World Class Commissioning
Berkeley has been working with the Board and executive team of a leading PCT to define how and over what timescale the PCT should adopt and implement the principles of world class commissioning. The process has been led by the executive team, involved the 50 most senior clinicians and managers in the organisation and has involved:
- definition of a local -end commissioning and planning cycle, mapping out the key commissioning and planning processes, building on DH guidance
- definition of the accountabilities, roles & responsibilities of the various parts of the PCT and the PEC in governing and supporting the commissioning agenda
- review and clarification of the role and expectations of practice based commissioners (PBC) in the commissioning process
- definition of how the enabling functions - IM&T, workforce, estates and finance – support commissioning;
Berkeley is now supporting the transition of mainstream PCT business into the new framework.
Health Centre Delivery – London PCT
Early in 2008 Berkeley was asked by a London PCT to review its plans for the implementation of a new Health Centre. Berkeley is now working with the PCT providing ‘hands on’ day-to-day project management experience. As part of its remit, Berkeley is ensuring that the governance of the project is fit for purpose and the business case clearly articulated. In addition, sound project management methods are being developed and deployed to ensure successful project delivery. The health centre is due to open in early 2009.
Practice-based Commissioning Strategy
Berkeley is working with GPs in a coastal town to define and secure agreement to a definition of local healthcare priorities, service needs and commissioning intentions.
As well as providing the foundation for the future development of a Practice Based Commissioning plan, this will also provide an important input to acute and community service provision and estates planning - and mitigate local public healthcare concerns by demonstrating clarity and consistency of direction.
Strategic Commissioning Plan and Operational Plan
Berkeley has assisted two large PCTs with the development of a first cut strategic commissioning plan, in line with SHA guidance.
This work involved the review and revision of the PCT’s strategic objectives and definition of the PCT local ambition for improvement in health and health services, alongside national targets and the Local Area Agreement with public service partners.
Berkeley also co-ordinated the development of a PCT’s Operational Plan for 2008/9, aligning investment proposals with the strategic commissioning objectives.
Achieving 18 weeks sustainably
Berkeley's PCT client is an early achiever for 18 weeks and is focused on sustainable achievement of the target following the initial December 2007 deadline through the introduction of new pathways and a shift of services closer to the patient.
Berkeley has worked with the PCT and PBC clusters to develop and implement reformed models of care across priority specialties. Where favourable to improved service quality, this has involved the development of alternative provider options.
Fit for the Future
After two years of analysis, a PCT asked for assistance with the final stages of their Fit for the Future commissioning programme. The programme had been driven by financial pressures and although a great deal of effort had gone into detailing the affordability of planned changes, little work had been done to consider the impact on patients.
Berkeley was asked to develop and articulate an understanding of how the short listed changes would affect patients, in particular setting out the rationale behind the more challenging options for the reconfiguration of acute services.
Working with medical directors and senior clinicians in acute trusts, Berkeley was able to develop a patient focused view of the planned changes that met with the agreement of all the clinicians involved. At the same time Berkeley helped the Fit for the Future team restructure and reword their programme document so that it was suitable for a consultation process, in time to meet the publicly agreed deadline.
Development and implementation of an enhanced stroke services pathway
Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Due to its significance the Department of Health has identified stroke as a national priority and set ambitious targets.
This PCT client decided to act as a pioneer and review, redesign and implement a stroke pathway based on national guidelines and the needs of the local population.
Berkeley facilitated the change by applying the structured approach of world-class commissioning. The steps taken included a systematic definition of needs, the identification of gaps in provision, the construction of an effective stroke pathway and partnering with suitable providers.
Reforming Community Services
This client, the provider arm of a rural PCT, aims fundamentally to shift care closer to home for the benefit of its 460,000 patients, transforming an ageing estate into a modern, fit for purpose healthcare facilities. To achieve this objective, the client has had to establish new 24/7 neighbourhood teams, implement a single point of access, reconfigure the county’s Minor Injury Units (MIUs) and maternity services, refurbish many community hospitals and close a number of community hospital beds.
Berkeley first led production of the public board paper which concluded on the PCTs 18 month public consultation period. Subsequently, Berkeley worked to support the mobilisation of the delivery team and approach to implement this complex change programme, ensuring robust governance arrangements were in place, with a programme steering group drawing on experts from across all local health and social care organisations chaired by the PCT Chairman. The programme is ongoing.
Information Management & Technology Strategy – Department of Health
Despite the government’s decision in 2003 to invest £12bn in the National Programme for IT, it remains a constant challenge to encourage NHS organisations to invest clinical and management time in the IM&T agenda. Many have failed to link the development and exploitation of IM&T with their mainstream business goals.
In 2006, the new NHS CEO and senior responsible owner for the NPfIT determined that IM&T should become part of the mainstream management agenda. Berkeley worked with the DH Director of IT Service Implementation, to devise a programme of work to “mainstream” IM&T in the NHS. This included the development of guidance for the NHS Operating Framework for 2007/08.
Benefits Realisation for IT-enabled service change – NHS Connecting for Health
The Deputy Chief Medical Officer (DCMO) was appointed as the Senior Responsible Owner to the National Programme for IT for the delivery of clinical engagement and benefits realisation across the service.
Through a referral from another client, Berkeley was asked to work directly for the DCMO to help define an engagement strategy and then develop the theory and practice of benefits planning, whereby IT was positioned as an enabler of wider business change within organisations and across wider health communities.
Berkeley co-ordinated a pilot of the benefits planning approach in 5 Local Health Communities across England and then defined a deployment strategy for benefits planning across the NHS.
This led to Berkeley’s involvement in merging the NPfIT benefits activity into the embryonic Integrated Service Improvement Programme (ISIP) and subsequently leading the development of ISIP products and rollout and support for the programme across the NHS.
Assuring Clinical and Cost Effectiveness
As the local NHS statutory commissioning organisation, PCTs are required to ensure and evidence that their population receives safe and high quality healthcare service in line with published national clinical standards and guidelines. This obligation, referred to as “ensuring clinical and cost effectiveness”, applies both to the contracting for and monitoring of existing services, and to the design of new pathways and service models, procured in some cases from new providers.
Berkeley has worked with the Clinical Directorate and Clinical and Cost Effectiveness Group within a leading PCT to develop and plan the implementation of a consistent framework for defining, applying, monitoring, reporting and enforcing clinical standards across all commissioning activities.
The PCT has decided this model should now be extended to cover patient safety and infection control.
Integrated Service Improvement Programme
As part of the Integrated Service Improvement Programme, Berkeley provided dedicated support to two SHA and associated PCTs to embed the principles of integrated service improvement within core business activities for planning and delivering whole-system change.
Berkeley worked with one of the SHAs to develop an approach to integrate planning, delivery and performance management within the SHA and across the local health and social care communities.
Berkeley supported the launch of an SHA wide integrated planning framework, developing a whole system change programme assurance framework, with a view to including this as part of the SHAs mainstream performance management in the future.
Urgent Care strategy – major city
One of the key areas identified for improvement in this major city is the access to emergency and urgent care to both health and social services. Berkeley worked with key stakeholders to understand the key health reform challenges in this area and to develop the ‘Hear and Treat’ healthcare model which was incorporated into the city’s healthcare strategy.
Social Enterprise – Licensing e-learning
The Department of Health and a Royal College have developed an Integrated Training Programme for the NHS. A key component is a web-based online training service, which has proved highly successful.
In 2006, the DH was looking at the opportunity of generating revenues by licensing access to the online training to other countries. This required the set up of a separate business entity, both to licence existing e-learning content and other specialty e-learning content developed in the future.
Berkeley worked with the team to define the operating model for the entity and develop the business plan. The work included the definition of the key functions, the financial flows, the resources and organisation structure required, the legal structure that it should take (A Community Interest Company was the form chosen) and the governance arrangements. Berkeley also developed an implementation plan.
The business plan was given DH approval and the new entity has now been successfully launched.
Read more about Berkeley's other clients