Our aim is to improve outcomes for people with mental health needs. We plan to meet this aim by constructively informing central and local government policy that relates to our work, through positive dialogue with policymakers. We also work collectively as a sector in understanding developments in government policy and in discovering how our services might adapt to meet the requirements of policy changes.

Summary of response:

  • There should be a coalition between commissioners, providers and users with a focus on collaborative commissioning shared outcomes and key performance indicators.
  • Commissioners should expect and encourage variation of practice within a clear framework.
  • The NHS Commissioning Board must include some people without long careers in the NHS and the system should permit new entrants provided they meet agreed criteria such as an accreditation system
  • A specialised commissioning negotiating board should be created. This will lead to national (service specific) standards for all.
  • GP practices should be coterminous with local authorities. This will prevent people falling through the gaps in services.
  • Support and facilitate a pathway approach to commissioning to ensure co-ordination and cost efficiency

 

Responses to questions:

Clinical engagement in commissioning:

Q1. How will commissioners access the information and clinical expertise required to make high quality decisions about the shape of clinical services?

1.1 There should be a coalition between commissioners, providers and users with a focus on collaborative commissioning shared outcomes and key performance indicators. There should be national standards and an accreditation system for specialist services, ideally that are service specific.

 

1.2 The Board should include a broad range of expertise. This should involve independent providers, user groups, representative organisations, the voluntary sector and the NHS. There should be clear definitions of quality with a focus on user experience.

 

Q2. How will commissioners address issues of clinical practice variation?

 

2.1 Commissioners should expect and encourage variation of practice within a clear framework, otherwise this will stifle innovation and research. There should be national care standards which feed in to a managed care system. Best practice should be shared and people should have the required resources to challenge commissioning decisions without fear. Regular decision reports should be published.

 

Q3. How will GPs engage with their colleagues within a consortium and how will consortia engage with the wider clinical community

3.1 Local arrangements will vary however there will be a need for GPs to evidence inclusion of a wide range of stakeholders within a defined health economy. Decisions should be made transparently and open to all and founded on objective assessment of need, choice and competency.

 

3.2 Patients or their representatives should be fully involved in decisions involving their care and understand the reasoning behind the decisions. All information should be accessible and easy to understand.

 

Q4. How open will the system be to new entrants?

4.1 The NHS Commissioning Board must include some people without long careers in the NHS and the system should permit new entrants provided they meet agreed criteria – accreditation process

 

Q5. Will care providers be free to offer new solutions which offer higher clinical quality, better patient experience or better value?

5.1 Yes. However, innovation must be balanced against stability. Quality, not just cost should be closely monitored. There needs to be a commonsense approach to new services that are based on what users want and need.

 

Q6. Will commissioners be free to access new commissioning expertise?

6.1 Yes as long as organisations that provide support and expertise are forced to demonstrate cost savings and competence and are not allowed simply to supply expensive consultants.

 

Q9. How will patients make their voice heard or their choice effective?

9.1 User groups should be involved in a way that goes beyond tokenism. Constant, publicly available user-generated feedback should be openly considered in decision making.

 

9.2 Clinical outcomes should be published online. A full list of measures and their importance to commissioning decisions should be available. Reports should be accessible and jargon-free where necessary a glossary of terms should be made available.

 

9.3 The Board should take account of user feedback and work with service providers to develop quality improvement plans based on that feedback.

 

Q18. What will be the role of local authorities in public health and commissioning decisions?

18.1 GP practices should be coterminous with local authorities. This will prevent people falling through the gaps in services. There should also be a duty on consortia to ensure that any gaps in services that develop are quickly addressed.

 

 

18.2 The care pathway should also be co-commissioned in a way that involves both health and local authority services. This would need to be individually case managed to ensure a coordinated approach.

 

Q29. What arrangements are proposed for commissioning of specialist services?

29.1 There should be a clear focus on the care pathway with a single contract, a single set of standards and a single CQUIN. This should create a consistent approach supported by national negotiations.

 

29.2 A specialised commissioning negotiating board should be created. This will lead to national (service specific) standards for all. There should also be agreed common outcome measures, including some reported by patients.

 

Q30. How will these arrangements interface with the rest of the system?

18.1 Consortia should have representation in specialised commissioning decisions. They should understand the interlinked nature of services and support a pathway approach to commissioning.

 

Recommendations:

1. There should be a coalition between commissioners, providers and users with a focus on collaborative commissioning shared outcomes and key performance indicators. There should be national standards for specialist services, ideally that are service specific.

2. There should be national care standards which feed in to a managed care system. Best practice should be shared and people should have the required resources to challenge commissioning decisions. Regular decision reports should be published.

3. Patients or their representatives should be fully involved in decisionsinvolving their care and understand the reasoning behind the decisions. All information should be accessible and easy to understand.

4. There needs to be a commonsense approach to new services that are based on what users want.

5. Clinical outcomes should be published online. A full list of measures and their importance to commissioning decisions should be available. Reports should be accessible and jargon-free where necessary a glossary of terms should be made available.

6. A specialised commissioning negotiating board should be created.

7. There should be a clear focus on the care pathway with a single contract, a single set of standards and a single CQUIN.

8. Consortia should have representation in specialised commissioning decisions. They should understand the interlinked nature of services and support a pathway approach to commissioning.