To brief the Committee on the World Class Commissioning Strategy.

The Committee was briefed on the World Class Commissioning (WCC) Strategy.

The Director of Public Health outlined the strategic priorities and cross cutting objectives of NHS Herefordshire’s Strategic Plan 2010-2015, as set out in the executive summary of the Plan included with the agenda papers.

The interim Director of Integrated Commissioning and the Director of Resources (NHS Herefordshire (NSHH)) gave a presentation on the Strategy. 

The interim Director highlighted the following elements of the Strategic Plan:

·         Programme budgeting to be used as a basis to match investment with outcomes

·         Procurement of  a new provider for mental health services

·         Establishment of a Transition Board to develop a recommendation on potential provider reconfiguration involving provision of high volume/high value pathways, locality based health and social care systems, urgent care system design, viable futures (eg Hereford Hospitals NHS Trust and divesting PCT provider Services.)

It was noted that five pathways had been identified as priorities: stroke, frail elderly, chronic obstructive pulmonary disease, diabetes and lower back pain.  The Stroke pathway was then discussed in more detail.

Plans for working with partners were outlined including: practice based commissioning – clinical leadership of change and quality improvement, active listening with patients and customers, positive engagement with all stakeholders, work with the Voluntary Sector, and with Hereford Hospitals NHS Trust and Herefordshire Provider Services.

The Director of Resources (NHSH) outlined a number of proposals designed to drive out efficiencies in 2010/11 to prepare for reduced investment in 2011/12 onwards:

·                     Reinvestment of savings from care pathway reviews into screening and care closer to home and to meet demographic and technological demands

·                     Disinvesting in low priority and ineffective treatments ensuring value for money for the taxpayer, benchmarking Herefordshire against good practice indicators

·                     Ensuring the long term sustainability of high quality, clinically safe services in Herefordshire

·                     Ensuring that investments are made only on the basis of programme budgeting priorities and data, and even then only when sustainable financial resources are available

·                     Achieving the target of transferring 5% of activity from the secondary to the primary sector and community services in each of the coming five years

·                     Upstream investment in Health and Wellbeing e.g. Smoking cessation

·                     More efficient use of the Estate to meet the new pattern of services

·                     Rationalisation of back office functions ( Shared Service Review)

·                     Reducing Management costs

In discussion the following principal points were made:

·         The proposed reduction in the number of hospital beds was questioned.  In reply it was stated that a lot of people were in hospital beds for whom alternative forms of care would be better.  Investment in health and social care would enable care to be provided in other settings.  The transformation of community services was being considered by the Transition Board.  It was suggested that the reasons for reducing hospital bed numbers needed to be effectively communicated.

·         That the scrutiny review of GP services had identified that GPs had some reservations about the operation of the practice based commissioning (PBC) arrangements.  The Integrated Director of Commissioning said that the establishment of one PBC group should improve the system’s operation and efforts were being made to engage GPs in the work to revise care pathways.  The Director of Quality and Clinical Leadership reported that to date 70% of PBC proposals had been accepted.  The Director of Resources (NSHH) commented that PBC was critical to clinical leadership of change to improve patient care and practice based commissioners held 80% of the NHSH budget.

·         The Associate Director of Integrated Commissioning commented that adult social care had been involved in the development of the WCC Strategy and was undertaking complementary developments, for example in the renegotiation of contracts with independent sector providers and the commissioning of mental health services, exploring care in community and primary care settings.

·         Preventative population health measures such as reducing smoking and the provision of housing were raised.  It was noted that the need for consideration of these matters was reflected in the Committee’s work programme.

·         The effect a tighter financial regime on the stated priorities within the WCC Strategy  was discussed.  The Director of Public Health asserted that the priorities remained irrespective of the financial position.  Efforts should be focused on ceasing to do things that were not effective.

·         In response to a question the Director of Resources (NHSH) confirmed that the scope for the more efficient use of public sector assets was being assessed.

RESOLVED:  that mindful of the significant changes proposed, for example the scale of the transfer of activity from the secondary sector to the primary sector and community services, regular updates on the World Class Commissioning Strategy be provided to the Committee describing progress and providing evidence of the degree of change and its effectiveness.