NWJIP

Wirral Borough Council and PCTs developed a Joint Commissioning Strategy for Older People in 2005, which was refreshed in 2006. Click here to download Wirral’s Revised Joint Commissioning Strategy for Older People.

Joint commissioning strategies have also been developed for learning disability services and physical & sensory disability services, and an adult mental health commissioning strategy is currently being drafted.

Each strategy contains:

• Comprehensive needs analysis.
• Gap analysis - consisting of market analysis, identification of service priorities, and exploration of funding options.
• Exploration of universal service contributions.
• Priorities and commissioning intentions identified.

What prompted the organisation to develop this approach?

Having prioritised strategic commissioning, Wirral appointed a number of joint roles over the past few years to write and prepare commissioning strategies, and to develop a clear strategic direction for the health and social care partnership. The main drivers for this work were:

• The growing population of adults and older people predicted to need health and wellbeing services in the future.
• The need to better understand population needs, resource allocation and service priorities.
• Government policy, especially the requirement to shift more resources into preventive care.
• Social services recognition that it needed to work together with health and housing, areas which were also having to think about older people and demography.

What has the work involved?

• A partnership arrangement with health was already in place prior to the development of commissioning strategies – ‘Wirral Health and Social Care Partnership’. The Partnership set up 'modernisation groups' whose role was primarily service development.
• The development of a commissioning strategy for older people highlighted the need for stronger governance and operational arrangements, and greater clarity as to the membership and role of the ‘Partnership’ and ‘Modernisation’ groups to drive through work on the strategy. Partnership arrangements are being re-visited and stronger governance arrangements are in place.
• A large amount of public health information was gathered using sources such as ONS on: population; healthy life expectancy; risk factor indicators such as local and national prevalence of diseases, falls and admissions to hospital. The first strategy for older people in 2005 also looked at indicators of health, equality and access to services such as the number of households with cars etc.
• Social care demand forecasting was undertaken to explore the number of people using services based on demography, assuming no changes in service configuration. These forecasts were then adjusted to take into account foreseeable shifts in services due to external demands such as meeting performance indicators and agreed LAA outcomes.
• Whole systems performance analysis was undertaken to explore the relationship between performance indicators such as C32 (people helped to live at home) against C72 (supported admissions) and against the residential sector occupancy level. Where the data didn’t match up it was interrogated to establish whether data cleansing was needed.

How have things changed for the better?

• The work has created a focus, direction and consensus between organisations about the importance of a commissioning strategy and about getting the information right. A strong consensus around the direction of travel has been developed. Greater political support has been achieved.
• It has allowed finance to be re-directed in a more structured way. For example, it has allowed the development of extra care and assistive technology by using mainstream community care budgets to re-direct money to preventive services. The strategy has been used as the basis for developing a financial strategy which has gone to cabinet.
• The involvement of older people has been embedded in the process of service development.
• The market has responded to the strategy by directing their service developments at the areas of need e.g. EMI care.
• It has established a link between macro and micro commissioning i.e. social work/care management. For example, as new services come on line such as extra care and assistive technology, commissioners will need to support care managers in developing their understanding of what these services can offer and who may benefit from them.

What have been the major challenges/drawbacks?

• The authority’s initial experience of engaging public health was problematic. Once the strategy, which evidenced a lack of health data, was made public, public health became fully engaged. It was also difficult to engage the PCTs in developing investment plans as part of the joint commissioning strategy.
• Analysing health data and gaps in information. Hospital activity data and public health data is readily available but analysis of such things as community therapy data is more problematic due to difficulties understanding its relevance and using it to support re-designing community health services.
• Lack of clarity as to how the commissioning strategy fits with PbC and PbR, and other plans and strategies. There is therefore a risk of work duplication.
• The challenge of estimating the rate at which the public will access services in the future due to public expectations, aspirations and economic wellbeing. Self directed care will support this as it will give a much clearer picture of what the public will want.

What lessons have been learnt?

• The importance of having robust data.
• The importance of developing commissioning as a function/process, alongside getting on with service development.
• The importance of identifying and ensuring the right competencies/business skills to undertake commissioning e.g. actuarial skills.
• The need for an over-arching strategy which drives service development.
• Peoples’ variable understanding of commissioning.

How might the work affect commissioning in the longer-term?

• The work has enabled the authority to look at the whole process of commissioning and identify weaknesses across the commissioning function.
• It has moved the authority forward in terms of analysing activity, and it is hoped that the commissioning process will develop and improve over time allowing more accurate forecasting.
• There has been a recognition of the need for longer-term planning i.e. the need to commission 10 or 15 years ahead rather than 3 years. Extra care housing is a good example – it takes 3 years to build and will be around for next 20-30 years – an expensive mistake to make.
• It gives support to the idea that commissioning cannot be single agency.

Contact

For more information about this case study please contact Jennifer McGovern, Joint Commissioning Manager, Wirral Metropolitan Borough Council This e-mail address is being protected from spambots. You need JavaScript enabled to view it .'; document.write( '' ); document.write( addy_text27377 ); document.write( '<\/a>' ); //--> This e-mail address is being protected from spambots. You need JavaScript enabled to view it