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Executive Summary:The Drive to Excellence:
NHS South of Tyne andWear Category SourcingProgramme and
Transformational RoadMapSubstance Misuse Services
[2008]
Alec Fraher September 2008
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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.
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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.
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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
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Starting the Transformation :
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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.
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Demand Side planning work
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1.Defining the Commissioning Landscape
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2.Measuring Market Capacity and Structure
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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
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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.
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5.Statistical Control 1 : The NHS
South of Tyne and Wear PCT
population analysis of theCommunities of Interest
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Statistical Control 2: How the Services Look by Investment at June 2008
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Statistical Control 3: Analysis By Patient Flow
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Statistical Control 3: Analysis by Clinical and Safeguarding Interests
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Statistical Control 4: How the Services Look to the Community by Provider Self
Assessment at June 2007: KEY NOTE MESSAGE: The Commissioning Gap between
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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.
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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.
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1.Defining the Supply Side Contracting Landscape
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2. Measuring the Supply Side Capacity for Localised Innovation by Market
Categorisation
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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
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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
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relationship ?
5.Control Process
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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.
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Measuring the Developing Market against Valuing Policy Impact Positions
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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
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Next Steps
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Creating Whole System Change:
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Creating Whole System Change
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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/8/14/2019 Sotw Road Map
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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/8/14/2019 Sotw Road Map
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The Secrets to Successful Strategy Execution, Gary Neilson et al, Booz and
Co, Harvard Business Review, June 2008
www.Booz&co.com