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What's different about North East Lincolnshire?

North East Lincolnshire Clinical Commissioning Group (CCG), in its strategic role as the commissioner at the centre of the local health and social care economy, has two functions:

  • To commission and procure a range of health and social care services on behalf of local people;
  • To empower individuals to directly procure services which meet their particular need.

North East Lincolnshire is unique in providing an opportunity for adult health and social care expenditure to be commissioned by one organisation, rather than separating out 'health care' from 'social care'. While these differ, and different funding arrangements exist between the two, the aims of both, and the constrained financial context within which both need to be delivered, are mainly the same. Benefits of this integrated commissioning are already evidenced. These include aligning fee rates and quality requirements for people in long term care irrespective of whether payment is from health or social care funds, and enabling services to increase integration when people contact us in time of crisis or when support needs arise on leaving hospital. Service providers should take note of this opportunity to provide integrated services across the two sectors and respond to maximise this.

The CCG ( www.northeastlincolnshireccg.nhs.uk)  took over responsibilities of the former Care Trust Plus (CTP). The unique relationship between commissioning for social care and health, already established by the CTP, results in:

  • A partnership  between health, social care, and the wider council
  • A single strategic commissioning responsibility led by the CCG along with market shaping and development
  • Local delegation of micro-commissioning to focus independent adult social work www.focusadultsocialwork.co.uk for people with social care needs.

Our emphasis on continuing to build relationships will enable even greater integration and enhanced clinical leadership across the system.

Who do we serve?

  • The adult population of NEL is currently around 159,800 and is expected increase to 161,016 by 2018.
  • Growth and level of overall need for adult social care (ASC) is likely to be somewhere between 5-15% between 2011-2018.
  • Approximately two thirds of current spend for ASC is for older people. North East Lincolnshire has a higher than average over 75 population, with an xpected 15% increase in number between 2011-2018, along with slightly higher increase in the number of those with Dementia.
  • The number of expected deaths for the same period is expected to be lower than average at about 5%. This will impact health and social care costs, a large proportionof which are committed in the last 6 months-1 year of life.
  • The challenges of supporting those with physical and/or learning difficulties or mental health needs remain, combined with the challenges associated with advances in medical treatments for the very young.

What services do we currently commission in financial terms?

The CCG secures all health services for people over the age of 18; planned expenditure in 2013-2014 is £281 million. Nearly £58 million (just over 20%) will now be purchased on behalf of the CCG by the NHS Commissioning Board (Primary Care and specialist/tertiary services). £5 million is the responsibility of the Public Health function of the local Council. Whilst this MPS is in line with current budgetary and contractual commitments, this should not be taken as the best way forward as new ways of describing, finding and organising services that cut across traditional boundaries may be appropriate. 

Services are described in a number of different ways because of the reliance placed on them:

  1. Restricted: we will always need to buy these from a particular organisation;
  2. Protected: limited competition is expected for these services as only a certain number/type of organisation might be suitable to provide these;
  3. Open: Open to tender from a wide range of providers.

What are our future commissioning intentions?

  • A move from 'block contracts' to payment for outcomes rather than activity;
  • Commissioning will be less for groups and more for individuals with their own budgets;
  • We may pay for outcomes rather than inputs;
  • To undertake reviews and recommission where quality falls below an acceptable standard.

Each service will have an underlying needs assessment that tells us how much we might need to buy now and in the future. We will identify current spend and provider, length of current commission, and why and when we would review this. Service providers will have to identify their current position and future opportunities in this context. (See example below).

'What we buy' template

Current provider:

xxxxxxxxxxxxxxxxxx

Value of contract in 2015-16:

 

Contract currency:

etc

Quantity i.e. how many people/episodes/contacts etc. as appropriate:

etc

Key quality or performance criteria:

 

Contract last reviewed:

 

Expected reveiw date:

 

Nature and extent of expected review:

 

Interdependencies with other services we buy: