The following are ideas for activities to get people talking together about the NHS and Commissioning

How much does it cost? (Commissioning, NHS Costs)

Two flipchart pages are taped together, end to end. At one end it says Pre-birth and at other 100+; a line is drawn between the two with rough sections indicating 0-20, 20-64, 65-85, 85+. The facilitator has a bag of 122 pennies. These are roughly split between the participants (depending on numbers). It is explained that the facilitator does not have an answer but just wants to get discussion going. Participants are asked to spend their money where they think it should go. This will raise loads of comments/questions and others can be prompted around growing population, increase in cancer diagnosis, increase in elderly population, etc. Note to group – each penny represents £1billion!

2) Gather the money into 7 separate piles (almost like stick figures). Each one represents a person. Place one pile in the over 65 section. Explain that in 1960 there were 6 people aged between 18-64 for every person over the age of 65. Take away three of the figures and say that in 20 years time there will be only be 3 people so how do we raise the money to pay for the NHS in the future?

Resources: Flipchart paper marked; 122p.
Note: Spending in England is £106b

What is Commissioning?

Shopping for Food - Participants in small groups invited to consider: “What factors determine what food you buy for next week’s meals?”

Feedback - examples are invited and broad links made to the elements of Commissioning – i.e. Planning, Specifying, Evaluating, Assessing Needs, Contracting, etc (Who does the shopping?)

In what order - Participants then asked to consider the order in which they get the food – does it start with a list, the people who will be eating, deciding who will buy and cook and how will they judge whether its value.

Who is Who in England?

Mix and Match Participants given the titles of the different organisations (Healthwatch, Clinical Commissioning Groups, etc) whilst others are given descriptions of what the organisation does. They are asked to find match the description to the title.

Meet the Relations Following the matching there is open discussion about the roles and relationships as well as comment on existing connections within the group.

Where do they go? Discuss where some of them would fit on the commissioning cycle and then 

Different Chairs Three chairs are set out at the front. The 1st illustrates the patient/carer experience; the 2nd reflects someone invited to comment or be involved; the 3rd is a Healthwatch representative. This helps people see that there is a difference between the role of giving your views, helping and the ‘Duty’ placed on Healthwatch to monitor what is happening.

Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS) capture different information. It is always worth adding two other measures around OUTPUTS and SATISFACTION.

Activity: Invite participants to think about Commissioning as shopping for the food you want to eat - e.g.. Who's is coming to dinner, what's in the cupboard, people's needs, etc. 

As the responses are given you can start to think about them as part of the cycle of commissioning.

Later Activity for PROMS & PREMS.

The providers of health services most often want to measure the OUTPUT (How many meals they produced or how many operations carried out) and the OUTCOME (How many people fed - numbers of people who attended and received treatment).

Patients often want the quality of the EXPERIENCE (What was the food like or do they feel better after the treatment?) and SATISFACTION (Was the service good or were you treated with respect and dignity?).

Sadly many PROMS and PREMS activities get many of these mixed up.

Layout the following headings on a flip chart


Cut out the cards below and ask participants to  arrange each under the appropriate heading.

Have diners enjoyed the meal

The choice of meals provided

The amounts of food produced

The number of people served

The number of meals served on time

The quality and presentation of the food

The number of meals eaten

The number of meals prepared

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