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Integrated Ambulance Commissioning Mark Docherty Director – London Ambulance Service Commissioning Former Chair of NACG 2 nd April 2014. What I am going to cover. Getting ambulance commissioning right Collaborative commissioning: the implications for the Independent Service - PowerPoint PPT Presentation
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Integrated Ambulance
Commissioning
Mark Docherty
Director – London Ambulance Service
Commissioning
Former Chair of NACG
2nd April 2014
What I am going to cover
• Getting ambulance commissioning right • Collaborative commissioning: the implications
for the Independent Service • An update from the National Ambulance
Commissioners Group (NACG)
THE EXTRAORDINARY ADVENTURES OF AN AMBULANCE COMMISSIONER
What is Commissioning?
• 1988 – 12 mentions in parliament• 1997 – 248 mentions• 2007 – over 1,000 mentions • 2011- ,000s of mentions in both chambers
• In 20 years it is a concept that has come from nowhere….and is now everywhere
What is commissioning really?
• Conscience – stewardship, quality assurance, public protection
• Brain – resource allocation, service design, planning
• Eyes and Ears – patient experience, receiving and analysing information back to brain and conscience
(Smith & Mays, 2005)• Not Arms and Legs – doing and delivering
CCGs?• 211 CCGs and average 226,000 population replace
– 151 PCTs with average population of 284,000• 19 Commissioning Support Units
(At April 2013)
Why?• Because commissioners are the local NHS and local Social Care –
there is no one else• Because somebody needs to decide what’s needed locally and
how best to get it• Because someone needs to challenge existing vested interests
and unresponsive services• Because one day I’ll need services too….
*NHS Commissioning Board is now known as NHS England
*
999 Call Activity - London
Apr-05
Jul-0
5
Oct-05
Jan-0
6
Apr-06
Jul-0
6
Oct-06
Jan-0
7
Apr-07
Jul-0
7
Oct-07
Jan-0
8
Apr-08
Jul-0
8
Oct-08
Jan-0
9
Apr-09
Jul-0
9
Oct-09
Jan-1
0
Apr-10
Jul-1
0
Oct-10
Jan-1
1
Apr-11
Jul-1
1
Oct-11
Jan-1
2
Apr-12
Jul-1
2
Oct-12
Jan-1
3
Apr-13
88000
98000
108000
118000
128000
138000
148000
158000
168000
Calls Median (CALLS)
Category A (Red 1 & 2) Activity
Apr-05
Jul-0
5
Oct-05
Jan-0
6
Apr-06
Jul-0
6
Oct-06
Jan-0
7
Apr-07
Jul-0
7
Oct-07
Jan-0
8
Apr-08
Jul-0
8
Oct-08
Jan-0
9
Apr-09
Jul-0
9
Oct-09
Jan-1
0
Apr-10
Jul-1
0
Oct-10
Jan-1
1
Apr-11
Jul-1
1
Oct-11
Jan-1
2
Apr-12
Jul-1
2
Oct-12
Jan-1
3
Apr-13
20000
25000
30000
35000
40000
45000
Cat A Median (A)
Category A Performance - LAS
Apr-10
May-10
Jun-1
0Ju
l-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-1
1
Feb-11
Mar-11
Apr-11
May-11
Jun-1
1Ju
l-11
Aug-11
Sep-11
Oct-11
Nov-11
Jan-1
2
Feb-12
Mar-12
Apr-12
May-12
Jun-1
2Ju
l-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-1
3
Feb-13
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
Ambulance Demand Challenges
The Financial Context
Collaboration
Types of CCG Collaboration e.g.
A collaborative model
National and Sub-National
CCG and Local
The National Ambulance Commissioners Group
• A forum for the lead commissioners, hosted by NHS Clinical Commissioners (NHSCC)
• A national expert group• No statutory or legal status• Undertakes high quality national work-streams • Contributes to National Publications e.g. “Tackling Demand
Together” & the “Good Practice Guide for Ambulance Commissioning (RCGP)”
• Invited to give evidence to the 2013 Health Committee on Urgent Care
The National Ambulance Commissioners Group
• Produces national models – e.g. national ambulance contract, PbR, Clinical Indicators, HART Specification
• Develops shared strategic direction ‘Achieving Integrated Unscheduled Care’ and shares technical knowledge and skills to improve their local leadership and contract management
• Provides informal induction and ongoing peer support for members
• Discussions are underway to enhance the role of the NACG and to formalise it’s status, so that it formally becomes the organisation that influences national commissioning direction
Key Points
• CCGs are in the driving seat• Massive challenges ahead• NHS Ambulance Providers on their own
unlikely to be able to solve all the urgent care challenges
• Partnerships are likely• Relationships are key