Neurological commissioning support: 'putting service users at the heart of commissioning'
Sue Thomas, Head of Neurological Commissioning Support
MS National Centre
Way Ahead 2009;13(4):4-5
What does commissioning of healthcare mean? It could be defined as the procurement, buying or purchasing of goods and services to maintain or improve the health of individuals or communities. Health care services have been commissioned for years with most of the healthcare budget spent in hospitals. Every year hospitals would ask for an increase in budget and new services would be commissioned but there was very little discussion about existing services and how they were working. There was also little measurement of quality and little regard for patient satisfaction with services. It's true to say that a good deal of the commissioning that took place was done from a historical perspective - 'that's what we bought last year - so let's have a bit more of it' but from both a user and clinician perspective were these services what individuals really wanted? Were users benefiting?
That was commissioning in the past. Current reforms, in particular Lord Darzi's 'High quality care for all'1, and the World Class Commissioning programme (WCC) have set out a framework that shifts the balance of power putting the service user central to any plans. There is also a much greater role for clinicians in influencing commissioning. Quality is a key feature and of course particularly important for people living with multiple sclerosis - understanding service user need and coordinating this into commissioning plans is vital for ensuring future service provision.
Commissioning is now on course to change. Initial changes had been made through payment by results and practice based commissioning (PBC) but the most significant changes will come through the world class commissioning framework which has been designed to improve organisational commissioning development.
Commissioning is now focused on evidence based, high quality, outcome led services, increased patient choice and reducing health inequalities.
World class commissioning has 11 competencies underpinning its framework, indicating that PCTs will:
- Locally lead the NHS
- Work with community partners
- Engage with public and patients
- Collaborate with clinicians
- Manage knowledge and assess needs
- Prioritise investment
- Stimulate the market
- Promote improvement and innovation
- Secure procurement skills
- Manage the local health system
- Make sound financial investments
It is against this background that Neurological Commissioning Support (NCS) has been developed, it's main aim is to put service users at the heart of commissioning. NCS is a consultancy service for health and social care commissioners jointly led by the Motor Neurone Disease Association, the Multiple Sclerosis Society and the Parkinson's Disease Society. The service, which has been in an experimental stage since 2007, is now fully operational.
What does Neurological Commissioning Support do?
NCS works alongside commissioners in order to:
- analyse needs, services and finances;
- engage with people affected by long-term neurological conditions;
- develop strategy and redesign services; and
- support the development of more effective service networks in order to deliver service improvements.
The service combines the credibility, authority, knowledge and expertise of three reputable and well-established national charities with the unique experiences of a strong and widely spread service user base. This strong service user engagement is perhaps the most attractive element of NCS adding a unique blend of knowledge and experience into core processes of commissioning. Recognising the needs and constraints of health and social care commissioners, NCS seeks to work alongside its commissioning partners in order to influence and improve the experiences of people affected by long-term neurological conditions like MS.
The key features of Neurological Commissioning Support are:
- to actively engage people affected by long-term neurological conditions in the commissioning process;
- to effectively involve the third sector in the commissioning of services;
- to maintain a cross-neurological focus;
- to utilise and develop partners' skills and knowledge base; and
- to ensure outward knowledge dissemination.
Vision
The vision for the service is that it will work towards improving gaps in service provision for people with MS (and other neurological conditions) so that users and carers have an equitable and appropriate service regardless of where they live.
Neurological Commissioning Support will also respond to strategic health and social services policy by ensuring that neurological services contribute to the implementation of new policy developments, for example the personalisation agenda and End of Life Care strategy2.
Projects
The following are amongst the projects that Neurological Commissioning Support has been engaged with to date:
Bath & North East Somerset (BANES): End of life care
NCS was engaged by Bath and North East Somerset PCT to establish the views and preferences of service users and carers regarding services at the end of life. Recommendations made included setting up a reference group of users and carers to assist the PCT in developing more appropriate services.
Following a stakeholder event in July 2008, and a detailed report by NCS, the PCT agreed to focus training of their staff on end of life issues for people affected by a long-term neurological condition. They have acquired funding for this, and the training scheme is currently being rolled out to all health and social care staff. Other outcomes of the project so far have included the formation of an end of life care service development reference group comprising service users and carers, and the opportunity to participate in a therapeutic discussion group for people affected by a long-term neurological condition.
The project is currently being published as an example of best practice in a guide for user involvement in end of life care, a collaborative effort from the National Council for Palliative Care (NCPC), and the National Cancer Institute (NCI). This project was the runner up in the NHS Involvement to Impact Awards (specialist services) 2008, following its outstanding service user involvement.
Cumbria: Individual health budgets
Cumbria was one of the first sites for the project 'In Control' which piloted direct payments and personalised budgets for social care. Working in partnership with the local authority who have now been piloting direct payments for over a year, the PCT approached NCS, requesting that they lead on the user involvement for an investigation into implementing personal health budgets. Stakeholder conferences were held in November 2008 and March 2009 and a scoping report was created to aid considerations.
Neurological Commissioning Support went on to assist the PCT in preparing its bid to the Department of Health to become a pilot for personal health budgets. As part of this work a group of twelve service users have volunteered to act as a 'living pilot', trialling a health budget, considering what they would use it for, troubleshooting areas of difficulty, and helping the PCT to reach solutions to the challenges which are already anticipated in this innovative work. This work is currently in progress.
Gloucestershire: Review of neurological services
NHS Gloucestershire has asked NCS to undertake a review of their neurological services within the county. This work is expected to be completed within 18 months and, heavily led by users and carers, has the potential to shape health and social care services for those people in the county affected by a long-term neurological condition, for the foreseeable future.
NCS has developed a commissioning wheel that can be used as a resource to aid commissioning. This looks at the components of strategic commissioning, procurement and micro commissioning (commissioning at a local level).
Strategy for the coming months
During the coming months NCS will be working with staff from its three supporting organisations to ensure local users have the skills to influence and change local neurology services. A framework that will enable users and carers to participate in the consultation work is being developed and training provided to realise this aim.
This is an exciting time as neurology services move forward and enable users and carers to be more actively involved in local health and social care service design and development.
And what about you? Commissioners in your area need to work with service users and providers to generate their future commissioning plans for long-term neurological conditions. Many of you may already be involved in commissioning at a local level. If you are not, then get involved. The MS commissioning pathway is a tool that can facilitate the engagement of health professionals and people with MS in the commissioning process. Read on to find out how the tool was developed and how it will enable people with MS to shape the future of their services.
References
- Darzi A.
High quality care for all: NHS Next Stage Review final report.
London:DH;2008. - Department of Health.
End of Life Care Strategy - promoting high quality care for all adults at the end of life.
London: DH; 2008.
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Way Ahead articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.
