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In 2003 the Joint
Commissioning Team was set up by Telford and Wrekin Borough Council
(a Unitary Local Authority) and Telford & Wrekin Primary Care
Trust (PCT). The staff are managed within the PCT but funded by a
pooled budget from the PCT, Adult and Consumer Care and Children
and Young People services of the Borough.
The Joint Commissioning
process is managed by Joint Commissioning Managers specialising in
particular sectors of the health, adult and consumer care and
children and young people markets. They are located in the same
office and working together as a Team. They are led by 2 Heads of
Joint Commissioning, one for Adults and one for Children and Young
Peoples Services. They are accountable to the PCT Director of
Modernisation and Commissioning. The partnership between the
Borough and the Primary Care Trust remains at the core of Joint
Commissioning Team activity.
The Adults Joint
Commissioning Team comprises:
-
Head of Adults Joint
Commissioning - engages with all key agencies providing Adult
services and infrastructure support within the locality and manages
team members.
-
Joint Commissioning
Managers (JCMs) and Officers (WTE)
-
Mental Health
JCM
-
Mental Health
JCO
-
Learning Disability
JCM
-
Older People
JCM
-
Carers JCM
(Vacancy)
-
Substance Misuse
JCM
-
Physical Disability
JCM
-
Admin
support
The Children and Young
Persons Team comprise:
-
Head of Joint
Commissioning (CYP) - engages with all key agencies providing
Children and Young People's services and infrastructure support
within the locality and manages team members
-
Joint Commissioning
Managers (JCMs) (WTE)
-
Generic
JCMs
-
Sexual Health JCM
(adults & young people)
-
Teenage Pregnancy
Co-ordinator
-
Substance Misuse
JCM
-
Admin
support
Experience in Telford
& Wrekin suggests that Joint Commissioning has a wider
understanding of the market in health, adult and consumer care and
children and young people services. This involves an awareness of
government expectations and initiatives, population trends,
developments in commissioning processes and practice, and the
problems and opportunities within particular sectors. Joint
commissioners are developing their own market intelligence about
what is happening on the ground locally. The Joint Commissioning
Team (JCT) balances present provision with anticipated changes in
demand and supply and, by judicious interventions, drives the
modernisation agenda.
4. What are the advantages of an Adult Joint
Commissioning Team?
Joint Commissioning
reduces the level of bureaucracy involved in the commissioning and
monitoring of services and leads to single forms of application and
points of contact for providers, across health and social care for
adults.
Key to the development
of Adult Joint Commissioning in Telford & Wrekin is the
co-terminosity of the PCT and Local Authority boundaries and the
engagement of Local Representatives, Service Users and Carers,
Clinicians, Service Providers and Business Managers in the process
of devising and delivering a strategy for the improvement of
community based services within the locality.
It offers:
-
A vision of what
services need to be in order to deliver a more cohesive and
comprehensive outcome for Service Users and Carers.
-
Clarity about local
priorities for service provision and improvement.
-
A better
understanding of each agency's commissioning intentions, wherever
possible to be based on a set of common principles and
objectives.
-
A clearer picture of
the level of investment being made and of the services being
commissioned.
-
Easier identification
of gaps in the provision.
-
Better links between
the range of services required by service users and carers covering
a wide range of health and adult social care
interventions.
-
An evidence based
approach to commissioning which incorporates joint assessments of
need where possible.
-
The production of
Strategies, Service Level Agreements, Service Specifications and
Care Pathways for all adult service areas.
-
The creation of a
mature relationship with key providers and the establishment of a
focus on sustainability and innovation in service
delivery.
-
The development of
Performance Indicators, along with monitoring processes.
-
The development of
key strategic information, including baselines and tracking
systems, which tell JCM/JCOs about the effectiveness of their
investments in terms of their impact on the 'big
picture'.
-
The development of an
agreed strategy for the modernisation of community and hospital
based services.
5. How does the Adult Joint Commissioning Team
deal with the depth and complexity of local needs?
The JCT draws on an
extensive range of information and expertise to assess, map and
commission health and social care services for all vulnerable
adults and their carers within Telford and Wrekin. Members of the
JCT are also directly involved in housing support services provided
under Supporting People and work strategically with others,
including Community Safety and Transport.
Services are
commissioned from statutory, voluntary and independent providers
and range from placements in Acute Hospital Wards, Psychiatric
Intensive Care Units, Nursing and Residential Care Homes to Carers
Services provided by CVS, a voluntary agency.
The Adult JCT has
developed a degree of independence from both the PCT and the
Borough. This allows Joint Commissioning Managers and Officers to
objectively review the merits of solutions in a range of
organisations and recommend the best solution, taking into account
best value, from an independent perspective. When commissioning is
undertaken within a single agency framework, it may more readily
succumb to in-house pressures. By keeping commissioning separate
from operational activity, it allows a clearer focus on strategic
planning. When the disciplines of planning and day to day
management are mixed, the nature of operational management is such
that it will always take precedence and this may be to the
detriment of strategic planning.
The Adult JCT can now
draw on a pool of understanding, knowledge and skills in relation
to Adult Joint Commissioning. The experience of the staff extends
from interpreting and linking government initiatives at the local
level, working at the leading edge of developments in service user
and carer involvement, to writing the specification of service
provision for groups of local service users with specialist needs.
They are developing mutual indicators for the performance
assessment of jointly commissioned services and they provide a
consistent approach to commissioning across all areas.
6. How does the
Adult Joint Commissioning Team meet the needs of service users and
carers?
Service users and
carers are fully engaged within the Adult JCT decision making and
implementation processes. The overall picture of local needs and
how the services are working on the ground is enhanced by feedback
from a range of sources, both formal and informal. These include
surveys of service users and reports from local community groups,
front line staff and local representatives. Members of the Adult
JCT have developed local networks for particular services. This
information is brought together within the Adult JCT and informs
the development of Health and Adult and Consumer Careprovision
within Telford and Wrekin.
7. What has the
Adult Joint Commissioning Team achieved?
Joint commissioning
arrangements have been one of the drivers for successful
Partnership working between Telford & Wrekin PCT and the
Borough of Telford & Wrekin.
Achievements to date
include: Pooled Budgets, using Health Act Flexibilities, for:
-
Joint Commissioning
Team
-
Substance
Misuse
-
Integrated Community
Equipment Service
-
Delayed
Discharges
-
Intermediate
Care
-
Learning Disability
Development Fund
-
Development of
Strategies for services to Carers, Older Adults, Older People
Mental Health, Adults Mental Health, Adults with Learning
Disabilities, Adults with Physical and Sensory Disabilities,
Substance Misuse.
-
Falls Co-ordinator
appointed and significant progress made towards a fully integrated
Falls Service.
-
Received Awards for
the Meals on Wheels Service and Low Level Preventative
Services.Enacting Government guidance in developing a mixed economy
of care for mental health e.g. the Rehabilitation
Project.
-
Establishing a
Primary Care Mental Health Team.
-
Better explanations
of NHS budgets, the services they are purchasing and their
contribution to joint service provisions.
-
Developed a range of
Section 28A Memorandum of Grants for Adults with Learning
Disabilities Services and Older Adults.
-
JCMs have taken the
initiative within Local Implementation Teams (LITs)/thematic
partnerships to improve their fitness for purpose.
-
Older People's Local
Implementation Team now chaired by an Older People's Forum
representative and the Forum now has over 800 members.
-
Actively raised the
profile of Assistive Technology and the Single Assessment
Process.
-
Influencing the
Housing Strategy to make sure that the need to bring back Service
Users placed outside Telford & Wrekin is addressed.
-
Developed services
within Continuing Health Care to bring Service Users, who are
placed elsewhere, back to Telford & Wrekin.
-
Contributed
significantly to the Supporting People Strategy and acting as a
Mentor for Joint Commissioning as well as actively being involved
in the production of a CD for Joint Commissioning.
8. Can we improve the performance of the Adult
Joint Commissioning Team?
A recent stock take
identified a number of areas where the effectiveness of the Adult
JCT could be enhanced.
A significant area for
improvement relates to difficulties in partnership working between
agencies, each with their own agendas, organisational structure and
associated cultures. Demands on the Adult JCM/JCOs are often made
with short timescales given. Different organisations and
portfolio/directorates require different administrative procedures,
for example different reports/formats on the same subject are
needed for the Borough Cabinet and for PCT Professional Executive
Committee and Board. The Adult JCT accommodates these at a cost to
its own resources including JCM/JCO and Administration time. The
Adult JCT is continually seeking to improve the ways it manages the
pressures placed upon it
A fundamental part of
commissioning is strategic planning and the production of strategy
documents. The JCT has, therefore, devised templates for
Strategies, Service Specifications, Service Level Agreements and
Care Pathways and these developments now assist with the
transferability of administrative processes.
Additionally, within
the commissioning cycle, a widely adopted process for change, a
shortfall in specific sections has become apparent i.e. critical
appraisal and epidemiological capacity; purchasing and contracting
and the capacity of existing data systems to provide 'off the
shelf' information to support needs analysis activities; these are
now all being addressed.
9. How would you
summarise the present position?
In Telford and Wrekin,
the Adult Joint Commissioning Team has been a reality for over 2
years. The focus of the Adult JCT is on improving services for all
vulnerable adults and their carers within Telford & Wrekin,
whether they are perceived as citizens, patients, carers or members
of the local community. The Adult JCT is developing new skills,
resources and ways of working. The team stimulates innovation in
the pursuit of difficult and long term goals and has emerged as a
key player in the local implementation of the modernisation agenda.
Although still in the early stages of development, the Adult JCT is
maturing rapidly in the face of the new challenges in health and
social care.
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