Dementia Commissioning Pack

Introduction

The Department of Health publishes a Dementia Commissioning Pack on 21 July 2011. Sponsored by the Strategic Health Authorities in England, the Dementia Commissioning Pack provides practical resources for commissioners for use with a range of different providers, setting out a commissioning framework and outline approach to identify service development and redesign priorities. Developed in consultation with a range of health and social care experts, including people with dementia and their carers/families, it sets out a framework for commissioning to deliver integrated care, person-centred services, better outcomes, and improved return on investment.

By focusing on outcomes, the Commissioning Pack aims to make it easier to commission better services for people with dementia by bringing together the service delivery, financial and commercial aspects of commissioning in one place. Much of the hard work in the commissioning process has already been done, by providing a commissioning framework, best practice specifications and costing tools, enabling commissioners to spend more time having an informed discussion with providers about service delivery and redesign and focusing on matters that will make the most difference to patients, rather than process or bureaucracy.

The Dementia Commissioning Pack is underpinned by the principles of,

  • person-centred care - recognising and respecting what makes each person unique; protecting people’s rights; and promoting self-determination, choice and independence.
  • partnership - working together to ensure that people, and their carers/families manage their health, have the best care, and achieve the best outcomes;
  • personalised - ensuring that services and support are tailored to the needs of each person, and that people have choice and control about their health and care support.
  • people and communities - ensuring that we are making the best use of skills, assets and resources in our communities to enable people with dementia, and their carers/families to live well.

Supported by an introductory handbook, the Commissioning Pack provides an outcomes-based commissioning framework consistent with the management of dementia as a long term condition. It includes an assessment tool and ‘contract inserts’ which describe what a dementia-friendly service looks like and which can be used by commissioners in a range of contracts, including those for post-discharge support, residential care, home care, community nursing, housing and assistive technology.

Specifications for memory services, specialist dementia services, and hospital mental health liaison services can be adapted for use in procurement and service re-design and can be inserted into National Standard Contracts. Associated performance indicators and a dashboard are provided, and each specification is supported by a ‘Case for change’ highlighting the evidence base for interventions and functions.

Costing tools for each specification enable commissioners to model services and pathways, setting out the savings associated with introducing the service and where savings fall in relation to health and/or social care. The tools also provide commissioners with the facility to compare and benchmark bids in a procurement exercise, within a financial envelope.

Patient information leaflets for each of the three services have been produced to complement the pack.

Opportunities to review and reduce the inappropriate prescribing of antipsychotics for people with dementia features throughout the resource and link to the national initiative: The Right Prescription: a call to action on the use of antipsychotic drugs for people with dementia.

Commissioning Framework and Assessment Tool The Assessment Tool provides an outcomes-based Commissioning Framework that enables commissioners to identify their local priority areas for service development and redesign across each of the four domains of the pack using national performance indicators: Early diagnosis and interventions, Better care at home and in care homes, Better care in hospital and Appropriate use of antipsychotic medication.
Best practice service specifications The service specifications set out a best practice evidence based care pathway which has been developed with a reference group of nationally recognised clinical and social care experts. The specification can be adapted for local use and can be used for service re-design with an existing Provider or as part of a procurement exercise. The specifications set out service outcomes, indicators and deliverables which can be inserted into the NHS standard contracts.
Cost/benefit tool The cost/benefit tools enable commissioners to understand the cost of the service based on the pathway and deliverables set out in the specification. These costs and resources can be flexed depending on any local adaptations made to the specification. The costing tool can be used to develop a ‘should cost’ which can be used to benchmark bids in a procurement exercise, together with an affordability envelope. It sets out the savings associated with introducing the service and where savings fall in relation to health and/or social care.
Case for change These documents set out the evidence base for the service and the patients to be included in the scope of the service. The document refers to relevant NICE/SCIE guidelines and can be used by commissioners as part of a business case for a new service or as part of service re-design.
Action plan(s) There are two Action Plans – one relates to Better Care in Hospital and one relates to a Joint health and social care action plan for improved community services. The assessment tool can be used to help identify the three priority actions in each of the plans. The documents set out a ‘request for proposals’ approach to encourage local ownership of development priorities and provides a simple governance and delivery template to help effect change.
Contract inserts One of the aims of the commissioning pack is to ensure that generic services are more inclusive and more ‘dementia-friendly’ in recognising and responding to the needs of people with dementia and their carers. This is particularly relevant in the better care at home/care homes aspect of the pack, where there are a wide range of services applicable to people with dementia, many of which are delivered through service specifications in a contract type setting. Commissioners can use contract inserts in new contracts with Providers to help ensure services meet the specific needs of people with dementia and their carers.
Guidance document The guidance document on antipsychotic medication provides advice on the initiation, reduction and review of the use of antipsychotic medication, together with alternative interventions to the use of antipsychotic medication.
Patient information leaflets Patient information leaflets take the relevant service specification and seek to empower patients and carers by setting out an explanation as to what to expect from the service and what to do if they do not get the service they expect.

Presentations and handouts

Guidance

Early diagnosis and interventions

At home, and in care homes

Hospital

Reducing inappropriate prescribing of antipsychotics

Templates

Early diagnosis and interventions

At home, and in care homes

Hospital

Reducing inappropriate prescribing of antipsychotics

Cost / benefit tools

For further information about the cost / benefit tools, please email [email protected]

Needs assessment

Patient information

Early diagnosis and interventions

At home, and in care homes

Hospital

Reducing inappropriate prescribing of antipsychotics