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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