Reverse Commissioning
An Effective Process to Engage
BME Communities
Dr Vivienne Lyfar-Cissé MBA
Transitional Lead
NHS BME Network
Background
• 2004
Launch of Brighton BME Network
• 2007
Launch of South East Coast
(SEC) BME Network
• 2008
SEC Race Equality
Service Review
Background contd:• 2009
Inaugural BME Conference
• 2010
Launch of NHS BME
Network Conference
• 2011
1st Anniversary Conference
NHS BME Network
Vision
“to be an independent and effective voice
for BME staff, patients, service users and
carers to ensure the NHS delivers on its
statutory duties regarding race equality”
What is Commissioning?
Several Definitions:
• The act of committing finite resources to
evidence based interventions particularly, but
not limited to the health and social sectors with
the aim of improving health, reducing
inequalities and enhancing patient experience
• The process of specifying, securing and
monitoring services to meet the individuals’
needs at a strategic level
The Commissioning Process
The Commissioning Process is driven by
and/or dependent on the need to:
• Manage knowledge and undertake robust and regular
needs assessments that establish a full understanding
of current and future local health needs and
requirements
• Prioritise investment according to local needs, service
requirements and the values of the NHS
• Work collaboratively with community partners to
commission services that optimise health gains and
reductions in health inequalities
• Proactively seek and build continuous and meaningful
engagement with the public and patients to shape
services and improve health
Commissioning Cycle
1. Assessing needs:
through a systematic process,
understanding of the health
and healthcare needs of the
PCTs resident population.
Commissioning Cycle
2. Reviewing services
and gap analysis:
reviewing the services
currently provided and based
on the needs, defining gaps
(or over provision).
Commissioning Cycle
3. Deciding priorities:
given a list of desirable actions
using available evidence of
cost effectiveness and based
on a robust and defensible
ethnical framework, prioritise
areas for purchase
Commissioning Cycle
4. Risk management:
understanding the key health
and health care risks facing
the PCT and deciding on a
strategy to manage it
Commissioning Cycle
5. Strategic options:
bring together all the available
information into a single
strategic commissioning plan
that outlines how the PCTs
will deliver its core objectives
(including those of the
SHA and DH)
Commissioning Cycle
6. Contract
implementation:
put those strategic plans
into action through
contracting
Commissioning Cycle
7. Provider development
(including care pathway
re-design and demand
management):
support provider improvements
or introduce new providers to
deliver the services required
(including setting up demand
management systems and
designing new care pathways).
This includes supporting
providers in decommissioning
of services where appropriate.
Commissioning Cycle
8. Management provider
performance:
monitor and manage the
performance of providers
against their contracts,
especially against KPIs.
Question
Why Reverse Commissioning?
Answer
The commissioning process has (in the main)
failed to identify the health needs and effectively
engage our BME communities. Consequently,
ethnic health inequalities remains a major
problem for BME people.
Ethnic Health Inequalities
General Statements
1. The incidence of CHD and diabetes is higher than
average in ethnic minority groups
2. Asians are more likely than others to have worse
reported health and also have long-term illness
3. Ethnic differentials in the incidence of mental health
are well reported
4. Generally people from ethnic minorities have lower
levels of satisfaction with health services
5. Etc Etc Etc
Ethnic Health Inequalities
Mental Health - Count me in census 2010
Since the inception of the Delivering Race Equality
Programme in 2005 three of the twelve goals have not
altered materially as follows:
• Admission rates remain higher than average among
some minority ethnic groups, especially Black and
White./Black Mixed groups for whom rates were two or
more times higher than average in 2010 (six times higher
than average for the other Black group). In contrast
admission rates have consistently been lower than
average among the Indian and Chinese groups and
about average in the Pakistani and Bangladeshi groups
• Detention rates have almost consistently being higher
than average among the Black, White/Black Caribbean
Mixed and Other White groups. The rates for being
placed on a CTO were higher among the South Asian
and Black groups.
• Although there have been annual fluctuations in
seclusion rates, they have been higher than average for
the Black White/Black Mixed and Other White groups, in
at least three of the six censuses
Reverse Commissioning
Flagship Project
Brighton and Sussex
University Hospitals NHS Trust
Eastern Road, Brighton, BN2 5BE
Dr Vivienne Lyfar-Cissé MBA
Associate Director of Development
New Structure of the NHS
Department of Health (including public health
England) – Overall responsibility for health,
public health and social care policy
Public health delivery
NHS
NHS
Commissioning
Board
Local
Commissioning
Group
Public
Health
Social
Care
Local authorities
(including health and
wellbeing boards)
Service delivery
Accountability to patients, service users and the public (underpinned by
the regulators and Healthwatch England)
Subject to Parliamentary scrutiny
Department
for
Communities
and Local
Government
NHS Commissioning Board
Remit to commission
services to meet the needs of
local communities
and resources allocated
accordingly
Remit to commission
services to meet the needs of
local communities
and resources allocated
accordingly
Remit to commission
services to meet the needs of
local communities
and resources allocated
accordingly
x
Lack of evidence
Remit to commission
services to meet the needs of
local communities
and resources allocated
accordingly
x
Lack of evidence
4 Es Model
Health Professionals
Engage
Educate
Enlighten
Enhance service delivery
BME Communities
Enable
Expert
Empower
Enhance patient experience
Establish
Reverse Commissioning Group
Remit to commission
services to meet the needs of
local communities
and resources allocated
accordingly
x
Lack of evidence
Health promotion
Ethnic health equalities
Remit to commission
services to meet the needs of
local communities
and resources allocated
accordingly
Health improvement
x
Lack of evidence
Does the Evidence Exist???
Generally
• Ethnic monitoring has been a legal requirement for many
years
Specifically (Mental Health)
• Mental Health Minimum Data Set (MHMDS) –the
statutory data set submitted by the providers of specialist
mental health services in England to the National Mental
Health Development Unit (NMHDU). The data provided
covers information concerning the following:
• Individual patients
• Services provided to those admitted to hospital
• Community Treatment Orders
• The Outcome of Care
Diabetes Department
Inpatient Data
Total Number of Patients
Total Number of BME Patients
= 775
= 61
Ethnicity of BME Inpatients - %
13.1%
Black
14.8%
Asian
21.3%
29.5%
Chinese
Mixed
13.1%
White Irish
6.6%
White Other
1.6%
Other BME
Diabetes Department cont’d
Outpatient Data
Total Number of Patients
Total Number of BME Patients
= 7526
= 976
Ethnicity of BME Outpatients - %
9.0%
Black
12.8%
Asian
31.4%
32.8%
6.4%
Chinese
Mixed
White Irish
6.8%
White Other
Other BME
0.9%
Diabetes Department cont’d
Percentage of Inpatient and Outpatient Data compared
Ethnic Group
Percent Inpatients
Percent of
Outpatients
Black
14.8
12.8
Asian
21.3
32.8
Chinese
1.6
0.9
Mixed
6.6
6.8
White Irish
13.1
6.4
White Other
29.5
31.4
Any Other Ethnic Group
13.1
9.0
Total
100.0
100.0
The NHS Outcomes Framework
2011/12
The focus of the Framework is on health improvement and its
purpose is threefold:
• To provide a national level overview of how well the NHS is
performing, wherever possible in an international context
• To provide an accountability mechanism between the Secretary of
State for Health and the NHS Commissioning Board; and
• To act as a catalyst for driving quality improvement and outcome
measurement throughout the NHS encouraging change in culture
and behaviour, including a renewed focus on tackling inequalities in
outcomes.
The NHS Outcomes Framework 2011/12
Duty of quality
1
NHS Outcomes Framework
Domain 2
Domain 3
Domain 4
Domain 5
Enhancing quality of
life for people with
long-term conditions
Helping people to
recover from
episodes of ill health
or following injury
Ensuring that people
have a positive
experience of care
Treating and caring
for people in a safe
environment and
protecting them from
avoidable harm
2
Duty of quality
Duty of quality
Domain 1
Preventing people
from dying
prematurely
NICE Quality Standards
(building a library of approx 150 over 5 years)
3
6
Commissioning
Outcomes
Framework
4
5
Commissioning
Guidance
Provide payment mechanisms
tariff
Standard
contract
CQUIN
Commissioning/Contracting
NHS Commissioning Board – certain specialist services and primary care
GP consortia – all other healthcare services
Duty of quality
QOF
Page 42-The NHS Outcomes
Framework 2011/12
“The Department of Health has made tackling health inequalities a
priority and it is also under a legal obligation to promote equality across
the equality strands protected in the Equality Act 2010. There is
therefore both a legal requirement and a principle in designing the NHS
Outcomes Framework that its induction will not cause any group to be
disadvantaged. We have used the equalities and inequalities
breakdowns to assess data availability in order to monitor this
commitment. Date collection is more complete for some of the strands
than others; for example, there is better coverage (questions are asked
as standard and patients provide the information) for age and gender
than for religion or belief and sexual orientation”.
Our question
- What about ethnicity?
What is Reverse Commissioning?
Reverse Commissioning is an effective process
to engage BME communities to ensure their
health needs are addressed by the NHS
Why Reverse Commissioning?
Reverse Commissioning is necessary because the
existing commissioning process has failed to
(i) identify the needs of BME communities
(ii) effectively engage with BME communities and
(iii) reduce/eliminate ethnic health inequalities.
How Does Reverse Commissioning
Work?
Reverse Commissioning works by:
• Using existing data and evidence to identify the needs of BME
communities
• By recognising that Health Professionals needs to be educated and
trained to enhance service delivery
• Recognising that BME communities need to be empowered to
engage with Health Professionals
• Recognising there is a need to establish lasting partnerships
between health professionals and BME service users to effect
change
• Using information gained from these partnerships to influence
commissioning by Local Clinical Commissioning groups.
Summary cont’d:
What are the Desired Outcomes of Reverse
Commissioning?
The desired outcomes of reverse commissioning are as follows:
• Clinical services that meet the needs of BME communities
• Enhanced BME patient experience
• Enlightened health professionals
• Enhanced clinical service delivery to BME people
• Reduction in ethnic health inequalities
• Health improvement for BME communities
• Health promotion programmes directed at BME communities
• Effective and lasting partnerships between health professionals and
BME services users to effect change
Conclusion
Effective commissioning to meet the needs
of BME communities is possible if we apply
the correct process
Discussion
How can we best deliver on the 4Es model?
4 Es Model
Health Professionals
Engage
Educate
Enlighten
Enhance service delivery
BME Communities
Enable
Expert
Empower
Enhance patient experience
The Big Move
1st Anniversary Conference
Date:
Friday 16 September 2011
Time:
09.30-16.30 Hours
Venue:
London Hilton Park Lane
Thank you
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What is Reverse Commissioning?