The Elephant in the Room

“The Elephant in the Room”: 

“The Elephant in the Room” Bill Boa Interim Director of Finance and Performance 6 February 2007

“The Elephant in the Room”: 

“The Elephant in the Room” “It sometimes is used to refer to a question or problem that very obviously stands to reason, but which is ignored for the convenience of one or more involved parties. The idiom also implies a value judgment that the issue should be discussed openly.” Wikipedia

“The Elephant in the Room”: 

“The Elephant in the Room” Guerilla Artist “Banksy” has another view:

So what are our elephants?: 

So what are our elephants? We don’t really know what “Commissioning” means; We don’t understand what it is that a PbC Cluster will be doing on 1st April 2007. We don’t have enough money to meet the “must do” targets of the NHS Plan; Where do we start?

What is Commissioning?: 

What is Commissioning? The Operating Framework for the NHS Better Care Better Patient Experience Better Value for Money Payments by Results – Money follows the patient Regulatory Framework Contractual Framework Patient Choice Practice based Commissioning Plurality of Providers

What is Commissioning?: 

What is Commissioning? The Operating Framework suggests: PbC Clusters determining what is needed; Patients taking informed choices; A national framework of contracts and Pricing; A national framework of quality standards; A range of providers capable of delivering against this contractual and qualitative framework

What is Commissioning?: 

What is Commissioning? Health needs Assessment, Local Priorities for Development NHS Contract Payments By Results National IS Contracts Performance Management of Contract Data Management Claims Management PbC Clusters and Public Health PCT PCT and PbC Clusters Health Needs analysis Contract Management Performance Management

What will Clusters do?: 

What will Clusters do? Consider processes for Cluster “Peer Review” – existing schemes/LES etc. (From April 2007) Agree a Commissioning Plans outline the practices commissioning objectives (Ready by November 2007), Commissioning plans that identify local health needs and prioritise action (Ready by November 2007),

What will Clusters do?: 

What will Clusters do? Agree split of performance management role with PCT, who will do what; Construct a 2008/09 Local Delivery Plan for the Cluster that feeds into the PCT wide plan (From November 2007);

What will Clusters do?: 

What will Clusters do? Undertake internal Performance Management reviews against Commissioning Plan/LDP within Cluster (From April 2008); Clusters can not change the format of the NHS contract; Clusters can not negotiate prices that are deemed to be in Tariff.

Where can we start?: 

Where can we start? The Primary Care Trust refers more patients to a first outpatient attendance than expected; Two of our three acute providers use more of their elective surgical beds for preoperative patients than expected; Two of our three acute providers have patients in beds for longer than the national average.

Where can we start? : 

Where can we start? The Primary Care Trust receives less funding than would be expected for its population; The Primary Care Trust spends more on Acute Hospital care than neighbouring Trust’s; The Primary Care Trust has a higher than expected number of emergency admissions across 19 conditions;

What can we do to influence this?: 

What can we do to influence this? Prescribing Reduce Emergency Admissions; Reduce referrals for First Outpatient Attendances/activity counted as first outpatient attendance; Reduce pre-operative stays by increasing accessibility to diagnostics; Discharge management;

How does Payments by Results help?: 

How does Payments by Results help? Unbundling the tariff – a number of outpatient procedures that are now priced separately to encourage flexible commissioning, these include epidural injections for pain management, subcutaneous injection; If emergency admissions are reduced below 2005/06 levels 50% of the cost will be available to the PCT/Clusters;

How does Payments by Results help?: 

How does Payments by Results help? The guidance issued for Payments by Results provides strict definitions to determine: When an outpatient attendance is a follow-up; What counts as an outpatient attendance and what doesn’t; When payment for emergency admissions can be withheld (the 14 day rule) Flexibility to unbundle or determine local tariffs Short-stay tariff and excess bed day cost