Slings and Arrows

Menstrual cycle hit me like a hurricane and I woke up from it yesterday realised once more there was a world out there!

Last Tuesday (I can’t believe it is so long since I posted!) I went to a training seminar on PCT Practice based third sector commissioning. Amongst the jargon and the unfamiliar acronyms I got flashes of understanding about what was going on. I share some of the most relevant bits for the postcard campaign:

This is a new system and everyone is trying to get a handle on it and alot of the commissioners are newly in post.

There lots of aims to the reforms according to who is speaking but it appears to be a government agenda who’s expressed about money followingthe paitent, more choices and a stronger

We now have a district-wide PCT with over all goalsagreed with central Government. Within the PCT,however, there are ‘divisions’ which ironically in Bradford are along the same lines as the old PCT boudaries. Each division sets its own key priorities according to its population mix. checking through the divisions in Bradford and Airedale PCT, 2 of the divisions have priorities/targets around maternal and child health.

Third sector groups can tender to do work that fulfills these priorites and targets. There is a big recognition of social needs and there was much reference to ‘social’prescribing’ recognising that social situations affect peoples health and health choices (or non choices) and that thrid sector organisations in the community can have a positive effect especiaaly here.

There is a cycle/process to ariving at these priorities and this is a key to us effecting policy and priority decisions. The starting point in the cycle is the ‘needs assessment’ that is assessment of the needs of the population. How is this done? By the old fashioned networking method – commissioners talk to people they know, who are recommended to them, who turn up on their doorstep. they go to community and neighbourhood forums. At Practice level commissioning is also very much about what GPs get coming through their surgery doors. This work is combined with national helath frameworks and priorities coming from central Government. Mixed together, these ingredients are formed into local priorites and targets which form the basis of the commissioning process.

Once the priorities are set the PCT welcomes agencies to approach them and tender to do work to fulfill certain priorites – this can be about medical and social need. The amounts tendered for can be small eg. £5000 or huge, say £145 000. It is a three year cycle to provide stability of care to the patient and funding for the organisation.

The key thing for us is to get in there at the needs assessment stage, getting commissioners to talk to groups of women and understand their experience – I keep banging on about one mother one midwife for instance. This is the key as I understand it, users need to voice their needs loud and clear to the PCT because the Government is telling them that they need to be sensitive to the needs of users. Even if you have appeared to miss the initial needs-priority-commissining faze, we were assured (on questioning) that the needs assessment is ongoing – so get in there girls!!!!

How do we get in there? I think the answer is any which way you can or want. At the event I went up to the Head of Partnership Commissioning (I think that is or includes third sector) and asked him for the names (and spellings) of every commissioner who had responsiblity for maternal and baby welfare, childbirth and breastfeeding. What was clear was that childbirth issues are spread around alot of commissioners – which can be looked on as a problem, a challenge or an asset – because you can work with the ones you can owrk with I suppose. My aim is to write to them all in the next couple of weeks to see if I can kickstart some progress on needs assessment that talks to users.

My question in regard to childbirth issues to everyone I speak to is:What is current user involvement in commissioning services? Where is the needs assessment being done? How can users get involved? Where I am asking the questions – there is some interesting responses – I guess because there is no significant user involvement. I don’t think they know how and where to begin in involving users at this stage – so maybe we need to approach them and start offering them some solutions?

This is a very potted assessment of commissioning based on a seminar in Bradford, however, it comes it simpler terms than what I received it! And I hope it gives women nationally an idea of what may be going on in their area. I would strongly suggest getting in there and asking around and finding out the names and contacts of commissioners responsible for childbirth issues and start approaching them. Users need to say what they want and indpendent midwves need to look at how they can tender for services not being currently rendered. It is a steep learning curve – but in anew system we can start to define and challenge how it works by using it.

As always, it needs to be fun. Getting all those names out of that guy was fun. by the time he had finished he had a twinkle in his eye as I had in mine – he knew what I was up to and he knew I meant business. And it amused both of us. Result! He also told me that a piece of work was being done on needs assessment in childbirth at the present time – finishing in October. A good time to get in there then – and all that came with a twinkle in the eye, a smile and a bit of cheek.

Well it is past the time the children should be getting ready for school so I will scarper!

Ruth