Reverse Commissioning
An Effective Process to Engage
BME Communities
Dr Vivienne Lyfar-Cissé MBA
Chair
NHS BME Network
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.
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
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
Commissioning/Contracting
NHS Commissioning Board – certain specialist services and primary care
GP consortia – all other healthcare services
Duty of quality
CQUIN
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?
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