Agenda item

The Select Committee will receive a presentation on this matter from Dr Lou Farbus, Head of Stakeholder Engagement & Specialised Commissioning.

The Select Committee were given a presentation on this matter from Dr Lou Farbus, Head of Stakeholder Engagement, NHS England (South), a summary of her presentation is set out below.

What is specialised commissioning?

Planning, funding, procuring, and performance monitoring specialised services.

Specialised Services = less common illnesses, conditions, treatments or services.

How do I know what is ‘specialised’?

Specialised services now cost £15bn a year across 146 specialised (‘prescribed’) services that are commissioned by 10 specialised commissioning ‘hubs’ across England.

The list of specialised services is under constant review. Each service comes under one of six ‘Programmes of Care’:

·  Internal medicine – digestion, renal, hepatobiliary and circulatory system

·  Cancer

·  Mental health

·  Trauma – traumatic injury, orthopaedics, head and neck and rehabilitation

·  Women and children – women and children, congenital and inherited diseases

·  Blood and infection – infection, immunity and haematology

How are they commissioned?

To be most safe and cost effective specialised services need to be planned and commissioned using populations of at least 1 million, which is larger than the populations served by most Local Authorities and Clinical Commissioning Groups, with many of the rarer conditions needing much larger planning populations than this. Consequently, specialised services are not provided in every hospital and tend to be found only in larger ones, which perhaps provide a range of specialised services. It is for these reasons that specialised services are commissioned on behalf of people who live in many different localities, both within and outside of the South West of England.

The benefits

·  Achieve the best outcomes for patients & carers by reducing ‘occasional practice’

·  Improve the patient/carer experience by concentrating resources in state of the art facilities

·  Build clinical competence

·  Improve the training of specialist staff

·  Ensure cost-effectiveness in provision

·  Make the best use of scarce resources [including staff expertise, high-tech equipment, donor organs, etc].

·  Support research and innovation

Challenges

·  We can’t please all of the people all of the time – services that move closer to some move further from others

·  Limited resources

·  Geography and infrastructure

·  Demand and capacity

·  Stakeholder engagement & maintaining momentum on shifting sands

Operating Model Design Principles

The South Way:

·  One team, and one way of working across the South

·  Principle of subsidiarity – local action on local issues

Integrated contract management:

·  Integrated contract, finance, clinical, service and business intelligence teams to deliver a multidisciplinary contract management approach.

·  Working as a team

Clear accountability:

·  Clear leadership responsibilities and lines of accountability

Better control:

·  Increased structure and improved processes to enable greater financial and operational control

South West Collaborative Commissioning Service Specific Priorities

• CAMHs
• Perinatal Mental Health
• Low/Medium secure
• Rehabilitation – inclusive of Neuro-rehab and Spinal Cord Injury
• Vascular – specifically Devon & Cornwall, and
• STP (unknown at July ‘16) and locality specific (e.g. Devon Success Regime; Cornwall Devolution) priorities

Planned Business (but not as usual)

·  Planned national procurements: CAMHS & PET/CT

·  Service Spec Compliance: Derogation

·  Quality & Safety: Performance Management

·  Responding to changes triggered by EU Referendum as necessary

·  Supporting and assuring the PPE re: migration of services out of providers (e.g. RNHRD; RDE) and the temporary cessation of provision to address effects of waiting times on patients’ (e.g. thoracics, spinal)

Councillor Lin Patterson asked how many specialist conditions were treated by the RNHRD.

Dr Farbus replied that either 7 or 8 were of a specialist nature.

Councillor Paul May asked how her role interacted with that of the CQC (Care Quality Commission) and Monitor.

Dr Farbus replied that they work in parallel with each other. She added that in a recent case she noticed that one provider was underperforming and she worked with the CQC and some activity was moved to a different provider.

Councillor Eleanor Jackson asked how under the new structure they will work with patients and carers.

Dr Farbus replied that there will be a task and finish group for each service to review care pathways which will feedback to the South Specialised Commissioning Oversight Group.

Councillor Eleanor Jackson commented that she felt it was important to capture the thoughts of genuine lay members with specialist knowledge.

Dr Farbus replied that they already do that and they kept in constant contact with Healthwatch.

Councillor Geoff Ward asked what role we can play if a child falls ill with a rare illness and there is either medication available in another country or it is very expensive.

Dr Farbus replied that they do have some influence and can talk to experts on our behalf or provide the contact details for a Specialist Commissioner. She added they could also assist with an exceptional funding application.

Councillor Geoff Ward asked if she would be involved if an outbreak of the Ebola virus occurred.

Dr Farbus replied that as this would come under one of the six ‘Programmes of Care’ her role would be to co-ordinate a robust response.

The Chair on behalf of the Select Committee thanked Dr Farbus for her presentation.