When East Staffordshire Commissioning Group awarded a £280m contract for care of people with long term conditions to Virgin Healthcare, it was determined to listen to the people who will use the service.
The seven year contract was a fusion of ideas from the commissioner, the provider and patients and carers, says East Staffordshire Clinical Commissioning Group accountable officer Tony Bruce.
Virgin Healthcare will being delivering services for people with long term conditions and the frail elderly next spring.
During the final stages of the competitive dialogue procurement process, says Bruce, the CCG worked with the two potential bidders to define measures for outcomes that patients and carers said would improve their health and wider lives.
“We had the dilemma of ensuring that the outcomes for a multi-million pound contract could be measured and that they reflected what our patients and carers had told us. We were mixing our creativity and ideas with theirs to achieve that.”
The bidders were asked to include possible key performance indicators and explain how they would evaluate progress against each of the indicators.
Bruce notes that from the earliest days of the CCG, improving the care for those with long term conditions and older people with frailty has been the top priority.
He points to grim indicators that, along with financial challenges, highlighted the need for dramatic change. These include above average hospital admission rates for people with long term conditions and poorer clinical outcomes (such as above average amputations for people with diabetes).
“We recognised that we had a big problem around integration of these services. We asked ‘what would good look like?’ and decided that outcomes based commissioning would be the best route.”
While the CCG’s GP leadership held workshops with their colleagues to develop clinical outcomes, there was a determination that the final outcomes framework would be based on input from the community.
“We wanted to get to the bottom of what matters to the patients, families and carers – we wanted to know about their perceptions and what would improve their quality of life. We worked with the (Midlands and Lancashire) commissioning support unit to get deep and meaningful information. We wanted to talk to real patients and carers as well as their representatives.”
The CCG commissioned consultants to lead the engagement work at scale. The 500 hours of engagement included:
•Structured interviews in both conventional health consultation settings (such as health centre waiting rooms) and in less-visited targets, such as workplaces
•Events that captured the words used most frequently by patients and carers when talking about how their lives, health and wellbeing could be improved.
“While that was underway we were carrying on talking to our MP, the overview and scrutiny committee and patient representatives as usual,” Bruce says.
As the project management board set about drafting the outcomes framework, the CCG appointed to it a patient and a carer representative. Bruce explains they followed a normal recruitment process rather than turn to voluntary groups because these people had a very specific brief.
“Their job was not to represent carers and patients as such but to make sure that what they had told us was incorporated in the outcomes. We effectively appointed an internal regulator to make sure we had listened.”
Both are now continuing their roles, working with CCG officials and Virgin Healthcare clinicians and managers on the joint mobilisation board planning for next April.
The carer member, John Bentley, says: “There was a general understanding that we need to look at different and creative ways of providing healthcare and that the service user and carer need to be at the front of that.”