipated in their local area, and
contribute to a strategy that addresses and
mitigates those risks.
3 Through your work, identiy anysignicant health and health care risks,
both current and looking ahead to the
uture. What evidence do you have or their
existence and what potential solutions can
you suggest to commissioners?
Step 4 Deciding priorities
Based on sound evidence and an ethical
ramework, commissioners need to be ableto advise the PCT on the current health and
health care priorities in their area.
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3 Is the evidence base comprehensive?Does it include the data and inormation
you have collected rom your services how
people access your services and the levels
o uptake? Are you aware o planned
investment/disinvestments plans that may
aect your service next year? Do you know
how mental health commissioning plans mayaect your service in the next 12 months? Is
the local Strategic Commissioning Plan (SCP)
inormed by the expertise o the people
working in your service and the data you
have collected?
Responsibility or some mental health
commissioning is being transerred
rom PCTs to general practitioners (GPs)
and other senior primary care clinicians
through a process known as practice-based
commissioning.
3 Are local practice-based commissionersaware o your service? How can your
specialist input improve their knowledge
o local health needs and the decisions
they make? Do they have plans or uture
investment/disinvestment that may aect
your service?
Step 5 Strategic options
By collating the evidence into a single
Strategic Commissioning Plan,
commissioners are able to take a strategic
view on immediate, medium and long
term commissioning objectives. The SCP
also takes into account national and
regional perormance indicators and
outcomes required by the SHA and the
Department o Health.
3 Read the Strategic Commissioning Planor your area. Do the priorities outlined
match your own views o the areas in most
need o service development? Do you have
the inormation necessary to infuence the
detail and delivery o the SCPs objectives?
Do you have a good understanding o the
local and national perormance drivers thatmay aect the way you deliver and monitor
the eectiveness o your service? Ask your
commissioner or a list o national and
regional priorities that are relevant to
your service and or guidance on how
you may be asked to meet perormance
indicators or targets.
Step 6 Contract implementation
Commissioners then translate their strategicplans into contracts, setting out value or
money, clinical and service use outcomes,
service models and perormance monitoring.
These ensure that the PCT is meeting its
obligations to procure high quality services
that achieve health improvements or all
sections o the community.
3 Do you have a good understanding o
the contract arrangements or your service?Are you aware o the new contracting
arrangements proposed in the standard
-
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200920
mental health contract guidance issued by
the Department o Health? The Department
o Health has published two new standard
contracts that will be used by primary care
trusts (PCTs) to contract health and care
services with any provider rom April 2009.
There is one or general community based
services and another or specialist mental
health/learning disability or substancemisuse services. The contracts contain
standard legal terms that cannot be changed
and a service specication template or
completion at a local level or each service.
For urther details, visit: www.dh.gov.uk/en/
Managingyourorganisation/Commissioning/
Systemmanagement/DH_085048
Step 7 Provider development
In addition, PCTs have a responsibility to
support and resource providers to improve
and develop their services and sta, and to
encourage new providers to develop new
and innovative service options.
3What are the outcomes expected romyou individually and rom your service as
a whole? How can you contribute to these
outcomes in your work, and how can you
best demonstrate tangibly that you aredoing so?
Step 8 Managing provider perormance
Commissioners are required to monitor
and manage the perormance o the
providers they commission. How providers
report on their perormance should be set
out in the contract, together with any key
perormance indicators that may have been
set by the SHA.
3 Have you seen the perormance returnsor your service or been involved in service
monitoring visits? Knowing what your
service specication says and what your
service is expected to deliver are important
as it will help you understand the strategic
process whereby your service
is commissioned and monitored.
Ask your local commissioner to add you to
their circulation list or any consultations.
You need all this inormation to inuence
commissioning decisions in your locality.
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048 -
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Workingbetter together
The introduction o World Class
Commissioning requires new competencies
or commissioners and proessionals involved
in the planning and procurement o mental
health services. These changing roles have
an impact on the commissioner-provider
relationship, resulting in a dierent dynamic
and new ways o working. As commissioners
consolidate the WCC competencies and theirrole develops, so too must the knowledge
and skill base o those who work with them.
World Class Commissioning requires
commissioners and proessionals to work
constructively and positively together. So
3Build a dialogue and share yourperspective
Develop a good working relationship withyour commissioners. Establishing regular
dialogue will help them understand and
appreciate the challenges proessionals ace,
and ensure your perspectives contribute
useully to strategic planning, quality o care
and service development. Your knowledge is
crucial to the commissioning process.
3Establish a shared evidence-base
The main ocus o commissioning is onmonitoring quality o care, identiying unmet
needs and improving outcomes. Establishing
a common set o measures to evaluate these
will acilitate decision making about service
improvements and innovation. Clinicians are
in a unique position to collect the necessary
data (through audits, clinical eectiveness
targets and the use o national guidance rom
the National Institute or Health and Clinical
Excellence (NICE)) to inorm commissioningdecisions. For more inormation on NICE
guidance, visit: www.nice.org.uk
Ask yoursel
Whatskillsandexpertisecan
I contribute towards each o the
commissioning cycle stages?
WhatdoIwantcommissionerstoknowabout local services and local needs beore
they make commissioning decisions?
WhatevidencehaveI/colleaguescollected
that could be used to argue or and
inorm the development o new services?
WhatknowledgeordatadoIholdon
local care pathways and current use o
resources?
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200922
The example below shows how proessional input can help drive strategic service improvement.
Invest to save
Proessional engagement in the quality and cost agenda
In line with the World Class Commissioning expectation on commissioners to review
and update established practices and care pathways, Sutton and Merton PCT, the
London Borough o Sutton and South West London and St Georges Mental Health
Trust are working with local proessionals to develop care pathways that are
responsive to current need, reduce costs and improve service delivery.
Commissioners have established an Invest to Save project to review all residential,
nursing and orensic care placements to ensure they meet WCC standards and use
evidence based practice and the recovery model.
The project is based on the premise that identiying savings and nancial
eciencies in the commissioning process must be accompanied by an equal ocus
on the quality and outcomes o services.
Commissioners work with residential and nursing providers to set clear targets
or quality and perormance so that they are better inormed about progress or
each patient/client.
Proessionals are given opportunity to comment on the most appropriate
pathway or users and any challenges they encounter when co-ordinating care
across agencies.
Monthly review meetings between commissioners and trust managers aim tomake continuous improvement in both the management o placements and
the commissioning requirements underpinning them.
Proactively seeking to involve and engage providers in the commissioning process
and giving proessionals an opportunity to exert real infuence over the direction
o change o services and to comment on the care pathway leads to improvements
in services, enhances the patients experience, boosts sta morale, and helps to
achieve national policy objectives.
For urther inormation contact [email protected]
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Useful links
World Class Commissioning
www.dh.gov.uk/en/
Managingyourorganisation/Commissioning/
Worldclasscommissioning/index.htm
Standard mental health contract
www.dh.gov.uk/en/
Managingyourorganisation/Commissioning/Systemmanagement/DH_085048
NICE clinical guidance
www.nice.org.uk
JSNA toolkit
www.nmhdu.org.uk
Commissioning and procurement the
mental health road map or commissionerswww.pasa.nhs.uk/PASAWeb/PCTzone/
mentalhealthservices/
Outcomes compendium: helping you select
the right tools or best mental health care
practice in your feld
www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/
DH_093316
Public Health Observatories
www.apho.org.uk
Readers are advised that all of the above links were
correct at the time of going to press. If you have problems
accessing the documents through the direct links detailed
above, they should be readily located via a search from
the relevant sites home page.
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.nice.org.uk/http://www.nmhdu.org.uk/http://www.pasa.nhs.uk/PASAWeb/PCTzone/mentalhealthservices/http://www.pasa.nhs.uk/PASAWeb/PCTzone/mentalhealthservices/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.apho.org.uk/http://www.apho.org.uk/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316http://www.pasa.nhs.uk/PASAWeb/PCTzone/mentalhealthservices/http://www.nmhdu.org.uk/http://www.nice.org.uk/http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Systemmanagement/DH_085048http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm -
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Department o Health (1999)National service ramework or mentalhealth. London: Department o Health.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598
Department o Health (2004)
The national service ramework or mentalhealth fve years on.London: Department o Health.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120
Department o Health (2005)Delivering race equality in mental health care:an action plan or reorm inside and outsideservices. London: Department o Health.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773
Department o Health (2006)Our health, our care, our say: a newdirection or community services.London: Department o Health.
www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882
Department o Health (2007)Commissioning ramework or health andwell-being. London: Department o Health.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604
Department o Health (2007)Putting people frst: a shared vision andcommitment to the transormation o adultsocial care. London: Department o Health
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118
Department o Health (2007)World class commissioning: vision.London: Department o Health
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956
Department o Health (2008)Department o Health strategic ramework.London: Department o Health.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085928
Department o Health (2008)High quality care or all: NHS next stagereview fnal report (the Darzi report).London: Department o Health.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
HMSO (2007)The Local Government and PublicInvolvement in Health Act 2007.London: HMSO.
www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1
HM Treasury (2007)2007 pre-budget report and comprehensivespending review: meeting the aspirations othe British people. London: HM Treasury.
www.hm-treasury.gov.uk/pbr_csr07_index.htm
Social Exclusion Unit (2004)Mental health and social exclusion. London:Ofce o the Deputy Prime Minister.
www.socialinclusion.org.uk/publications/SEU.pd
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1http://www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1http://www.hm-treasury.gov.uk/pbr_csr07_index.htmhttp://www.socialinclusion.org.uk/publications/SEU.pdfhttp://www.socialinclusion.org.uk/publications/SEU.pdfhttp://www.hm-treasury.gov.uk/pbr_csr07_index.htmhttp://www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1http://www.dh.gov.uk/en/Publicationsandstatistics/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080956http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598 -
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Acknowledgements
The National Mental Health Development
Unit and Commissioning Support for
London would like to express their thanks
to the members of the London Clinical and
Professional Engagement Advisory Group
(CPAG), who generously gave their time
and expertise to inform this guide.
Thomas Barnes Honorary consultant, WestLondon Mental Health Trust/Proessor o
Clinical Psychiatry, Imperial College, London
Jed Boardman Senior Policy Adviser,
Sainsbury Centre or Mental Health
Deborah Colvin GP, City & Hackney PCT
Sophia Frangou Head o Section,
neurobiology o psychosis, and Sub-Dean,
Institute O Psychiatry/Honorary ConsultantPsychiatrist, South London and Maudsley
NHS Foundation Trust
Catherine Gamble Nurse Specialist,
South West London and St Georges
Mental Health Trust
Claire Helman Director o New Initiatives,
Together: Working or Well-being
Sian Rees Senior Policy Advisor, MentalHealth, Department o Health
Bernadette Simpson Personalisation Lead,
Department o Health
Linda Seymour Head o Policy, Sainsbury
Centre or Mental Health
Geraldine Strathdee Clinical Adviser,
Healthcare or London
Yvonne Stoddart National Acute Care
Programme Lead, National Mental Health
Development Unit
Angela Yphantides Mental Health Project
Lead, Healthcare or London
Catherine Jackson Report Editor
Particular thanks are due to Claire Helman
rom Together and the CAPITAL Project
Western Locality Group.
Project Team
Jim Symington Chair
Louise Howell Programme Consultant
Nicholas Cohen Administrator
-
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Mental Health World Class Commissioning.A quick guide for mental health professionals / August 200926
Comments and eedback
We value your eedback on this guide. Please
let us know i you ound it helpul.
I you are a mental health proessional with
examples o good practice in engagement
with your local commissioners and are happy
to share these with others, please send your
comments/examples to:
Louise Howell
National Mental Health Development Unit
Wellington House (Room 306)
133-155 Waterloo Road
London SE1 8UG
Email: [email protected]
About the National Mental Health
Delivery Unit
The National Mental Health Development
Unit (NMHDU) is the agency charged by the
Department o Health with supporting the
implementation o mental health policy in
England in collaboration with the NHS, local
authorities and other major stakeholders.
The national mental health commissioning
programme (MHCP) exists to support
the development o innovative and
ground-breaking concepts in mental
health commissioning. It aims to support
commissioner development through
collaboration, inormation exchange
and partnerships with national and
local agencies. The programme is one
o six NMHDU work areas and has been
commissioned through the Department
o Health to aid the achievement o
World Class Commissioning (WCC) inMental Health.
For urther inormation on the NMHDU
Mental Health Commissioning Programme,
please visit www.nmhdu.org.uk
About Commissioning Supportor London
Commissioning Support or London (CSL)
was launched on 1 April 2009. The London
Development Centre (LDC), where work on
this guidance began, became one o the
ounding members o this new pan-London
agency. CSL brings together several London
organisations, including NHS Londons
commissioning support unction, Healthcare
or London and the London Health
Observatory to provide support to Londons
31 PCTs to enable them to strengthen
their perormance against the World Class
Commissioning requirements.
The CSL Mental Health Commissioning
Programme addresses issues specic to
mental health commissioning in London
by working directly with commissioners
and partner agencies. The programme
aims to aid the achievement o World Class
Commissioning, through the development
o knowledge, learning and tools or
mental health commissioners by acilitatingthe sharing o good practice, interpreting
Department o Health and other relevant
policy guidance and the production o tools
and products that respond to their needs
and priorities.
mailto:[email protected]://www.nmhdu.org.uk/http://www.nmhdu.org.uk/mailto:[email protected] -
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CommissioningSupport or London,
18th FloorPortlandHouse
StagPlaceLondonSW1E7RS
Telephoneswitchboard:
020 8433 6868
www.csl.nhs.uk
Designedbywww.Design-Culture.co.uk
http://www.csl.nhs.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.design-culture.co.uk/http://www.csl.nhs.uk/ -
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Commissioning Supportfor London