Commissioning for
Value
A programme to help CCGs identify
value opportunities and improve
healthcare for their populations
September 2013
What is Commissioning for Value?
Commissioning for Value is about identifying priority
programmes which offer the best opportunities to improve
healthcare for your populations; improving the value that
patients receive from their healthcare and improving the
value that populations receive from investment in their local
health system.
“Value in any field must be defined around the
customer, not the supplier. Value must also be
measured by outputs, not inputs. Hence it is
patient health results that matter, not the
volume of services delivered. But results are
achieved at some cost. Therefore, the proper
objective is… patient health outcomes relative
to the total cost (inputs). Efficiency, then, is
subsumed in the concept of value. ”
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Source: Porter ME. (2008). What is Value in Health Care?
Harvard Business School.
What is Commissioning for Value?
In his Dear Colleague letter to the NHS of 10 October – Planning for a sustainable
NHS, Sir David Nicholson set out ten key points to support planning for a
sustainable NHS. The letter included information about the ‘Commissioning for
Value’ packs for CCGs to help you identify where there is greatest opportunity to
improve outcomes.
The packs aim to help identify real opportunities for improvement of outcomes and
to increase value for local populations. The localised information will support
discussions about prioritising areas for change, utilising resources and will help you
as local leaders make improvements in healthcare quality, outcomes and efficiency.
They are also the first product CCGs will receive as part of the new planning round
for commissioners - a vital part of NHS England’s ‘Call to Action’ where everyone is
being encouraged to take an active part in ensuring a sustainable future for the
NHS.
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The approach - where to look...using indicative data
The Commissioning for
Value approach begins
with a review of indicative
data to highlight the top
priorities (opportunities)
for transformation and
improvement.
This is achieved using
Programme Budgeting
Marginal Analysis and
Spend and Outcome data
to highlight those clinical
programmes where the
health economy is an
outlier and therefore will
be most likely to yield the
most improvements to
clinical pathways and
policies.
4
Bespoke Commissioning for Value insights packs CCGs
By mid-October, we will deliver bespoke
Commissioning for Value packs to all
211 CCGs, with an offer of follow-up
events and support.
These packs will have triangulated data
for the top Programme Budget
Categories by spend for your population
and will suggest priority programme
areas which offer the best value
opportunity for service improvements
Quality
Spend
5 Commissioning for Value – September 2013
Direction
of Travel
How will using this pack benefit my population?
• Achieved Turnaround (Warrington CCG - Winner of HSJ Commissioning Organisation of the
CCGs can and are using
the “Right Care approach”
to shift spend
Achieving financial
stability in West Cheshire
It’s not just about money Right Care in West
Cheshire led to real
quality improvements in
6 Commissioning
Value 2013
just
one annualforcycle
Year 2012)
• Financial sustainability (West Cheshire CCG - Winner of HSJ Commissioning Organisation of
the Year 2010)
• Clinically led annual QIPP planning and delivery (Borough of Wigan) Clinical Leaders driving
change (Vale of York CCG)
• Galvanising commissioners in a growing number of health economies (20+ CCGs and
growing)
Year 1 – “Came from behind” - Implemented system mid year
Year 2 – “Delivered as went along” - Began at year start, achieved by end
Year 3 – “Planned ahead” - Began before year start, overachieved
Year 4 – “Ahead of the curve” - 20% of QIPP delivered by start
Year 5 – Increased focus on Quality!
- A&E attends & admissions, Elective & Nonelective activity, OP Firsts and –
- Follow-ups – all decreased
- Outcomes & Quality – improved
- Integration occurred across health sectors
and with social care
Enabled by, for example :
- Medicines administration training to care
homes
- Personalised care plans (LTC)
- Community endoscopy, optometry,
ophthalmology, neurology & pain
management pathways
- MRI Scanner Direct Access
How will using this pack help my CCG Development
The use of these packs and the approach described can help CCGs develop the strategic
commissioning skills necessary for delivering quality care today and transforming services
for tomorrow, as outlined in the following 3 of the 6 assurance domains:
Domain 1
A strong clinical and multiprofessional focus
Domain 3
Clear and credible planning and
delivery
Domain 4
Robust governance
arrangements
• Constant clinical focus on improving quality and outcomes
• Significant engagement from constituent practices
• Involvement of the wider clinical community in commissioning
• System-wide strategic planning
• Evidence based operational planning
• Effective delivery of the plan
• CCG is clinically led and properly constituted with the right
governance arrangements
• Delivers statutory functions efficiently, effectively and economically
• Procures high quality support as required to meet the business
needs
7
Two follow-up events for CCGs…
To support CCGs in making use of the insight packs, two follow-up events were
organised for CCGs and their partners. The events were designed to:
• understand what the insight packs are telling you about your population health
outcomes
• how to use the insights in the packs to direct your improvement efforts
• learn from early adopters who have successfully used this approach to deliver
results
• get face to face support in surgeries where your insight packs can be
discussed on an individual, CCG basis
• network with commissioning support services who can help you to move
forward
The presentation for these events are now online at:
www.rightcare.nhs.uk/commissioningforvalue/
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Other resources to help get the most our of Commissioning for Value
The Right Care website will offers a new Resource Centre to support
CCGs including:
•
•
•
•
Online videos and ‘how to’ guides
Theme based Webinars
Case studies with learning from previous pilots
Tried and tested process templates to support taking the
approach forward
• Advice on how to produce level 2 packs locally, within the CCG or
working with local intelligence services
NHS England will also be publishing further material to help
commissioners navigate their way through the planning process,
including detailed planning guidance and financial allocations. You will be
able to find out more about this in the CCG bulletin and on the NHS
England website.
www.rightcare.nhs.uk/resourcecentre
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