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Behind the scenes


23 April 2015

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Commissioning support units can play a huge part in facilitating commissioners in achieving their dreams. The North of England CSU highlights its recent work

Over the last few years the NHS has seen a great deal of change, with the Health and Social Care Act delivering wholesale reform to the way services are commissioned in the NHS.


The question is have these changes seen commissioning transformed for the better?

Commissioning support units can play a huge part in facilitating commissioners in achieving their dreams. The North of England CSU highlights its recent work

Over the last few years the NHS has seen a great deal of change, with the Health and Social Care Act delivering wholesale reform to the way services are commissioned in the NHS.


The question is have these changes seen commissioning transformed for the better?


I firmly believe they have and that the sector I am lucky enough to work in – commissioning support – is a large part of the reason why commissioning has been able to reinvent itself – to the benefit of patients and the system as a whole.


The NHS reforms led to the creation, just over two years ago, of commissioning support units (CSUs). The original purpose of these organisations was to provide at-scale, commissioning expertise (in particular business intelligence and transformational support) to clinical commissioning groups (CCGs) for a fraction of the management resource vested with the predecessor primary care trusts (PCTs), freeing CCG clinicians to concentrate on improving quality of care, patient outcomes and experience.


However, the key difference between CSUs and other organisations in the NHS is that while CSUs have NHS values at their heart and are very much part of the NHS family, they also operate a private sector business model, with the need to generate revenue to stay in business.

The need to innovate
The success that CSUs have had recently in helping to reform commissioning has been driven by two factors – innovation and the ability to share best practice.


Firstly, to stay competitive in what is a commercial marketplace CSUs have found that to thrive they need to innovate. Some CSUs have struggled and, when combined with other contributory factors, have found it difficult to retain or win new customers, which in turn has undermined their viability. This has led to a substantial reduction in the number of CSUs, with there now only six CSUs that have made it on to the Lead Provider Framework – down from 27 when CSUs came in to existence at the start of 2013.


At North of England CSU we realised early on that innovation would be key to our business model. This is not just because it benefits us but because we know that the NHS cannot meet the massive challenges it faces without innovation. A £30 billion funding gap, the need to create a more patient-focused model and the need to deliver more care in the community are just a few of the massive challenges outlined in Simon Stevens’ Five Year Forward View.


One concrete example of innovation in practice is the project we are running in the north east on managing winter pressures. We have been working with CCGs, acute providers, local authorities and the ambulance service to develop a web-based tool that allows pressures on the health service in the north east to be monitored in a holistic and cross-boundary way. The data is monitored in real time by the Winter Resilience team, who liaise closely with stakeholders to manage operational capacity across the region.


And the results have been impressive. Last winter there was a 39% reduction in ambulance handover delays, a 21% reduction in the number of beds unavailable due to delayed transfers of care and a 24% reduction in the number of elective operations cancelled within 24 hours.


The programme is up and running again this winter in the north east and across Cumbria. The service now features a ‘flight deck’ that provides the ambulance service with a richer set of data about capacity in our hospitals, enabling more informed decision making about where to take patients at times of high demand. Anecdotal evidence shows that, while urgent and emergency care has been incredibly busy over the past few months, the approach we are taking has ensured the whole health and social care system is better connected and that capacity is managed in the best way possible.


Another example of innovation comes in the area of business intelligence. In the north east five different business intelligence tools were either in existence or in the process of being created – a legacy of the old system of PCTs. This meant the system of processing and collecting data across the primary and secondary care sectors was being replicated many times over at unnecessary cost. By consolidating the best of the systems into a single business intelligence tool (reports, analysis and intelligence delivering results (RAIDR)) we are able to share and exchange information more easily and at a significantly lower cost – within touching distance of our ultimate goal – ‘one version of the truth’. So successful has this process been that the system has now been taken up by 41 CCGs across the north east, Cumbria, north west, Suffolk and Yorkshire, covering 20% of the country. Our aim is to keep RAIDR ahead of the pack and for that reason we continue to invest heavily in its development – £500,000 in 2014 alone in new dashboards, automatic alerts and risk stratification for our customers.

CSUs working together
Despite competing with each other, CSUs are harnessing the power of collaboration, thereby leveraging added value from such innovative developments. An example of this came last year when five CSUs – North of England CSU, North and East London CSU, South CSU, South West CSU and Midlands and Lancashire CSU – came together to form a strategic alliance known as the Elis Group.


This alliance exists precisely so that best practice is spread across the commissioning support sector and also to raise the overall status of the commissioning support profession. We are currently looking at how we can formally ensure continuing professional development for people who work in commissioning support, acknowledging the skill set and expertise of those who work in the profession through the development of an Elis Academy. Another example of this collaboration is the Knowledge Hub, a web-based repository for best practice that has been developed by CCGs in the north east and Cumbria and adopted by the Elis Group for the benefit of all of our customers.


There are also several programmes where Elis Group CSUs have joined together, recognising that in this way they can provide additional expertise and services that are valued by customers. All of this has contributed to a situation where CSUs are viewed by our partner organisations in the NHS as ‘transformational partners’ rather than merely ‘transactional partners’. This allows us to engage with CCGs in wider strategy development rather than single issues or just back office support.

Why commissioning matters
When looking at the contribution CSUs are making to transforming commissioning, it is important to remember that, in the grand scheme of things, CSUs are still in their infancy. They were only created two years ago and in that time have already made a significant contribution to re-shaping commissioning in the NHS. If you think about the impact in just two years, just imagine what could be done in the next five years and the next 10, particularly in the arena of joint commissioning as business intelligence tools such as RAIDR embrace both health and social care data to provide integrated intelligence.


We must also keep in mind why the reform of commissioning matters. Good commissioning transforms care and delivers great outcomes for patients. Poor commissioning jeopardises patient safety and wastes tax-payers money. Even though patients may not be aware of the work we do, getting things right behind-the-scenes can be the difference between fast access, high-quality care with an excellent outcome and poor access, poor care and a poor outcome.
Commissioning is being transformed day-by-day, week-by-week, month-by-month and I feel more passionate than ever about the difference we are making and our potential to achieve a lot more – for both health and social care commissioners.

Stephen Childs is the managing director of North of England CSU.

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