Strategic Business Plan for the
Joint Commissioning Unit
A Business Plan to reduce the current c.£140
million/yr by 20% over 3 years
SC&I Mgrs Forum
Commissioning Matrix
A Commissioning Matrix has been developed to gain a panoramic overview
of expenditure across the JCU – both NHS and Council. This reveals:
•comparative spend between service areas e.g. OP, MH LD, PD, Carers
•comparative spend between prevention and core services
•comparative spend between service
Older
Physical
Mental Learning
types e.g residential v community
People Disability
Health Disability
•comparative spend between
NHS and Local Government
Care Homes
•Comparative spend between
CHC Funded
Council
in-house (e.g. NHS) and external
Funded
•distribution between providers
Home Care
•distribution in/out of Borough
Day Care
•provides opportunity to improve
value for money e.g. unit costs
Respite Care
•provides opportunity for service and Prevention:
provider rationalisation
Supporting
People
Equipment
Third Sector
Carers
SC&I Mgrs Forum
Version 4 05.07.10
Agenda Item 7.4
Supporting citizens to stay independent longer
Those not eligible
for a package can
get further
information
Universal
Services,
Prevention
And early
Intervention
First
contact
advice and
signposting
Council
Review may suggest
enablement
Meet
immediate
needs and
enable
Assessment
and
Resource
Allocation
Enablement
Validate
Resource
Allocation
Support
plan
Authorise
&
Validate
Go live
Monitor
& review
Self-directed support
Continually look for
opportunities to enable, signpost
or give advice to increase
independence
SC&I Mgrs Forum
Encourage to the left, not inevitable drift to the right
•Shift demand to lower cost interventions
•High focus on value for money on core
high
Core
Prevention tertiary
Cost
Enablement secondary
Universal primary
low
low
Number of citizens
high
SC&I Mgrs Forum
JCU as an engine of change for improvement
and value for money
• Clear assignment of lead roles/duties within overall commissioning
matrix
• Prioritise workloads so that challenging but achievable – manage
individual performance
• Leave enough room for relationship building
• Publish clear commissioning plans based on ongoing annual cycle
with involvement of all main parties
• Set grounds for de/re-commissioning – use procurement wisely and
effectively
SC&I Mgrs Forum
Benefits
The JCU Business Plan will aim to reduce the current c £120 million per year of
spend by 20% over 3 years. We shall do this by obtaining:
1) Value for money (VFM) from the Core services that do meet needs
effectively (i.e. standard fee levels instead of individually negotiated)
2) Savings from keeping Service Users in high cost services for as long as they
need to be (i.e. emphasis on rehabilitation, recovery, intermediate care)
3) Savings because citizens will be signposted/diverted to alternative services,
rather than to the core, costly services
4) Savings because there will be a range of interventions to help people stay
independent longer
5) Further commissioned prevention services which the resultant savings will
be reinvested in further prevention services
SC&I Mgrs Forum
Roles and responsibilities
Strategic Commissioning
RAS
Brokerage
•Operational Commissioning
•Integrated Health and Social
Care Teams
•Assessment and Care
Management
•Support Planning for
personalisation
•Care Navigation
Menu of
Services
Prevention
• Clear recognition of both
strategic and operational
roles/activities
• Each Joint Commissioner
working on a discrete set of
work objectives
• Each to develop a core set of
skills and competencies
Market Shaping
SC&I Mgrs Forum
Structure Chart
SC&I Mgrs Forum
Next Phase
Each commissioner to be set goals for:
• Developing preventive services with explicit cost savings for the
core matrix
• Challenging and achieving Value for Money from within the core
matrix
All to be brought together as a single cohesive Cost
Improvement/Business Plan for the JCU
SC&I Mgrs Forum
Service Developments
Historical
Service
Model
Target
Operating
Model
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Historical Operating Model
•
•
•
•
•
•
•
•
Services purchased by Councils
Traditional approach – legacy services
Narrow range of choice
Special Relationships
‘Cottage Industry’ – “small, inexperienced providers”
‘Open Cheque Book’ – provider led fees
Workforce problems
Short sighted and ineffective commissioning
SC&I Mgrs Forum
Target Operating Model
•
•
•
•
•
Services purchased directly by consumers
Individual budgets – self funding
‘Menu’ of services with clear tariffs/fees (RAS)
Wider range of care and support – wider choice
Independent brokerage, navigation, advice and advocacy – shifts
focus from inputs to outcomes
• Strategic procurement – framework agreements
• No special relationships
• Smarter Commissioning
SC&I Mgrs Forum
Strategic Context
Financial Climate – National, Local and
Individual
Comprehensive Spending Review – Health
£20 billion savings
NHS White Paper – Liberating the NHS
GP Commissioning and Council joint
working
Transformation – Personalisation, Choice
and Control
Walsall population – health and wellbeing,
increase in obesity, poorer health and
wealth inequalities
Living profile – age and health
Longevity of complex health needs
Increase in co-morbidity
Big Society – Voluntary Sector
Strategic shift of investment towards
reablement.
Reduction in residential & out of borough
placements
Reduction in Hospital Accident and
Emergency attendees
Transition towards Adults and Children's
commissioning
Social Care packages need to change
Commissioning practice needs to change
Black Country collaborative groups e.g.
Mental Health, NHS Ambulances
Shared Services
Uncertainty – resources and where they sit
SC&I Mgrs Forum
Commissioner led Developments General
•Care Home Market shaping
(self assessment workbook)
•Homecare market shaping
•Day care market shaping
•Third sector market shaping
•Prevention Strategy (PCT/LA)
•Workforce Planning
•Culture change
•Contract monitoring
•Improved procurement
•Quality assurance / compliance
•Market relationships – revitalise
commissioning forums
•Commissioning specifications for
Programmes and Pathways
•Holding NHS provider Trusts to
account via cost and volume
contract monitoring against
nationally defined pathways
•Set framework for operational/
micro commissioning via RAS and
menu of services – (panels)
SC&I Mgrs Forum
Commissioner Led Developments specific
Psychological Therapies
Frail Elderly Pathway
Housing 21 extra care
Centre for Independent Living
Hollybank as joint rehab ctre
Community equipment to retail
Goscote Centre / day services
AgeWell in Walsall
Clarification and contracting for
extra care
Urgent Care Centre
In Control principles to CHC
Rapid Assessment Treatment
Team – OPMH/Dementia
Community Meals to retail
Charging arrangements
SC&I Mgrs Forum
Prevention 1 of 2
Prevention Agenda
System Component
Allocated Lead
1 - Domiciliary Care/Community
Support procurement
Tracy Simcox
2 - 3rd Sector Development/coproduction
Tracy Simcox/Anne
Doyle
3 - Housing Related Support
Toolkit
Tracy Simcox/Carol
Jones
4 - JCU Contracts Register
Tracy Simcox/Carol
Jones
5 - Prevention Strategy
Tracy Simcox
6 - Procurement Flowchart and
supporting documents
Tracy Simcox/Carol
Jones
7 - Micro Markets Co-ordinator
Tracy Simcox
8 - Key Ring Living Support
Networks
Tracy Simcox
9 - JCU Contract/range of
schedules
Tracy Simcox/Carol
Jones
10 - Business Support
Tracy Simcox
QIPP Value
£16.7m
SC&I Mgrs Forum
Prevention 2 of 2
System Component
11 – Community Meals
Anne Doyle
12 – Benefits Based
Charging
Anne Doyle
13 – OP Panel
Prevention Agenda
Allocated Lead
14 – Electronic Monitoring
System
QIPP Value
Tracy
Simcox/Carol
Jones/Anne Doyle
Tracy Simcox
SC&I Mgrs Forum
Complex Care
Improving the Quality of Life in Continuing Health Care
System Component
Allocated Lead
Screening for Continuing health
Care
Hazel Wilkes
Full Assessment- Decision
support tool- MDT
Hazel Wilkes
Commissioning CHC Providers
residential and home based
Hazel Wilkes
Rehabilitation
(Traumatic brain injury)
Hazel Wilkes
Funded Nursing Care-process
Jane Robinson
Commissioning CHC assessors
in Hospital DLT
Hazel Wilkes
Eligibility Panel Weekly
Tracey
Everitt/Caroline
Adams
Commissioning Outreach
Assessment Team
Hazel Wilkes
Embedding Transition
Personalisation
QIPP Value
Combined
QIPP
Value
Tracey Everitt
Hazel
Wilkes/Caroline
Adams
SC&I Mgrs Forum
Mental Health 1 of 4
Allocated Lead
Value
Anet Baker
£1,839,204
Anet Baker
£2,331,469
Anet Baker
£1,663,789
Early Intervention
Anet Baker
£503,728
Eating Disorders (Black Country
project)
Anet Baker
£41,652
Marcus Law
£489,122
(transformation project)
Michael Hurt
£620,952
Community Rehab/Assertive
Outreach (transformation project)
Anet Baker
£1,170,621
Individual Packages of
Care/Social Care
Marcus Law
£4,721,503
Electro Convulsive Therapy
Anet Baker
TBC
System Component
Enhanced Primary Care
Community Mental Health Teams
(transformation project) home treatment/crisis
Early Interventions
Prevention Agenda
Resolution (transformation project)
Combined
QIPP
Value
=
TBC
Day and Vocational Services
(transformation project)
Day Services Older People
SC&I Mgrs Forum
Mental Health 2 of 4
System Component
Allocated Lead
QIPP Value
Anet Baker
£128,779
Anet Baker
£34,125
Michael Hurt
£601,159
Older Peoples Mental Health
Teams (transformation project)
Michael Hurt
£1,901,415
Older Peoples Rapid Access
Team – new procurement project
Michael Hurt
£352,000
Older Peoples Inpatient
Services – (transformation project)
Michael Hurt
£3,290,810
Adult Inpatient Services (Black
Anet Baker
£15,734,563
Community Development
Workers (Transformation project)
Anet Baker
£124,039
Out of Area Placements/NHS
funded (QIPP)
Marcus Law
TBC
Psychiatric Liaison
(transformation project)
Carer Support Service
(transformation project)
Early Interventions
Prevention Agenda
Memory Clinic
Country Capacity Planning Project)
Combined
QIPP
Value
=
TBC
SC&I Mgrs Forum
Mental Health 3 of 4
Allocated Lead
Value
Accommodation Market
Development
Mark Williams
TBC
Accessing suitable housing
options
Mark Williams
TBC
Consultant Services Adult
Anet Baker
£1,493,112
Consultant Services Older
People
Michael Hurt
£271,267
Adult Mental Health Employment
Service (transformation project)
Marcus Law
£36,387
Anet Baker
£72,988
Anet Baker/
Michael Hurt
£77,000
Michael Hurt/
QIPP Lead
TBC
Out of Area Placements
Marcus Law/
QIPP Lead
TBC
Early Interventions in Psychosis
Anet Baker/
QIPP Lead
TBC
Early Interventions
Prevention Agenda
System Component
Criminal Liaison Service
IMCA/IMHA
Dementia Prevention & Early
Intervention
Combined
QIPP
Value
=
TBC
SC&I Mgrs Forum
Mental Health 4 of 4
System Component
Early Interventions
Prevention Agenda
BUPA Elmore
Allocated Lead
Michael Hurt
Value
£622,752
WPH (transformation project))
Anet Baker
£107,000
Walsall Black Sisters
Anet Baker
£50,000
Anet Baker
£47,000
Marcus Law
TBC
New Project – Pro Vision IALT
Campaign
Helen Cook
TBC
New Project – Information
Service for GPs (web based)
Helen Cook
TBC
Michael Hurt
£12,300
IMCA
(Black Country procurement project)
ReThink
- transformation project
Alzheimer’s
Age Concern Dementia
Michael Hurt
Asian Womens Support
Anet Baker
Combined
QIPP
Value
=
TBC
£107.000
£600
SC&I Mgrs Forum
Unscheduled Care 1 of 2
Winter Pressures
Prevention Agenda
System Component
Allocated Lead
Frail & Elderly Crisis PID
Jane Hayman
Urgent Care Centre
Joyce Bradley
Unique Care
Mike Johnson
Rehabilitation
(Step Up / Step Down )
Jane Hayman
Community Nursing Services
JCU Led Telehealth / Telecare
Gill Grigg
Hospital Discharge
Jane Hayman
Patient Education
Peter Mitchell
Falls / Osteoporosis / NoF
De-prioritised
Stroke
Paulette Myers &
Jane Hayman
QIPP Value
Combine
d QIPP
Value
=
£2.9mil
SC&I Mgrs Forum
Unscheduled Care 2 of 2
Winter
Pressure
s
System Component
Allocated Lead
Development Sub Acute Unit
Jane Hayman
Residential & Nursing Homes
Lloyd Brodrick
Quality In Care Homes
Lloyd Brodrick
Sally Roberts
Extra Care Housing 21
Contract Management
Lloyd Brodrick
Reprovision Project
Management
Lloyd Brodrick
Non H21 Extra Care
Lloyd Brodrick
H21 Contract Monitoring
Peter Blackburn
Claire Hammond
Care Homes Closure Prog:
Peter Blackburn
Service Development JCU
Support
Tracey Martin
Performance Management
Tracey Martin
QIPP Value
Combined
Value
£38.2mil
SC&I Mgrs Forum
Disabilities 1 of 2
Personalisation
NHS Walsall
System Component
Allocated Lead
Care pathways
All 3 disabilities
commissioners
Forensic step down service
Stuart Lackenby
Assessment and treatment
service
Stuart Lackenby
Transforming community
services
Ian Staples
Disaggregation of Pooled
budget
Ian Staples
Information and Advice
Natalie Borman
Stuart Lackenby
In house day service
development
All 3 disabilities
commissioners
Transitions
Ian Staples
Autism
Ian Staples
ICES/telecare/telehealth
Natalie Borman
QIPP Value
Combine
d QIPP
Value
=
£
SC&I Mgrs Forum
Disabilities 2 of 2
Personalisation
System Component
Allocated Lead
RAS development
Stuart Lackenby
Centre for Independent living
Natalie Borman
Extra care Housing
Stuart Lackenby
User led organisation
Natalie Borman
Stuart Lackenby
Employment
Ian Staples
Out of Area
All 3 disabilities
commissioners
HollyBank redevelopment
Natalie Borman
Residential – Supported
living
All 3 disabilities
commissioners
Personal Budgets
Stuart Lackenby
Reablement pathway
Natalie Borman
QIPP Value
Combine
d QIPP
Value
=
£
SC&I Mgrs Forum
Focus
“Everything we do will improve
the experience of using the
service, and value for money”
SC&I Mgrs Forum