Mental Health Act Commission's Biennial Report; Risks, Rights, Recovery

It is reported that patients deemed to be a threat to themselves or others are being denied hospital beds while commissioners squabble over money. The Mental Health Act Commission has found practitioners are being told to delay sectioning people with urgent mental health needs until primary care trusts ascertain who should pay for their treatment. The problem is being blamed on high bed occupancy levels and the need for PCTs to balance budgets. The Mental Health Act Commission claims that this has encouraged PCTs not to detain patients who have travelled from other areas until the home PCT has agreed to pay. The commission's biennial report Risks, Rights, Recovery criticises the practice as "improper".

(Published 2008, 290 pages)

Implementing practice based commissioning

In its recent report, the Audit Commission described the current state of implementation of practice based commissioning (Putting Commissioning in to Practice). The commission defined such commissioning as a way of managing financial risk as well as a means of improving services and use of resources. Under practice based commissioning, primary care trusts devolve indicative budgets to practices (practices do not receive the actual money, but operate within an agreed budget held and administered by the primary care trust) to give them financial incentives to manage referrals, and to commission and redesign services to make them more convenient, appropriate, and cost effective.

BMJ, 2007;335:1168

(Ask your local health librarian about access to this article - don't know who they are? Use HLISD to find them)

Learning from investigations

The Healthcare Commission has urged boards of all NHS trusts in England to heed the lessons from serious failings in healthcare services. It has highlighted the importance of good leadership, effective management and systematic use of information. The Learning from investigations report reviewed all investigations undertaken by the Commission under its statutory powers from August 2004 to April 2007. Investigations are undertaken where patient safety is seriously at risk. The report highlights clear common trends in the investigations the Commission has undertaken: poor leadership; ineffective management; inadequate teamwork with staff feeling unable to communicate problems; and a lack of clarity about who was responsible for what across the trust.

(Published 2008, 64 pages)

Working Across Boundaries for 18 weeks and beyond – registration now live

The NHS Institute is holding a learning and sharing event (registration link) for NHS organisations to work across professional boundaries to reduce delays. The day will showcase No Delays improvement work implemented by Ambassador Sites and Learning Networks and include sessions on a number of NHS Institute tools. A key focus of the day will be team development and facilitated action planning, so priority of attendance will be given to those coming in teams.

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Podcast of the Commissioner Volume 3 Issue 2

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Towards World Class Commissioning Competency

This paper is intended to assist the thinking of those currently seeking answers to questions, such as: What are health care commissioners required to do? What knowledge, skills, attitudes and behaviours are required to do it well? Who (either within or beyond the NHS) is most likely to possess these attributes at the moment? How should these capabilities be developed and distributed in future? The paper concludes that a one-size fits- all approach to defining and developing commissioning competency is unlikely to be optimal, and reiterates that competency depends not just on knowledge and skills, but on values, motivation, and agency. This is an important message for those involved in commissioning at all levels of the system.

(Published December 2007, 24 pages)

Practice based commissioning - budget setting refinements and clarification of health funding flexibilities, incentive schemes and governance

The direction of travel for practice based commissioning remains unchanged. This document follows up the commitment made in Practice based commissioning: practical implementation to refine the budget setting methodology, and responds to requests received through the Commissioning Framework for Health and Well-being consultation for clarification on the flexible use of NHS funds, governance arrangements and incentive schemes.

(Published December 2007, 16 pages)

King's Fund statement on NHS Operating Framework 2008/09

Commenting in response to the publication of the NHS Operating Framework for 2008/09, King’s Fund chief executive Niall Dickson said:

'It is right that the government should set national priorities and right too that they should maintain the assault on hospital infections and the drive to cut waiting time. These are areas that patients are justifiably concerned about and it is imperative the NHS makes progress in them.‘

Crucially, this document is an important step forward in getting to grips with what has long been the Achilles heel of the service – commissioning. The Department of Health is right to emphasise that better care and services will not be achieved through central directives and targets, but through better local commissioning led by primary care trusts (PCTs).

Practice and Provider Monitor (PPM) - a common information source for both providers and commissioners

Designed to build on the Practice Based Commissioning (PBC) and Hospital Activity Tracker (HAT) tools, PPM allows commissioners, GPs and service providers to share, discuss and monitor in-hospital activity on-line.

The new PPM tool includes: new, easy-to-use tool design; budgeting function with the ability to upload and cascade budgets down to practice level; an activity query facility, enabling the GPs, PCTs and acute trusts to highlight queries and resolutions with one another; new standard built-in reports; an HRG national tariff look-up table for easy reference.

Collaborative commissioning of National Screening Programmes

This best practice guidance sets out roles and responsibilities for the collaborative commissioning of national screening programmes, as recommended in Sir David Carter's Review of Commissioning Arrangements for Specialised Services.

(Published December 2007, 23 pages)

A funding model for health visiting

This is the second of two papers offering the information required to work out how to fund a health visiting service. The first paper gave the basic requirements, while this one identifies and explains the separate components of the service along with issues of scope and skill mix.

Community Practitioner, Dec 2007, vol. 80, no. 12, p. 24-31

A personal approach to public services

Across the political spectrum there is broad agreement around the direction of travel in public service reform, with the emphasis being on localism, citizen engagement, plurality of provision, personalisation, and choice. The ultimate prize is public services that are targeted at the greatest need, delivered in a coherent way, and responsive to users’ views and experiences. This is addressed by A Personal Approach to Public Services.

(Published 2007, 27 pages)

Evidence-based Commissioning Collaboration

The Evidence-based Commissioning Collaboration is currently made up of 2 commissioning consortia: North Derbyshire, South Yorkshire & Bassetlaw Commissioning Consortium (NORCOM), and part of The North East Yorkshire & North Lincolnshire Primary Care Organisation (NEYNL), which, on behalf of PCTs in their areas, are working with the School of Health and Related Research (ScHARR). ScHARR is based in the University of Sheffield and houses the northern arm of the Trent Research and Development Support Unit.

The objective of the Collaboration is to share research knowledge about the effectiveness and cost-effectiveness of service interventions to inform the commissioning process. These will usually be interventions which are not likely to be addressed by NICE in the near future. The choice of topics is determined collectively by the PCTs through their commissioning Consortia.

Other documents and conferences

Event: Working Across Boundaries for 18 Weeks and Beyond

Sustainable Pathway-Based Commissioning: An Interactive Workshop

National Stroke Strategy

Annual health check consultation: Commission sets out proposals for 2008/09 assessment of NHS trusts

How to change practice: understand, identify and overcome barriers to change

Liverpool - Joint commissioning & service delivery and Mental Health

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World Class Commissioning

The Department is transforming the commissioning health and care services in the NHS to drive unprecedented improvements in patient outcomes. We worked with commissioners and their partners to develop a vision for world class commissioning and a set of 11 organisational competencies. Delivery of this vision will take place within an assurance system. This will improve performance and development, and reward commissioners as they move from their current position towards world class standards.

Kings Fund Briefing: Practice-based commissioning

Practice-based commissioning (PBC) is a policy intended to give more decision-making power over NHS resources to general practitioners (GPs), and allow them to design and deliver completely new services or commission others to do so. It has a number of underlying policy objectives including delivering more cost effective and convenient forms of treatment outside hospital. Practice-based commissioning is a key strand of recent NHS reform policy in England alongside Payment by Results, patient choice and enhanced competition between providers. This briefing looks at the development of PBC in England, examines the pace of implementation and offers some analysis of the impact – current and future – on NHS services.

(Published November 2007, 10 pages)

New Commissioner Module for the No Delays Achiever Now Available

The NHS Institute for Innovation & Improvement has now launched the new Commissioner Module for the No Delays Achiever. The new functionality is designed to support commissioners in working with their providers to achieve 18 week patient pathways. If you are a commissioner you can now compare multiple provider data to help you work with your providers in identifying and tackling variation and delay. As ever, the library of service improvement tools, techniques and case studies can also help commissioners find the most effective ways of working with their healthcare partners. Other improvements in response to user feedback include clearer organisation of graphs, a new ‘getting started’ section, an enhanced feedback function, and improved overall design.

www.nodelaysachiever.nhs.uk

For a full outline of modifications:

www.nodelaysachiever.nhs.uk/news

Communities of Practice: Commissioning Patient Pathways

The NHS Institute’s No Delays Priority Programme is establishing two communities of practice as part of the evolution of its existing commissioning network to examine and tackle current commissioning challenges. Each Community will consist of around 15 members, meeting initially in London and Coventry. Places are limited, so apply soon.

Putting commissioning into practice

This report sets out to determine whether practice based commissioning (PBC) is working from a financial management perspective. As well as key findings, the report explores the barriers to effective implementation of PBC, and includes case study examples of solutions and notable practice, recommendations and prospects for the future.

(Published November 2007, 76 pages)

Kings Fund Briefing: Payment by Results

In 2002 the Department of Health announced a fundamental change to the way in which NHS hospitals in England are paid for the work they do. Under this new system – Payment by Results (PbR) – hospitals are reimbursed for the activity they carry out using a tariff of fixed prices that reflect national average costs. The government is currently considering whether and how the system can be improved and extended to more services in the future. This briefing explains how Payment by Results works, examines the evidence on whether the system has achieved, or is likely to achieve, the policy aims set for it, and describes the government’s current proposals for the future of PbR.

(Published October 2007, 8 pages)

PARR case finding tool

The King’s Fund has released a ground-breaking software tool that helps PCTs use routine data to predict the risk of emergency re-admission to hospital. Many PCTs in England have found PARR very useful in their attempts to reduce emergency hospital admissions and allocate resources more effectively.

Treatment Centres

Treatment Centres (TCs) offer safe, fast, pre-booked day and short-stay surgery and diagnostic procedures in areas that have traditionally had the longest waiting times, such as ophthalmology and orthopaedics. TCs will play an important part in modernising the NHS and delivering a patient-centred health service. Whether NHS-run or managed by companies in the independent sector, the additional capacity TCs provide will be crucial in bringing down waiting times and giving patients more choice about when and where they are treated.

Services for people with learning disabilities and challenging behaviour/mental health needs

Services for people with learning disabilities and challenging behaviour/mental health needs is an updated version of the guidance originally produced by Professor Mansell and his project team in 1993. This good practice guidance sets out the actions that should be taken in order to effectively meet the needs of people with challenging behaviour. The guidance contained in this document supports the agenda set out in 'Valuing People' (2001) and the focus on personalisation and prevention in social care.

(Published November 2007, 43 pages)

Valuing People’s Oral Health

Best practice guidance to improve oral health in disabled children and adults. This document builds on the principles within Choosing Better Oral Health and uses the evidence-based approach within Delivering Better Oral Health as a guide to assist all who provide and commission dental services for people with disabilities.

(Published November 2007, 53 pages)

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Diabetes in the NHS: Commissioning and providing specialist services

Diabetes has come a long way since the publication of the National Service Framework (NSF). Self management is now recognised as the key to improved health outcomes, but people with diabetes also need the active support of organised, proactive and expert health, community and social services.

This small booklet aims to address this issue by providing details of the improved pathways that can be designed for people with diabetes, the governance issues that can be addressed by PCTs and the money the can be saved by acute trusts and commissioners, if the expertise of consultant diabetologists and the teams they work with is used to the full.

(Published September 2007, 26 pages)

NHS Stop Smoking Services

This updated guidance is intended for everyone involved in managing, commissioning or delivering NHS stop smoking services. It has been developed by means of a collaboration with representatives from SHAs, PCTs, the Information Centre and academics from the field of smoking cessation.

(Published October 2007, 26 pages)

Commissioning for Patient Pathways

This practical guide will support commissioning managers by creating a structured approach to commissioning planned care pathways that will meet 18 weeks and build towards a sustainable pathway-based commissioning approach.

(Published September 2007, 54 pages)

Commissioning specialist adult learning disability health services

Good practice guidance on the commissioning of specialist adult learning disability health services for adults, in particular to assist in responding to shortcomings identified in these services in recent Healthcare Commission reports including those into abuse in Cornwall and Merton and Sutton.

(Published October 2007, 21 pages)

Care Outside Hospital

The NHS Operating Framework for 2008/2009 expects PCTs to take ambitious steps toward providing care as close to the patient's home as possible. NHS organisations need to focus their efforts on those areas most likely to bring significant benefits and to apply effective approaches to ensure that the change delivers.

Prioritise Opportunities: User Guide

To download this document you must first register with the site

Toolkits

Delivering the 18 week patient pathway

Delivering an 18 week patient pathway from GP referral to the start of treatment by the end of 2008 is a key objective for the NHS. This website is dedicated to supporting the Service and provides access to: information to help you implement the changes, details of initiatives around the NHS that are already achieving improvements in the patient's journey, case studies to allow you to share best practice, and programme resources, including presentations and reports.

Eye care

PCTs have an increasing role to play in commissioning a wide range of community based services for patients with chronic eye conditions. In the National Eye Care Services Steering Group's first report it has made recommendations for PCTs in commissioning services for glaucoma, cataract services, low vision services and age-related macular degeneration (ARMD). A new step by step guide has been produced to support Commissioners.

(Published October 2007, 64 pages)

Commissioning Roadmap

The North West Commissioning Roadmap website is aimed at commissioners of adult health and wellbeing services in local authorities and PCTs in the North West.

It is a way of sharing practice around the region by offering advice, case studies, summaries of national guidance, comprehensive resources sections with links to other websites, and regional contact details.

Facing the Future

The Government's response to Facing the Future: a review of the role of health visitors. It includes recommendations on the workforce and sets out the government plans for taking forward the relevant recommendations.

(Published October 2007, 22 pages)

Report of the High Level Group (HLG) on Clinical Effectiveness

There is variation in clinical practice in the NHS and in the treatments that patients receive. Some of this may be appropriate but patients may also receive treatments which are not very effective or for which there is no evidence. The HLG found that there is much work already being undertaken by a range of organisations and some good examples in local organisations. It also found that there is no ‘single bullet’ to address the issue of clinical effectiveness. This is a complex issue. Staff in the NHS need to be empowered locally to take ownership of the agenda and promote clinically effective practice.

(Published October 2007, 56 pages)

Other documents

16th wave: clinical guidelines and public health guidance referred in September 2007

Helping GPs to commission services more

Practice Based Commissioning GP practice survey

National Specialist Commissioning Advisory Group Annual Report 2006/07

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