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East Midlands Specialised Commissioning Group



East Midlands Specialised Commissioning Group (EMSCG) commissions high cost services that affect small numbers of people on behalf of the nine PCTs in the East Midlands. “Specialised services” are defined as high cost, low volume interventions and treatments that need a critical mass of patients to make treatment centres cost effective. With a population of over 4.4 million the East Midlands is the fastest growing region in England, and over £500m was spent buying specialised services in 2008/09.


The problem

The EMSCG were engaged in strategic planning for 2010/11 and required updated needs assessments and profiles for the major services they commission within the areas of mental health, cardiovascular (including renal), paediatrics and cancer. A system for identifying how these services compare to national and international averages (benchmarking) was also required. Bazian was commissioned by EMSCG to assist in work relating to understanding health needs and trends across the region and the use of health indicators and benchmarks to monitor service provision.


Our solution

Bazian undertook a review of publically available health indicators that were relevant to specialised commissioning in order to derive a list of indicators that could be tested for feasibility. Through a systematic and transparent process, a short list was selected that was aligned with EMSCG’s strategy goals. Bazian saw the development of a health outcome indicator set as having three main steps:

  1. Select a balanced set of measures
  2. Specify operational definitions
  3. Build data collection plans

The work built on consensus reached at a health indicators workshop held with a range of stakeholders earlier in the year. Alongside the short-list of indicators was presented a practical consideration of their feasible use and a suggested work-plan to establish the routine reporting systems required for the ongoing collection and monitoring of specialised services. Bazian also made recommendations for a more comprehensive program of ongoing work to validate these outcomes and to ensure that they align with the work that is currently being undertaken by the EMSCG in relation to QIPP (Quality, Innovation, Productivity and Prevention) and CQUIN (Commissioning for Quality and Innovation) frameworks.

The indicator set proposed by Bazian was designed so that it was sensitive to the activities of commissioners i.e. a measure of quality commissioningthat is also aligned with quality of care. It was also necessary to remember that indicators developed for use by other tiers of commissioning (for example PCTs or national level commissioning) are not always appropriate for use by specialised commissioning.


The outcome

Bazian produced a series of indicators designed to be easy to implement and sensitive to the activities of commissioners. In order to gain the maximum benefit from the set of indicators provided, Bazian recommended to EMSCG that they:

  1. seek agreement from the original working group on this short-list of indicators
  2. establish an ideal reporting timeline for each indicator (that should tie in with feasibility of data collection)
  3. pilot data collection processes
  4. regularly assess the overlap of the requirements of this project with other initiatives that are ongoing or being developed; including QIPP, CQUIN and the development of network standards (e.g. renal network)