Friday, 27 June 2008

Confessions of a Campaigner:of Postcards and PCTs

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 run by our local CVS ( Council for Voluntary Services) bless them. 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:

Skip this bit if you have no time to read it all:

This is a new system and everyone is trying to get a handle on it and alot of the commissioners are newly in post.
The stated aim is to deliver world class commissioning ie. health services to citizens.
The framework of health reforms is stated as being about more choice for patients, a stronger voice for users , money following the ‘paitient’, more diverse range of care provision and providers, better patient experience, value for money, quality of care.
There was much talk about the patient pathway becoming a seamless package of social and medical care delivered where and when the patient needs it most. Lord Darzi’s report not then published was alluded to with his recommendation that we should not move the patient closer to care but the care closer to the patient.
The key drivers of this reform were stated as: Local Government and Public Involvement in Health Act 2007, Local Area Agreements, Vital Signs (these are the criteria the Department of Health have for a good PCT), Joint Strategic Needs Assessments (what?), Operating Frameworks, Local Delivery Plans. I know what some of these are – the rest I will ask about as I go along.
They need the third sector: to deliver information for their needs assessment and to deliver care that the nhs cannot provide because a) it is too innovative and b) they cannot get that close to the user to provide appropriate care.

And now for the bit that made real sense in terms of what we need to achieve locally:

We now have a district-wide PCT with overall goals agreed with central Government (35 agreed targets out of a Government menu of 198 to choose from). Within the PCT, however, there are 'divisions' which ironically in Bradford are along the same lines as the old PCT boundaries. 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. It is worth checking what the stated health priorites of your PCT are, and its individual divisions.

Third sector groups can tender to do work that fulfills these priorities 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 third sector organisations in the community can have a positive effect especially here. (YES I know this has been said before but lets take them at their word and demand delivery)

There is a cycle/process to arriving 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 health 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 fulfil certain priorities - 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-commissioning 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. For instance, at the event I went up to the Head of Partnership Commissioning (I think that 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 work with. 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 what the PCT commissioners were saying to us – we need your input, your information to make the process sensitive to people’s needs.

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! Hopefully it gives a flavour of what may be going on in your 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 independent midwives need to look at how they can tender for services not being currently rendered. It is a steep learning curve - but in a new 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 this was achieved with a twinkle in the eye, a smile and a bit of cheek.

Ruth Weston is a mother of five children who runs her own business, building, hiring and selling pools. She is passionate about giving her daughters the opportunity of giving birth at home with a midwife they know, without a fight or a campaign. contact her at or sign up to her email newsletter ‘Choices in Childbirth’ at . for more information on the postcard and other national campaigns see

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