Commissioning Officer – Children
Commissioning Systems Development – South
South Tees Clinical Commissioning Group

• 42 major contracts across NHS Tees
• Majority are nationally mandated standard contracts:
– NHS Standard Acute Contract - NTHFT, STHFT, Nuffield,
Ramsay etc
– NHS Standard Community Contract - North Tees
Community Provider, MRCCS, Assura Sexual Health,
Hospices etc
– NHS Standard Mental Health Contract - TEWV, Alliance,
MIND etc.
• Total Contract Budget of £856m
• Over 200 providers
• QIPP Challenge

Middlesbrough
Redcar &
Cleveland
Total Tees
Acute Services
- Planned Care
- Urgent Care
Prescribing
Estate and “Other”
Total
£469,000
£2,000,000
£1,375,000
£1,536,000
£5,380,000
£2,000,000 £2,469,000 £3,269,000
£5,434,000 £7,434,000 £10,557,000
£1,242,000 £2,617,000 £5,031,000
£420,000 £1,956,000 £2,946,000
£9,096,000 £14,476,000 £21,803,000

• 12/13 Affordability versus Forecast Outturn activity/cost
• SHA/DH expectations
– Operating Framework requirements must be negotiated in to contracts
– Deadlines for contract signature
• FAILURE TO AGREE WITH PROVIDERS WILL RESULT IN NOT HAVING A SIGNED
CONTRACT AND CCGS AFFECTED WON’T ACHIEVE AUTHORISATION
• Clinicians views are not necessarily the organisation’s views
• Payment by Results (PBR)
– It is in the Foundation Trusts (FTs) interests to grow their business
– Commissioners are immediately on the back foot once a patient enters “the system” – “Patient Pinball”
• FTs will exploit Primary Care’s inability to manage demand
• “It is what it is” – a negotiation: we don’t get everything we want!

• Delayed publication of Operating Framework and
Standard National Contracts
• Lack of evidence based, clinically credible proposals resisted as unsafe/high risk to FTs
• New services/changes to pathways – “Pilot Vs.
Procurement”
• Overall impact of Commissioning Intentions:
– Don’t do anything which may increase overall costs
– Consider system wide impacts on other stakeholders, e.g. Social Care

• NHS Hartlepool and Stockton on Tees
Clinical Commissioning Group
– Hartlepool CCG
– Stockton-On-Tees CCG
• South Tees Clinical Commissioning Group
– Middlesbrough CCG
– Redcar and Cleveland CCG
– Greater Eston CCG

• Still in process of formation
– Structures
– Leadership
– Priorities
• Heavy Authorisation Process
• Wide Agenda
– CAMHS IS part of it – we do have clinical engagement!

• Earlier intervention in CYPs Emotional Health and Well-being
• Shifting resources upstream through 2 priorities:
– CAMHS service transformation (TEWV CAMHS contract – changing the core service to deliver accessible, community based services)
– Developing Tier 1 and 2 services
• Co-ordinating commissioning across Tees
• Developing/increasing the capacity of the broader delivery system – schools, VCOs

• Strategic CAMHS Stakeholder Group – meets monthly - LA rep, GPs, Head Teacher and VSO rep – increased commitment to CYP’s MH
• Strategic Tees-wide Plan - response to NST review, needs assessment - mapping of ‘tier 2’ services
• TEWV CAMHS Performance dashboard - using new
Info management system in TEWV
• Service transformation funding agreed….
• BOND – capacity building in early intervention MH third sector services

• Aim to drive down T3 referrals - increase earlier intervention, and increase capacity within other services through consultation, training and shared, co-ordinated pathways
• Potential non-recurring - £0.5m
– fund increased activity and development at tier 2
– embed workforce plan for sustaining new service model
– manage risk/existing demand at tier 3/4
• £200k ring-fenced for third sector sub contracting – to extend good practice in pathway development and increase access for vulnerable groups

• Funding window – speedy action required
• NHS capacity to drive change through commissioning
• Financial climate – mitigate impact of early intervention cuts
• BOND – building interest and momentum
– Schools – interest in funding services
– Improving quality of VCS/alternative providers
– Identifying and sharing models of good practice

• Strengthen LA/NHS commissioning
– co-ordinating/joint commissioning for LAC, VSO etc
– commissioning with/by schools for early intervention support in schools
• Develop outcomes framework - for CYPs MH services Tier 1 – 3 – as a basis for commissioning
• Develop core TEWV offer/spec
• Commission training programme from CAMHS for T1 and 2 service providers as part of service transformation