Commissioning post the Health
and Social Care Act, 2012
Eleanor Davies
Associate Director Joint Mental Health Commissioning
Lewisham Clinical Commissioning Group and London Borough of Lewisham
The Health and Social Care Act in a
nutshell
 The Health and Social Care Bill puts clinicians at the
centre of commissioning, frees up providers to
innovate, empowers patients and gives a new focus
to public health.
 Arguably the most radical shake up of the NHS since
its inception and unequivocally the most extensive
reorganisation of the structure of the NHS to date
Case for change
 Rising demand and treatment costs
 Need for improvement
 State of the public finances
Key legislative changes
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Clinically led commissioning
Provider regulation to support innovative services
Greater voice for patients
New focus for public health
Greater accountability locally and nationally
Streamlined armslength bodies
The new NHS commissioning system
 The focus of new commissioning system is Accountability and
Outcomes
 Clinical Commissioning Groups (CCGs) are the new statutory
(accountable) bodies for most commissioning - Primary Care Trusts
(PCTs) and Strategic Health Authorities (SHAs) are abolished
 NHS England holds CCGs to account and is accountable for other
commissioning (e.g. Primary Care and specialist services)
 Various other national bodies are being developed as well as Public
Health moving to Local Authorities and Public Health England
 CCGs will have £25 per head of population to spend on their
organisations (we call this commissioning support)
 CCGs have to balance how they spend this – In house staff /
purchased from a CSS / shared
What’s happening in London…
There are 32 emerging CCGs in London, who will need to demonstrate they have robust
commissioning support in place
Enfield
Barnet
Harrow
Haringey
Waltham
Forest
Hillingdon
Brent
Camden
Camden
Ealing
Islington City &
Hackney
Redbridge
Newham
Hammersmith Central London
& Fulham
Tower
Hamlets
Havering
Barking &
Dagenham
West London
Commissioning
Hounslow
Southwark
Richmond
Wandsworth
Greenwich
Lambeth
Lewisham
Bexley
Kingston
Merton
Bromley
Sutton
Croydon
Wave 1 – 3 CCGs
Wave 2 – 15 CCGs
Wave 3 – 11 CCGs
Wave 4 – 3 CCGs
7
What type of organisation is a
Commissioning Support Unit?
NHS
England
Accountability
CCG
Services
CSU
• The 2013 NHS will be genuinely different
– CCGs will be small, light, clinical
commissioning organisations
– CSUs will be vital to getting CCGs up
and running and critical to the
success of the commissioning system
overall
– Hosted by NHS England
– 23 CSUs in England, 3 in London
– CSUs are funded by CCG income and
by income from other customers
Three CSUs are taking shape in London
North Central
and East London
North West
London
South
London
The South London CSU Story so far
• SLCSU is developed from CCG views
• SLCSU is designed to give CCGs benefit of local
services and the benefits of working at a larger scale
to centralise expertise
• £30m+ organisation, c300 staff, all 12 CCGs will
purchase core services
Development of South London
Clinical Commissioning Groups
• Well prepared for the transition
– Started on 1st April
– First board meetings taking place
What’s it really like….
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Stressful!
People are applying for new jobs or their old ones
£20 billion of NHS efficiency savings required nationally.
Large LA budget reductions
In Lewisham GPs are increasingly becoming more on board
with changing referral patterns. Less lone operators, more
group think and peer pressure.
 There is still the tendency to think like providers rather
than commissioners…
Lewisham Joint Mental Health
Commissioning
 2 posts transferring to the CCG. One part funded by the LA
 c.£90m budget
 Covering:
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Adult Mental Health – for health and social care
IAPT service
NHS Specialist services
NHS Forensic services
Mental Health of Older Adults – for health and social care
Dementia services – for health and social care
Adult Mental Health Voluntary sector – for health and social care
 £4.5m health savings and £600k LA savings required from 2011/12
– 2013/14. More savings to come….
Some positives to savings!
 The scale of efficiency savings make it imperative to do things
differently – real radical change is required
 E.g.
 Closed a two 16 bedded specialist Continuing Healthcare Unit and
reinvested £1.6m of recurring money into our Dementia pathway with
£370k taken as QIPP
 Commissioned a 3 month Forensic triage model which has diverted 75%
of people away from Medium Secure Units and saved £1.3m to
commissioning budgets
 Commissioned a support planning and brokerage service to support
people to use their Individual Budgets
 Commissioned local secondary care ASD and ADHD diagnosis and
treatment clinics rather than using specialist services
How can the you influence the health
and social care agenda
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Lobbying CCGs and Health and Wellbeing Boards
Support commissioners in their role – not just GPs
Identify gaps in provision
Share best practice
Share evidenced based practice
Give ideas for efficiency savings – support whole system
transformation
 Improve public awareness and engagement
 Influence big decision makers