Strategic Business Plan for the Joint Commissioning Unit

Strategic Business Plan for the Joint Commissioning Unit A Business Plan to reduce the current c. £ 140 million/yr by 20% over 3 years SC&I Mgrs Forum

Commissioning Matrix A Commissioning Matrix has been developed to gain a panoramic overview of expenditure across the JCU – both NHS and Council. This reveals: • comparative spend between service areas e. g. OP, MH LD, PD, Carers • comparative spend between prevention and core services • comparative spend between service Older Physical Mental Learning types e. g residential v community People Disability Health Disability • comparative spend between NHS and Local Government Care Homes • Comparative spend between CHC Funded Council in-house (e. g. NHS) and external Funded • distribution between providers Home Care • distribution in/out of Borough Day Care • provides opportunity to improve value for money e. g. unit costs Respite Care • provides opportunity for service and Prevention: provider rationalisation Supporting People Equipment Third Sector Carers SC&I Mgrs Forum

Version 4 05. 07. 10 Agenda Item 7. 4 Supporting citizens to stay independent longer Those not eligible for a package can get further information Universal Services, Prevention And early Intervention First contact advice and signposting Council Review may suggest enablement Meet immediate needs and enable Assessment and Resource Allocation Enablement Validate Resource Allocation Support plan Authorise & Validate Go live Monitor & review Self-directed support d an on i nt n ve tio r te n in eve rly pr Continually look for opportunities to enable, signpost or give advice to increase independence Ea SC&I Mgrs Forum Encourage to the left, not inevitable drift to the right

• Shift demand to lower cost interventions • High focus on value for money on core high Core Prevention tertiary Cost Enablement secondary Universal primary low Number of citizens high SC&I Mgrs Forum

JCU as an engine of change for improvement and value for money • Clear assignment of lead roles/duties within overall commissioning matrix • Prioritise workloads so that challenging but achievable – manage individual performance • Leave enough room for relationship building • Publish clear commissioning plans based on ongoing annual cycle with involvement of all main parties • Set grounds for de/re-commissioning – use procurement wisely and effectively SC&I Mgrs Forum

Benefits The JCU Business Plan will aim to reduce the current c £ 120 million per year of spend by 20% over 3 years. We shall do this by obtaining: 1) Value for money (VFM) from the Core services that do meet needs effectively (i. e. standard fee levels instead of individually negotiated) 2) Savings from keeping Service Users in high cost services for as long as they need to be (i. e. emphasis on rehabilitation, recovery, intermediate care) 3) Savings because citizens will be signposted/diverted to alternative services, rather than to the core, costly services 4) Savings because there will be a range of interventions to help people stay independent longer 5) Further commissioned prevention services which the resultant savings will be reinvested in further prevention services SC&I Mgrs Forum

Roles and responsibilities Strategic Commissioning RAS Brokerage • Operational Commissioning • Integrated Health and Social Care Teams • Assessment and Care Management • Support Planning for personalisation • Care Navigation Menu of Services Prevention • Clear recognition of both strategic and operational roles/activities • Each Joint Commissioner working on a discrete set of work objectives • Each to develop a core set of skills and competencies Market Shaping SC&I Mgrs Forum

Structure Chart SC&I Mgrs Forum

Next Phase Each commissioner to be set goals for: • Developing preventive services with explicit cost savings for the core matrix • Challenging and achieving Value for Money from within the core matrix All to be brought together as a single cohesive Cost Improvement/Business Plan for the JCU SC&I Mgrs Forum

Service Developments Historical Service Model Target Operating Model SC&I Mgrs Forum

Historical Operating Model • • Services purchased by Councils Traditional approach – legacy services Narrow range of choice Special Relationships ‘Cottage Industry’ – “small, inexperienced providers” ‘Open Cheque Book’ – provider led fees Workforce problems Short sighted and ineffective commissioning SC&I Mgrs Forum

Target Operating Model • • • Services purchased directly by consumers Individual budgets – self funding ‘Menu’ of services with clear tariffs/fees (RAS) Wider range of care and support – wider choice Independent brokerage, navigation, advice and advocacy – shifts focus from inputs to outcomes • Strategic procurement – framework agreements • No special relationships • Smarter Commissioning SC&I Mgrs Forum

Strategic Context Financial Climate – National, Local and Individual Comprehensive Spending Review – Health £ 20 billion savings NHS White Paper – Liberating the NHS GP Commissioning and Council joint working Transformation – Personalisation, Choice and Control Walsall population – health and wellbeing, increase in obesity, poorer health and wealth inequalities Living profile – age and health Longevity of complex health needs Increase in co-morbidity Big Society – Voluntary Sector Strategic shift of investment towards reablement. Reduction in residential & out of borough placements Reduction in Hospital Accident and Emergency attendees Transition towards Adults and Children's commissioning Social Care packages need to change Commissioning practice needs to change Black Country collaborative groups e. g. Mental Health, NHS Ambulances Shared Services Uncertainty – resources and where they sit SC&I Mgrs Forum

Commissioner led Developments General • Care Home Market shaping (self assessment workbook) • Homecare market shaping • Day care market shaping • Third sector market shaping • Prevention Strategy (PCT/LA) • Workforce Planning • Culture change • Contract monitoring • Improved procurement • Quality assurance / compliance • Market relationships – revitalise commissioning forums • Commissioning specifications for Programmes and Pathways • Holding NHS provider Trusts to account via cost and volume contract monitoring against nationally defined pathways • Set framework for operational/ micro commissioning via RAS and menu of services – (panels) SC&I Mgrs Forum

Commissioner Led Developments specific Psychological Therapies Frail Elderly Pathway Housing 21 extra care Centre for Independent Living Hollybank as joint rehab ctre Community equipment to retail Goscote Centre / day services Age. Well in Walsall Clarification and contracting for extra care Urgent Care Centre In Control principles to CHC Rapid Assessment Treatment Team – OPMH/Dementia Community Meals to retail Charging arrangements SC&I Mgrs Forum

Prevention 1 of 2 System Component Allocated Lead Tracy Simcox 2 - 3 rd Sector Development/coproduction Tracy Simcox/Anne Doyle 3 - Housing Related Support Toolkit Prevention Agenda 1 - Domiciliary Care/Community Support procurement Tracy Simcox/Carol Jones 4 - JCU Contracts Register Tracy Simcox/Carol Jones 5 - Prevention Strategy Tracy Simcox 6 - Procurement Flowchart and supporting documents Tracy Simcox/Carol Jones 7 - Micro Markets Co-ordinator Tracy Simcox 8 - Key Ring Living Support Networks Tracy Simcox 9 - JCU Contract/range of schedules Tracy Simcox/Carol Jones 10 - Business Support Tracy Simcox QIPP Value £ 16. 7 m SC&I Mgrs Forum

Prevention 2 of 2 System Component Allocated Lead 11 – Community Meals Anne Doyle 12 – Benefits Based Charging Anne Doyle 13 – OP Panel Prevention Agenda QIPP Value 14 – Electronic Monitoring System Tracy Simcox/Carol Jones/Anne Doyle Tracy Simcox SC&I Mgrs Forum

Complex Care Improving the Quality of Life in Continuing Health Care System Component Allocated Lead Screening for Continuing health Care Hazel Wilkes Full Assessment- Decision support tool- MDT Hazel Wilkes Commissioning CHC Providers residential and home based Hazel Wilkes Rehabilitation (Traumatic brain injury) Hazel Wilkes Funded Nursing Care-process Jane Robinson Commissioning CHC assessors in Hospital DLT Hazel Wilkes Eligibility Panel Weekly QIPP Value Tracey Everitt/Caroline Adams Commissioning Outreach Assessment Team Embedding Transition Personalisation Combined QIPP Value Hazel Wilkes Tracey Everitt Hazel Wilkes/Caroline Adams SC&I Mgrs Forum

Mental Health 1 of 4 System Component Allocated Lead Value Anet Baker £ 1, 839, 204 Anet Baker £ 2, 331, 469 Anet Baker £ 1, 663, 789 Early Intervention Anet Baker £ 503, 728 Eating Disorders (Black Country project) Anet Baker £ 41, 652 Marcus Law £ 489, 122 (transformation project) Michael Hurt £ 620, 952 Community Rehab/Assertive Outreach (transformation project) Anet Baker £ 1, 170, 621 Individual Packages of Care/Social Care Marcus Law £ 4, 721, 503 Electro Convulsive Therapy Anet Baker TBC Enhanced Primary Care Community Mental Health Teams (transformation project) home treatment/crisis Early Interventions Prevention Agenda Resolution (transformation project) Day and Vocational Services (transformation project) Day Services Older People Combined QIPP Value = TBC SC&I Mgrs Forum

Mental Health 2 of 4 System Component Allocated Lead QIPP Value Anet Baker £ 128, 779 Anet Baker £ 34, 125 Michael Hurt £ 601, 159 Older Peoples Mental Health Teams (transformation project) Michael Hurt £ 1, 901, 415 Older Peoples Rapid Access Team – new procurement project Michael Hurt £ 352, 000 Older Peoples Inpatient Services – (transformation project) Michael Hurt £ 3, 290, 810 Adult Inpatient Services (Black Anet Baker £ 15, 734, 563 Community Development Workers (Transformation project) Anet Baker £ 124, 039 Out of Area Placements/NHS funded (QIPP) Marcus Law TBC Psychiatric Liaison (transformation project) Carer Support Service Memory Clinic Early Interventions Prevention Agenda (transformation project) Country Capacity Planning Project) Combined QIPP Value = TBC SC&I Mgrs Forum

Mental Health 3 of 4 Value Mark Williams TBC Accessing suitable housing options Mark Williams TBC Consultant Services Adult Early Interventions Allocated Lead Accommodation Market Development Prevention Agenda System Component Anet Baker £ 1, 493, 112 Consultant Services Older People Michael Hurt £ 271, 267 Adult Mental Health Employment Service (transformation project) Marcus Law £ 36, 387 Anet Baker £ 72, 988 Anet Baker/ Michael Hurt £ 77, 000 Michael Hurt/ QIPP Lead TBC Out of Area Placements Marcus Law/ QIPP Lead TBC Early Interventions in Psychosis Anet Baker/ QIPP Lead TBC Criminal Liaison Service IMCA/IMHA Dementia Prevention & Early Intervention Combined QIPP Value = TBC SC&I Mgrs Forum

Mental Health 4 of 4 System Component BUPA Elmore Allocated Lead Michael Hurt Value £ 622, 752 £ 107, 000 Early Interventions Anet Baker Walsall Black Sisters Prevention Agenda WPH (transformation project)) Anet Baker £ 50, 000 Anet Baker £ 47, 000 Marcus Law TBC New Project – Pro Vision IALT Campaign Helen Cook TBC New Project – Information Service for GPs (web based) Helen Cook TBC Michael Hurt £ 12, 300 IMCA (Black Country procurement project) Re. Think - transformation project Alzheimer’s Age Concern Dementia Michael Hurt Asian Womens Support Anet Baker Combined QIPP Value = TBC £ 107. 000 £ 600 SC&I Mgrs Forum

Unscheduled Care 1 of 2 System Component Allocated Lead Joyce Bradley Unique Care Winter Pressures Jane Hayman Urgent Care Centre Prevention Agenda Frail & Elderly Crisis PID Mike Johnson Rehabilitation (Step Up / Step Down ) Jane Hayman QIPP Value Community Nursing Services JCU Led Telehealth / Telecare Gill Grigg Hospital Discharge Jane Hayman Patient Education Peter Mitchell Falls / Osteoporosis / No. F De-prioritised Stroke Paulette Myers & Jane Hayman Combined QIPP Value = £ 2. 9 mil SC&I Mgrs Forum

Unscheduled Care 2 of 2 System Component Winter Pressures Allocated Lead Development Sub Acute Unit Jane Hayman Residential & Nursing Homes Lloyd Brodrick Quality In Care Homes Lloyd Brodrick Sally Roberts Extra Care Housing 21 Contract Management Lloyd Brodrick Reprovision Project Management Lloyd Brodrick Non H 21 Extra Care Lloyd Brodrick H 21 Contract Monitoring Peter Blackburn Claire Hammond Care Homes Closure Prog: Peter Blackburn Service Development JCU Support Tracey Martin Performance Management Tracey Martin QIPP Value H 21 Extra Care Non H 21 Extra Care Combined Value £ 38. 2 mil Residential & Nursing Care SC&I Mgrs Forum

Disabilities 1 of 2 System Component Allocated Lead Forensic step down service Stuart Lackenby Assessment and treatment service Stuart Lackenby Ian Staples Disaggregation of Pooled budget Ian Staples Information and Advice Personalisation All 3 disabilities commissioners Transforming community services NHS Walsall Care pathways Natalie Borman Stuart Lackenby In house day service development All 3 disabilities commissioners Transitions Ian Staples Autism Ian Staples ICES/telecare/telehealth Natalie Borman QIPP Value Combined QIPP Value = £ SC&I Mgrs Forum

Disabilities 2 of 2 System Component Allocated Lead Stuart Lackenby Centre for Independent living Natalie Borman Extra care Housing Personalisation RAS development Stuart Lackenby User led organisation Natalie Borman Stuart Lackenby Employment Ian Staples Out of Area All 3 disabilities commissioners Holly. Bank redevelopment Natalie Borman Residential – Supported living All 3 disabilities commissioners Personal Budgets Stuart Lackenby Reablement pathway Natalie Borman QIPP Value Combined QIPP Value = £ SC&I Mgrs Forum

Focus “Everything we do will improve the experience of using the service, and value for money” SC&I Mgrs Forum