How it works

1. Review of commissioning and procurement

It is intended that Herefordshire Council and Herefordshire Primary Care Trust, jointly named ‘Herefordshire Public Service’ (HPS), will integrate their separate commissioning and procurement functions. A key development is the appointment of a director of integrated commissioning who will start in August 2008.

*Commissioning is the set of linked activities required to assess care and support needs, plan and specify services, secure those services and evaluate outcomes.

Procurement is the process of choosing a provider through competitive tendering or single sourcing.

A review, started by CSED (Care Services Efficiency Delivery), of aims, structure and functions across HPS began in June 2008 and is likely to continue for most of the year. It will include how functions across various interests can be joined up and possibly co-located in one building. Commissioning staff, buyers and contract managers will move offices accordingly.

The Alliance has suggested a practical ‘litmus test’ for the effectiveness of integration, i.e. could several contracts of one provider be handled by one commissioner – a single point of access? If this achieved such a provider would have continuity and a better chance of developing a better professional relationship based on mutual understanding.

2. Review of NHS provider services in Herefordshire

Through the summer and autumn of 2008 there will be a NHS review to ensure provider services are fit for purpose and organised in sustainable configurations…’

Attention will be given to the services Herefordshire PCT and Hereford Hospitals NHS Trust provide but also to their financial sustainability. The review is therefore about fit-for-purpose organisations as well as services.

Wider stakeholders have been invited although meaningful participation may be difficult. The Alliance has agreed to be involved and through members will offer views on the services under review and raise specific issues, e.g. contestability (i.e. whether some services satisfy criteria for wider competitive tendering). We will also encourage recognition of, and linking up with, services within the wider provider community so that all partners are involved in the vision and implementation of better health, care and support services – a shared wellbeing agenda.

3. Adult Commissioning and Children’s Trust Boards

The Alliance is represented at these two important strategic boards which review commissioning plans, budgets and service developments, evaluate outcomes and approve procurement proposals.

4. Third sector commissioning manager

The purpose of this post is to get involved in the planning, shaping, needs analysis and outcome evaluation functions of commissioning. We aim to achieve more choice, a stronger voice and better outcomes to service users served by a diverse range of providers with more freedom to innovate and improve.

Engagement of the third sector (as well as other stakeholders and provider groups) is essential to the development of service models that are robust and realistic, and a critical element of market development. Commissioners need to understand more clearly the third sector, the organisations within it, their structure, governance and financial regimes, as well as their role in the commissioning process.

We see as priorities:

5. Self-directed care and support (personalisation)

‘Self-directed’ means that people can exercise choice and control over the support they need. Through individual budgets people can manage their own support budgets and the support they buy. The budget and support plan is agreed with the Council and management of support and payment can be assisted by support brokers which could be individuals or organisations.

Having piloted self-directed care/support with people who have learning disabilities, Herefordshire Council aims to offer this to all adults who meet the criteria. This means people can choose who they would like to support them whether they are existing provider organisations or personal assistants (who could be neighbours or relatives). The support they choose to receive may be very different to that currently on offer and experience from the pilot suggests people opt for support that helps them to pursue personal interests and ambitions.

Also Herefordshire Primary Care Trust has expressed interest in becoming a pilot site for individual budgets for patients. Sooner or later, therefore, people will be able to choose their own health care as well, to assist their wish to live independently.

It is likely that purchasing of care and support will move away from block contracts as Herefordshire Public Services begin to buy less whilst people buy more using their individual budgets. It is unclear at this stage what the ratio between block contracts and individual buying (spot purchasing) will be. It is currently thought that some care services, domestic violence, substance and alcohol misuse services may continue to be block purchased.

It may be a mistake, however, to assume that self-directed support will only apply to adults. ‘in Control’, the national campaigning charity for self-directed support, reports that a number of authorities across the country are ‘making self-directed support available to everyone across the whole age range’ including those under 18!

 

 

* Definition taken from Health Service Management Centre, 2006, ‘Commissioning in the reformed NHS: policy into practice’.

 
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