Commissioning for
Paediatric Surgical
Services
Commissioner
Overview
Julia Grace, Regional Programme of Care
Lead
Accountable Commissioner For: Neonatal
Critical Care; Paediatric Critical Care,
Paediatric Medicine and Congenital Heart
Services
19th November 2014
www.england.nhs.uk
Since 1st April 2013.....
Commissioning landscape :
• 212 clinical commissioning groups (CCGs)
• Local Authorities
• Public Health England
• NHS England - direct commissioning responsibility
Primary Care
Public Health and Screening
Armed Forces Health
Offender Health
Specialised Commissioning
www.england.nhs.uk
NHS England Board
Direct Commissioning Committee
Clinical Priorities Advisory Group
Specialised Commissioning
Oversight Group
Women &
Children's
Programme of
Care Board
Cancer & Blood
Programme of
Care Board
CRGs
www.england.nhs.uk
CRGs
Internal Medicine Mental Health
Programme of
Programme of
Care Board
Care Board
CRGs
CRGs
Trauma
Programme of
Care Board
CRGs
Medical Genetics
Specialised Commissioning
Oversight Group
Paediatric Surgery
Mental Health
Paediatric Medicine
Women and Children
Paediatric Cancer Services
Paediatric Cardiac Services
Blood and Cancer
Metabolic disorders
Paediatric Intensive Care
Trauma
Neonatal Critical Care
Paediatric Neurosciences
Internal Medicine
Complex Gynaecology
Specialised Maternity
Fetal Medicine
Multi-system disorder
Commissioning Products
 SERVICE SPECIFICATIONS
 CLINICAL COMMISSIONING POLICIES
 QUALITY DASHBOARDS
 CQUINS
 QIPP
 5 YEAR STRATEGY
www.england.nhs.uk
Service Specifications
Specification
Work Programme Status
Beckwith-Wiedmann Syndrome with
Macroglossia
Unchanged – Paused until 2015
Bladder Exstrophy
For discussion with Centres
Complex Tracheal Disease
Draft specification to be shared with
relevant CRG’s for comment
Draft specification being reviewed by
RDAG
Craniofacial
Paediatric Surgery (& surgical
pathology, anaesthetics and pain)
To be revised in 2015 incorporating
Transition and Paediatric Medicine
Spec’s – Paused until 2015
Paediatric Surgery – Chronic Pain
Paused until 2015
Paediatric Surgery – Neonates
As for Paediatric Surgery – Paused
until 2015
www.england.nhs.uk
Commissioning Products
Derogation
•
High level results published on the POC page
http://www.england.nhs.uk/wp-content/uploads/2014/10/derogations-womenchildren-040614.pdf
•
CRG to sense check information
•
Ongoing work with Providers and AT Commissioners – provider
derogations completed before 1/4/2015
•
Commissioner Derogations – working with Providers
www.england.nhs.uk
QIPP
• Challenging financial gap for specialised
• Discussions at CRG level
• Enhanced Recovery – standardisation of pathways
for electives – minimisation of LOS
• Procedures of limited clinical value – reducing
variation
• Review of specialised procedures before trim point
• POC QIPP Workshop
www.england.nhs.uk
Commissioning Products
CQUINS
•
•
•
•
•
•
•
Currently in development for 2015/16
Fewer CQUINS
Challenge – applicable for all units
Stretch Targets
Link to QIPP
Derogation = non eligibility
Commissioner driven
www.england.nhs.uk
Strategy
Commissioning Intentions Published
http://www.england.nhs.uk/wpcontent/uploads/2014/10/comms-intents-2015-16.pdf
Prices
• Convergence to most efficient quartile costs
• No payments above mandatory tariffs
Services Moving In and Out
Out –
Wheelchair services
Renal dialysis & morbid obesity (pending)
In –
Some specialist adult heamatology services
www.england.nhs.uk
Strategy
• Co-commissioning – models being developed
• Prime Contractor Model Opportunities
• Strategic Service Reviews – Derogation
• New Prioritisation Process (28/10/14)
• Clinical Utilisation Reviews
• Patient in the optimal setting
• Provider derogations – fully compliant before 1/4/15
www.england.nhs.uk
Strategy
Five Year Forward View
• Radical Upgrade to Prevention & Public
Health
• Action: Demand, Efficiency and Funding
• National action on obesity, smoking,
alcohol and other major health risks
• Promote employee health and reduce
sickness related unemployment
• Improved partnerships with voluntary
organisations and local communities
• Shared health and social care budgets
www.england.nhs.uk
Strategy
Five Year Forward View
• Break down barriers between health care
providers, GP, Secondary, Specialists &
acute and mental health
• Integrated out of hospital care :
• “multispecialty community provider”
• “primary and acute care systems”
• Integrated emergency and urgent care
• More support for frail elderly people in
care homes
• Greater investment in primary care
• More GP training places
• Raising the game on health technology
• Test Bed and Green Field Sites
www.england.nhs.uk
Still Lots to Do!!
• NHS England – Organisational Alignment and Capability
Programme
• Consultation on the proposed structures
• Effective From 1 April 2015
QUESTIONS ?
www.england.nhs.uk