Overview of the commissioning landscape Mark Docherty

Integrated Ambulance Commissioning Mark Docherty Director – London Ambulance Service Commissioning Former Chair of NACG 2nd April 2014

What I am going to cover • Getting ambulance commissioning right • Collaborative commissioning: the implications for the Independent Service • An update from the National Ambulance Commissioners Group (NACG)

THE EXTRAORDINARY ADVENTURES OF AN AMBULANCE COMMISSIONER

What is Commissioning? • • • •

1988 – 12 mentions in parliament 1997 – 248 mentions 2007 – over 1,000 mentions 2011- ,000s of mentions in both chambers

• In 20 years it is a concept that has come from nowhere….and is now everywhere

What is commissioning really? • Conscience – stewardship, quality assurance, public protection • Brain – resource allocation, service design, planning • Eyes and Ears – patient experience, receiving and analysing information back to brain and conscience (Smith & Mays, 2005) • Not Arms and Legs – doing and delivering

CCGs? • 211 CCGs and average 226,000 population replace – 151 PCTs with average population of 284,000

• 19 Commissioning Support Units (At April 2013)

Why? • Because commissioners are the local NHS and local Social Care – there is no one else • Because somebody needs to decide what’s needed locally and how best to get it • Because someone needs to challenge existing vested interests and unresponsive services • Because one day I’ll need services too….

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*NHS Commissioning Board is now known as NHS England

Calls Median (CALLS)

Apr-13

Jan-13

Oct-12

Jul-12

Apr-12

Jan-12

Oct-11

Jul-11

Apr-11

Jan-11

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Oct-07

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Jan-06

Oct-05

Jul-05

Apr-05

999 Call Activity - London

168000

158000

148000

138000

128000

118000

108000

98000

88000

Cat A Median (A)

Apr-13

Jan-13

Oct-12

Jul-12

Apr-12

Jan-12

Oct-11

Jul-11

Apr-11

Jan-11

Oct-10

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Oct-07

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Apr-05

Category A (Red 1 & 2) Activity 45000

40000

35000

30000

25000

20000

Feb-13 Mar-13

Jan-13

Dec-12

Nov-12

Oct-12

Sep-12

Aug-12

Jul-12

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Feb-11 Mar-11

Jan-11

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Oct-10

Sep-10

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Jun-10

May-10

Apr-10

Category A Performance - LAS 85.0%

80.0%

75.0%

70.0%

65.0%

60.0%

Ambulance Demand Challenges

The Financial Context

Emergency Preparedness Hazardous Response MERIT / HEMS 999 Life Threatening Urgent Primary Care Patient Transport Services

Collaboration

Types of CCG Collaboration e.g.

A collaborative model

National and Sub-National

CCG and Local

The National Ambulance Commissioners Group • A forum for the lead commissioners, hosted by NHS Clinical Commissioners (NHSCC) • A national expert group • No statutory or legal status

• Undertakes high quality national work-streams • Contributes to National Publications e.g. “Tackling Demand Together” & the “Good Practice Guide for Ambulance Commissioning (RCGP)”

• Invited to give evidence to the 2013 Health Committee on Urgent Care

The National Ambulance Commissioners Group • Produces national models – e.g. national ambulance contract, PbR, Clinical Indicators, HART Specification • Develops shared strategic direction ‘Achieving Integrated Unscheduled Care’ and shares technical knowledge and skills to improve their local leadership and contract management • Provides informal induction and ongoing peer support for members • Discussions are underway to enhance the role of the NACG and to formalise it’s status, so that it formally becomes the organisation that influences national commissioning direction

Key Points • CCGs are in the driving seat • Massive challenges ahead • NHS Ambulance Providers on their own unlikely to be able to solve all the urgent care challenges • Partnerships are likely • Relationships are key