Commissioning for a better future: A starter for ten

Commissioning for a better future: A starter for ten

Social Care Innovation Network June 2020

• A framework for commissioning for the future that sets out how commissioning can practically support the development of asset-based areas. Sets out good practice examples and alternative approaches to commissioning care and support across England. Provides examples (with links) of how better outcomes have been achieved through alternative and positive approaches to commissioning.

Commissioning Healthcare in England [book]

Commissioning Healthcare in England: Evidence, Policy and Practice
Edited by Pauline Allen, Kath Checkland, Valerie Moran and Stephen Peckham, April 2020

• A book bringing together research which the Policy Research Unit in Commissioning and the Healthcare System (PRUComm) has undertaken during the period 2011 to 2018. The analytical work supports understanding of how NHS commissioning operates and how it can improve services and access, increase effectiveness and respond better to patient and population needs.

Thinking differently about commissioning: learning from new approaches to local planning

Thinking differently about commissioning: learning from new approaches to local planning
Kings Fund 6 February 2020

• Collaboration is promoted as a key tool for improving health services. Visits to CCGs (South Tyneside, Tameside and Glossop, Bradford district and Craven) suggest that collaborative planning arrangements at place level – on footprints that are often approximately co-terminous with local authorities – will be important in the future. 
• This report explores the implications of new ways of working for the development of integrated care systems, how NHS England and NHS Improvement’s regional teams operate, and wider ways of working among NHS national bodies.

What is commissioning and how is it changing?

What is commissioning and how is it changing?
Kings Fund 19 September 2019

• Commissioning is the process by which health and care services are planned, purchased and monitored. This explainer looks at the commissioning process in detail, the history,  organisations involved and how it is changing.

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care
BMC Health Services Research (2019) 19:648, 6 September 2019

• This paper explores the process by which commissioning organisations make their decisions to commission innovative health technologies. Based on a case study of four CCGs exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK.
• Highlights include the importance of priority setting, valuing evidence, assessing value for money, cross-organisational collaboration, and negotiating commissioning pathways.

In summary,

The whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link.

The whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link.
BMC Health Serv Res. 2019 Apr 15;19(1):228. 

• Findings indicate that commissioning has significant limitations in enabling large-scale change in health services, particularly in engaging providers, supporting implementation, and attending to both its transactional and relational dimensions.

Abstract

Improving community support for older people’s needs through commissioning third sector services: a qualitative study.

Improving community support for older people’s needs through commissioning third sector services: a qualitative study.
Journal of Health Services Research & Policy, 24(2), 116–123. 10 April 2019
https://doi.org/10.1177/1355819619829774
An exploration of the relationships between commissioning organisations and third sector organisations across one region of England, both with an interest in supporting the needs of older people identified a diversity of commissioning arrangements for third sector services. Service data, including assessments of needs and outcomes, were reported to commissioners, however commissioners did not appear to use this to full advantage to inform future commissioning decisions. 

Abstract

Understanding the new commissioning system in England

Understanding the new commissioning system in England: contexts, mechanisms and outcomes
PRUComm 30 November 2018

• This study explores how the new commissioning system is functioning after reorganisation of the NHS in England in 2012. The research aimed to assess the impact of the reforms on the operation and outcomes of the commissioning system.

See the other report by PRUComm : Investigating recent developments in the commissioning system

Investigating recent developments in the commissioning system

Investigating recent developments in the commissioning system
PRUComm November 2018

• A description of the complex changing landscape in which CCGs are working.

See also the other PRUComm report : Understanding the new commissioning system in England

The capacity of health service commissioners to use evidence: a case study.

The capacity of health service commissioners to use evidence: a case study.
Health Services and Delivery Research v6 (12), March 2018

• This study from University of Warwick examines the critical review capacity of representative (region, size, urban/rural) commissioning networks in England to acquire and use different types of evidence to inform their decisions about service interventions.
• Based on interviews with a range of stakeholders across 13 networks the study found that commissioning networks led by CCGs lack capacity to use different types of evidence to make well-informed decisions. The use of local knowledge about patients, and the patient experience of services, may be poor and CCGs make poor use of data about population need and existing services.
• The study develops a self-development psychometric tool for CCG-led commissioning networks to reflect on and enhance their critical review capacity with respect to the acquisition and use of different types of evidence.

Issues that affect implementation of integrated health and well-being services

'It is not a quick fix' structural and contextual issues that affect implementation of integrated health and well-being services: a qualitative study from North East England.
Public Health. 2017 Nov;152:99-107

• Using interviews conducted as part of two separate evaluations of integrated health and well-being services in North East England supplemented by informal observations, this paper provide learning in terms of the delivery and commissioning of similar services.
• [NHS OpenAthens ID required to read full text]

Abstract
The objective of this article is to examine the factors affecting the design, commissioning and delivery of integrated health and well-being services (IHWSs), which seek to address multiple health-related behaviours, improve well-being and tackle health inequalities using holistic approaches.
STUDY DESIGN: Qualitative studies embedded within iterative process evaluations.
METHODS: Semi-structured interviews conducted with 16 key informants as part of two separate evaluations of IHWSs in North East England, supplemented by informal observations of service delivery. Transcripts and fieldnotes were analysed thematically.
RESULTS: The study findings identify a challenging organisational context in which to implement innovative service redesign, as a result of budget cuts and changes in NHS and local authority capacity. Pressures to demonstrate outcomes affected the ability to negotiate the practicalities of joint working. Progress is at risk of being undermined by pressures to disinvest before the long-term benefits to population health and well-being are realised. The findings raise important questions about contract management and relationships between commissioners and providers involved in implementing these new ways of working.
CONCLUSIONS: These findings provide useful learning in terms of the delivery and commissioning of similar IHWSs, contributing to understanding of the benefits and challenges of this model of working.

What is commissioning and how is it changing?

What is commissioning and how is it changing?
Kings Fund  18 September 2017

• A blog by looking at the commissioning process, the organisations involved and how it is changing.

Where next for commissioning?

Provider voices: Where next for commissioning?
NHS Providers June 2017

• A series of interviews with providers from across the NHS discussing the commissioning landscape.
• Includes a potted history of commissioning in healthcare.
• Five key interlinked and overlapping themes emerge from the interviews:
• the value of commissioning getting closer to people...
• ..and understanding local place: the importance of scale and geography
• the need to accept the emerging diversity of approach to commissioning structures
• the rapid blurring of the purchaser-provider split and a lesser focus on the internal market 
• the need to focus on commissioning as a strategic function.
• "As the NHS moves to collaborative local system working via sustainability and transformation partnerships and accountable care organisations and systems, we need a full and proper debate about how commissioning (and provision) needs to adapt to this new, emerging, world."

Faulty by design. The state of public-service commissioning

Faulty by design. The state of public-service commissioning
Reform January 2017

• The purpose of this paper is to evaluate the success of current approaches to commissioning by central government, local authorities and commissioning bodies. It uses interviews, a literature review and evaluation of the publicly available data.
• This paper looks at three critical and interdependent areas of commissioning - outcomes based commissioning, fragmentation of commissioning within and across policy areas and the localisation agenda.

Helping CCGs use innovation and evidence in commissioning

Evidence for Innovation: A Strategic Insight Tool
Innovation Agency AHSN NW Coast, June 2016

• A self assessment tool for CCGs.
• The purpose of this tool is to highlight how an organisation uses evidence for innovation, improvement and  transformation. 
• The tool takes the format of a maturity matrix which enables a conversation around evidence that reflects a wider set of subjects other than just technology or NICE guidance and encourages a more systematic  approach to using evidence in the commissioning process.
• The tool can be used at Board Level, or at an individual project or intervention level.

Experience-based co-design of healthcare

Partnering with users to improve the quality of healthcare
ESCR May 2016

• Research on improving people’s experience of healthcare suggests that work is needed to use experience data, not just for measurement but to stimulate local service improvement. Experience-based co-design uses video interviews with service users to engage staff in just such a change process.
• This report recommends that 
• Experience-based co-design (EBCD) of healthcare involving service users as partners with staff should be actively promoted nationally and locally, as an effective way to achieve person-centred improvement and cultural change in healthcare
• ‘Trigger films’ of people talking about their experiences of services are a key part of the initiative. Existing, nationally produced trigger films have been shown to be a low-cost high impact resource. 
• Policymakers should consider funding and support for further trigger films to expand this free-to-use national resource. 
• National and local health organisations should raise awareness among NHS staff about the Healthtalk online resource on health experiences, and support development of new interview collections to cover areas not yet included in the Healthtalk archive.
• Maintenance of The King’s Fund EBCD toolkit should be supported, alongside continued investment in The Point of Care Foundation codesign training programme for NHS staff and patient leaders.

Commissioning identity crisis

Commissioning’s identity crisis, Comment from Nigel Edwards, chief executive Nuffield Trust
BMJ 18 November 2015;351:h6008

• "Almost 25 years after the “purchaser-provider split” in England, questions are yet again being asked about the purpose of commissioning as attempts are made to sort out the muddle left by former health secretary Andrew Lansley’s reorganisation, which in 2013 abolished primary care trusts and handed commissioning to GP led groups. Politicians and officials are clear that they want to revisit commissioning policy without the pain and embarrassment of having to legislate again or undertake any visible reorganisation."
• Changes discussed include new care models developed under Five year Forward View, devolution and use of personal budgets.

Exploring the GP ‘added value’ in commissioning

Exploring the GP ‘added value’ in commissioning: What works, in what circumstances, and how?
PRUComm 13 October 2015

• An exploration of the potential added value that clinicians, specifically GPs, bring to the commissioning process through interviews and observations of commissioners at work.
• Four programme theories were identified that were most frequently claimed by both GPs and managers around frontline knowledge about patient experience and services, clinician to clinician conversations and GP-manager symbiosis.
• While GPs can and do ‘add value’ to the commissioning process, there was evidence of duplication of effort, wasted opportunities and failure to make best use of GPs time and talents.
• The report includes actionable messages for GPs, CCGs and policy makers, 

CCGs dont work as the policy documents assumed

NHS commissioning practice and health system governance: a mixed-methods realistic evaluation
Health Serv Deliv Res 2015;3(10)

• Under the 2012 NHS reform CCGs now buy – ‘commission’ – services from NHS bodies, charities, voluntary organisations, local government and private firms. 
• This study of CCGs in four English case studies found that in certain ways this system was not yet working as policy documents assumed. 
• Commissioning work was often laborious and uncertain. 
• Doctors played little part in financial negotiations with hospitals. 
• There was little competition between hospitals, and what competition there was affected only a few aspects of hospital services. 
• Legal controls were rarely used.
• This report describes the convergence of commissioners’ and providers' interests across multi organisational pathways.

What is the point of a pilot?

The Multiple Purposes of Policy Piloting and Their Consequences: Three Examples from National Health and Social Care Policy in England
Journal of Social Policy, April 2015, vol 44(2)

• Using three case studies from health and social care – the Partnerships for Older People Projects (POPP) pilots, the Individual Budgets pilots and the Whole System Demonstrators (WSD) the paper identifies multiple purposes of piloting.
• The research found that piloting for generating evidence of effectiveness was only purpose. Piloting was also aimed at promoting policy change and driving implementation, both in pilot sites and nationally.
• Policy makers appeared to be using pilots mainly to promote government policy, using evaluation as a strategy to strengthen the legitimacy of their decisions and to convince critical audiences. 
• These findings highlight the ambiguous nature of piloting and thus question the extent to which piloting contributes to the agenda of evidence-based policy-making.