Specialised Commissioning & Network Planning
As clinical areas become increasingly specialist, it is impractical for every hospital to be fully staffed and equipped to meet needs at a local level. The most appropriate solution to maintain the quality of clinical outcomes, as well as managing costs, is for hospitals to work within a networks of specialists centres, with feeder regions or hospitals.
Such services include, Cardiac, Stroke, Cancer, PICU, NICU, Renal, CAMHS and many more.
The problem then turns into a set of fundamental questions: How many centres? Where should they be located? What configuration delivers the best service I can afford?
The ultimate aim is to maintain clinical quality whilest ensuring any patient waits are acceptable and they are not turned away or forced to receive treatment at the opposite end of the country. Resources must be optimised (cost contained), whilst travelling times to network centres kept to a minimum.
The dilemma for the commissioner is balancing a set of competing needs, whilst taking account of their local conditions, constraints and politics.
Healthcare Decisions has been involved in network planning since 2000 with both the networking policy agenda as well as providing NSH England and regional commissioners with practical tools and approaches for supporting these complex decisions.
Example areas Healthcare Decisions has worked in include:
National Children's and Adolescent Mental Health Service (CAMHS) network planning tool.
National Secure Learning Disability Planning
National Neonatal ICU network planning tool
Manchester based Cardiac Services network planning
CYPMHS Web Tool roll-out and Modelling Project 2017/18
Example output from modelling work
At the end of 2017 until end of April 2018 a programme of support from SCW, NECS (North of England CSU) and Healthcare Decisions was commissioned by NHS England to support nine areas of the country to test the assumptions underpinning their place based commissioning plans for children and
and young people’s mental health using the new web based version of the CYPMH modelling tool.
Healthcare decisions led in three of those areas (working with the CSUs) in:
Beds, Luton and Milton Keynes, and
North East London.
The purpose of the project was to support areas to test and develop their place-based commissioning plans with the aim of developing community services in alignment with the availability of local beds giving consideration to:
reducing inappropriate inpatient admissions
providing alternatives to inpatient admissions, supporting step down facilities and earlier discharge where admission is necessary
reducing delayed transfers of care
improving outcomes for children and young people using mental health services
improving the experience of mental health and related services for children and young people and their families and carers.
CAMHS Network Commissioning 2015/18
In 2014 South Central & West (SCW) CSU, in collaboration with Healthcare Decisions Ltd. and Oxford NHS Trust, were commissioned by NHS England to develop a strategic modelling tool across health, education, the third sector and local authority services, to help plan and improve the delivery of children’s and young people’s mental health services.
The objectives of the work were to improve partnership working; improve community based outreach; reduce placement of children in inappropriate beds; reduce placement of children far from home; reduce waiting times; and, to help planning and investment in services that would improve transition between children’s and young adult mental health services.
This tool is being used nationally by CAMHS commissioners and is available on the SCWSCU Web Site.
“This solution is simply brilliant. It is a step change in this domain. We will look back and see this as the moment when the world turned on its heels.”
Clinical Advisor to NHS England
“For so long planning child adolescent mental health with its complex web of commissioners , providers and settings has been in the 'too difficult' box. This iterative, thoughtful project has challenged all those involved to find innovative solutions to support joint working. The team has listened to stakeholders but also stretched us, constantly grounding us with what is possible now, whilst designing a tool that can flex in the future as we collect data and outcomes nationally for the first time.”
Project Sponsor, NHS England