Sotw Road Map

8/14/2019 Sotw Road Map

1/36

Executive Summary:The Drive to Excellence:

NHS South of Tyne andWear Category SourcingProgramme and

Transformational RoadMapSubstance Misuse Services

[2008]

Alec Fraher September 2008


2/36


3/36

Market Category Sourcing . Using the latest in Public Service Management techniques the NHS

South of Tyne and Wear PCTs will assess the strategic value and market position all organisations

and the impact this brings to the lives of local people.

World Class Commissioning. Service excellence as the unashamed standard of care andtreatment for all patients and public

The NHS South of Tyne and Wear PCTs are up for the challenge of being World Class

Commissioners. The changing times are viewed as a new opportunity to do things better than

before. The NHS South of Tyne and Wear PCT category sourcing programme is a first step in our

pursuit of excellence.

We would like to thank the dedicated staff, employed within the NHS and our partner organisations

that have and will continue to contribute to this effort. All have, over the years, brought their ideasand their experience with existing processes, technology and communication, as well as a deep

desire to improve substance misuse services. For this we thank you and ask that you all join us in

the pursuit of excellence.

The following document summarises the NHS South of Tyne and Wear PCT road Map for providing

substance misuse services efficiently to meet patient and public expectations, using resources

more effectively in response to budget pressure, and enhancing services and consolidating

functions without large scale disruption.

The major task of re-invigorating a whole system approach will be a long term endeavour aided by

leading technologies and the dedication and commitment of the hundreds of people making up the

drug and alcohol treatment system. This Road Map is a critical first step.


4/36

Drive to Excellence

The Drive to Excellence is a bold, proactive move to create a long term solution for the challenges

and opportunities that lie ahead. It is a cultural shift in how the South of Tyne and Wear views its

substance misuse business.

The intent is to ensure that the individual agencies within the sub regional work together to reach

enterprise goals. The South of Tyne and Wears enterprise goal is to serve the patient and public.

The Category Sourcinf Programme is the initial action plan.

In the South of Tyne and Wears current NHS and Local Authority structure, each area serves its

constituency. This puts the burden on patients and public to know how their services differ, who

provides them and how they interact with each other sub regionally.

Moving from the current practice of each local area being relatively autonomous to an enterprise

or whole system approach will increase transparency and accountability. Right now there are too

many overlapping functions across the agencies, and we can do better than that.

The transformation from an individual service level agreement model to an enterprise model is

shown in the following graphic that envisions a balanced model that includes three levels of

functions:

Community Specific Functions: Unique community and front line public services and expertpatient programmes for patients that are delivered by those best suited to the Bottleneck and

Routine Category position.


5/36

Shared Knowledge Functions: Shared business and technology functions that can be grouped

together to promote effective delivery of front line services that are best provided by those in the

Routine Category position

Collaborative Clinical and Planning Functions: An infrastructure of planning and developmentfunctions, if performed by a dedicated team allows those in the Bottleneck and Routine categories

to focus on patient and public demand.

Whole System Transformation


6/36

Starting the Transformation :


7/36

Service Transformational has been in development over a period of 12 months from June 2007 to

June 2008, it involves hundreds of hours of detailed and difficult discussion, report writing and

scrutiny from two external academic bodies. Above all it has involved the sharing of ideas and

expertise among colleagues determined to engage in thought leadership, innovation and to

change the way substance misuse services are delivered meeting the challenges World Class

Commissioning presents us head on. What has become known as The Sunderland Approach has

been adapted for use at a sub-regional level. This project has used Six Sigma methodology:

Define, Measure, Analyse, Control and Improve . The graphics below show the conceptual

framework that informs the approach.


8/36

Demand Side planning work


9/36

1.Defining the Commissioning Landscape


10/36

2.Measuring Market Capacity and Structure


11/36

3.Analysis of the Market Capacity and Structure:

1. Feasibility Study; 2. Spend Analysis and Patient Flow

Analysis

3. Concordat Development 4. Commissioning Model Development

5.Select the Procurement Options 6.Provider Enablement


12/36

4.Improvements: KEY NOTE MESSAGES

KNM1. The use of open and restricted procurementprocedures has had the net result of producing a

commissioning model based on competitive demand and

service substitution; this undermines market development

and management.

KNM2. This model has no legal basis when applied to NHSprovided services.

KNM3. The reliance on this approach to procurement hashad adverse effects on the development of collaborative and

joint supply models of delivery, stifles innovation and

impedes sustainable growth impacting negatively on local

communities.

KNM4. The use of this model, kmowingly, or otherwise isnot safe or sound if the real beneficiaries of planning are the

end users; it does favour those providers best adapted to

winning competitive beauty contests and as such is

anticompetitive.

KNM5. The lack of understanding of the full range ofStatutory Permission Giving works against the satisfaction

of public and social policy objectives and competitive

demand models aggravate this dynamic.

KNM6. The Any Willing Provider rules can only sensibly beapplied in stable, mature market conditions and there is no

evidence that these conditions exist.

KNM7.Applying the full range of Statutory Permissionsnecessitates the use of category sourcing and the

engagement of a provider enablement programme to create

level play and ensure balance between cooperation and

competition.


13/36

5.Statistical Control 1 : The NHS

South of Tyne and Wear PCT

population analysis of theCommunities of Interest


14/36

Statistical Control 2: How the Services Look by Investment at June 2008


15/36

Statistical Control 3: Analysis By Patient Flow


16/36

Statistical Control 3: Analysis by Clinical and Safeguarding Interests


17/36

Statistical Control 4: How the Services Look to the Community by Provider Self

Assessment at June 2007: KEY NOTE MESSAGE: The Commissioning Gap between


18/36

Community Results and Customer Results suggests that a silo mentality exists where

concentrated efforts is put on internal processes rather than value stream development beyond

the needs of the person and organisation.


19/36

Statistical Control 5: The Commissioners Competency Assessment at June

2007: Key Note Message: Adaptability is crucial to truly align services to customer

and patient need and this is ONLY achieved through the effective engagement of

senior management and clinical leadership in this task.


20/36


21/36

1.Defining the Supply Side Contracting Landscape


22/36


23/36

2. Measuring the Supply Side Capacity for Localised Innovation by Market

Categorisation


24/36


25/36

3. Analysing The Supply Side Capacity for Change:The success or failure ofValuing Policies is wholly dependant upon how we behaviour day to day, it is only by

understanding the inner workings of each provider that we are assured excellence in service

delivery.

Excellence Model


26/36

4. Improving the Supply Side:

REASSESS: Q: Does

This Provider ReallyKnow What Its

Customers/Patients

Need?

RENEGOTIATE: Q:

What is theStrategic Position

and Value of this

Provider?

MIGRATE: Q: Which

partners are betterplaced to meet

need?

TERMINATE: Q: If

customer or patientneed does not

represent value for

money, end the


27/36

relationship ?

5.Control Process


28/36

The Transformational Road Map

Commissioning requires the

purposeful management of thevested professional, customer

and organisational obligations

and interests, with the sole

aim of ensuring

proportionality, transparency

and fair play, using the totality

of statutory permission to

address the health

inequalities, social andeconomic problems of a

patient or customer group and

the wider population in pursuit

of Public Health and Order and

Social Protection.

It is achieved by the use of

legal and democratic process

to ensure that the right

information is used to assess

need and resources aligned to

best meet this need.


29/36

Measuring the Developing Market against Valuing Policy Impact Positions


30/36

Analysis of ExcellenceKey Messages:

When considering

a provider that is

striving forexcellence a

Commissioner

must be large

minded enough to

know when

Providers need

help from

elsewhere in the

system.

What Providers

ought to feel

threatened by is

not that their

service(s) are

being

transformed, but

by the worldwide

revolution in the

provision of healthcare.

All too often,

innovation is


31/36

Next Steps


32/36

Creating Whole System Change:


33/36

Creating Whole System Change


34/36

Useful References:

Towards World Class Commissioning Competency, University of Birmingham,

Health studies Management Centre School of Public policy.

www.hamc.bham.ac.uk

World Class Commissioning, Department of Health Gateway Ref: 8754 and

9915

www.dh.gov.uk

Fundamental Concepts of Excellence, Centre for Excellence Development, Dr

Mike Perrides

The State of Minnosota, Drive to Excellence Transformational Road Map,

www.minnosota.us

Lean Enterprise Institute,

www.lean.org.uk

Excellence Models in Health and Social Care, Dr Phillip Barden, CEO Centre

of Excellence in Performance Management and Innovation (CPMI)

www.cpmitraining.co.uk
http://www.hamc.bham.ac.uk/http://www.dh.gov.uk/http://www.minnosota.us/http://www.lean.org.uk/http://www.cpmitraining.co.uk/http://www.hamc.bham.ac.uk/http://www.dh.gov.uk/http://www.minnosota.us/http://www.lean.org.uk/http://www.cpmitraining.co.uk/


35/36

Using P4 Methods to Ensure Strategic Control of Commissioning Processes,

Alec Fraher, Institute of Public Care/CSIP Commissioning eBook.

www.alecfraher.org

Report on Social Protection in Europe, Commission of the European

Communities COM(2000)163 final

Report on modernising social protection and developing good quality

healthcare (Committe on employment and Social Affairs)

www.europeanunion

Gateshead Joint Strategic Needs Assessment

www.gateshead.gov.uk

Mental Health, Self Harm and Alcohol Specific Conditions, Geoff Beacon,

Beacon Dodsworth Ltd.

www.beacondodsworth.co.uk

The Right Way to Manage Customers, Vikas Mittal et al, Harvard businessReview, April 2008
http://www.alecfraher.org/http://www.europeanunion/http://www.gateshead.gov.uk/http://www.beacondodsworth.co.uk/http://www.alecfraher.org/http://www.europeanunion/http://www.gateshead.gov.uk/http://www.beacondodsworth.co.uk/


36/36

The Secrets to Successful Strategy Execution, Gary Neilson et al, Booz and

Co, Harvard Business Review, June 2008

www.Booz&co.com

Sotw Road Map

Documents

Transcript of Sotw Road Map