Integrated Ambulance

Commissioning

Mark Docherty

Director – London Ambulance Service

Commissioning

Former Chair of NACG

2nd April 2014

What I am going to cover

• Getting ambulance commissioning right • Collaborative commissioning: the implications

for the Independent Service • An update from the National Ambulance

Commissioners Group (NACG)

THE EXTRAORDINARY ADVENTURES OF AN AMBULANCE COMMISSIONER

What is Commissioning?

• 1988 – 12 mentions in parliament• 1997 – 248 mentions• 2007 – over 1,000 mentions • 2011- ,000s of mentions in both chambers

• In 20 years it is a concept that has come from nowhere….and is now everywhere

What is commissioning really?

• Conscience – stewardship, quality assurance, public protection

• Brain – resource allocation, service design, planning

• Eyes and Ears – patient experience, receiving and analysing information back to brain and conscience

(Smith & Mays, 2005)• Not Arms and Legs – doing and delivering

CCGs?• 211 CCGs and average 226,000 population replace

– 151 PCTs with average population of 284,000• 19 Commissioning Support Units

(At April 2013)

Why?• Because commissioners are the local NHS and local Social Care –

there is no one else• Because somebody needs to decide what’s needed locally and

how best to get it• Because someone needs to challenge existing vested interests

and unresponsive services• Because one day I’ll need services too….

*NHS Commissioning Board is now known as NHS England

*

999 Call Activity - London

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Jan-0

9

Apr-09

Jul-0

9

Oct-09

Jan-1

0

Apr-10

Jul-1

0

Oct-10

Jan-1

1

Apr-11

Jul-1

1

Oct-11

Jan-1

2

Apr-12

Jul-1

2

Oct-12

Jan-1

3

Apr-13

88000

98000

108000

118000

128000

138000

148000

158000

168000

Calls Median (CALLS)

Category A (Red 1 & 2) Activity

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Jan-0

9

Apr-09

Jul-0

9

Oct-09

Jan-1

0

Apr-10

Jul-1

0

Oct-10

Jan-1

1

Apr-11

Jul-1

1

Oct-11

Jan-1

2

Apr-12

Jul-1

2

Oct-12

Jan-1

3

Apr-13

20000

25000

30000

35000

40000

45000

Cat A Median (A)

Category A Performance - LAS

Apr-10

May-10

Jun-1

0Ju

l-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-1

1

Feb-11

Mar-11

Apr-11

May-11

Jun-1

1Ju

l-11

Aug-11

Sep-11

Oct-11

Nov-11

Jan-1

2

Feb-12

Mar-12

Apr-12

May-12

Jun-1

2Ju

l-12

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-1

3

Feb-13

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

Ambulance Demand Challenges

The Financial Context

Collaboration

Types of CCG Collaboration e.g.

A collaborative model

National and Sub-National

CCG and Local

The National Ambulance Commissioners Group

• A forum for the lead commissioners, hosted by NHS Clinical Commissioners (NHSCC)

• A national expert group• No statutory or legal status• Undertakes high quality national work-streams • Contributes to National Publications e.g. “Tackling Demand

Together” & the “Good Practice Guide for Ambulance Commissioning (RCGP)”

• Invited to give evidence to the 2013 Health Committee on Urgent Care

The National Ambulance Commissioners Group

• Produces national models – e.g. national ambulance contract, PbR, Clinical Indicators, HART Specification

• Develops shared strategic direction ‘Achieving Integrated Unscheduled Care’ and shares technical knowledge and skills to improve their local leadership and contract management

• Provides informal induction and ongoing peer support for members

• Discussions are underway to enhance the role of the NACG and to formalise it’s status, so that it formally becomes the organisation that influences national commissioning direction

Key Points

• CCGs are in the driving seat• Massive challenges ahead• NHS Ambulance Providers on their own

unlikely to be able to solve all the urgent care challenges

• Partnerships are likely• Relationships are key