Effective Commissioning in Health and Social Care

Richard Field, Judy Oliver

• Publisher: Learning Matters
• Year: 2013
• Print ISBN: 9781446282267, 9781446282250
• eBook ISBN: 9781446293744
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

It is essential that in today?s public sector, social care and health managers have a thorough and critical understanding of best practice in commissioning services. This guide has been developed to underpin core aspects of commissioning services in health and social care with tools and strategies that really work. The authors go through the commissioning process step-by-step in order to help the reader better understand the following:

·  The distinguishing characteristics of commissioning ;

·  how commissioning is affected by changes in the public sector generally and health and social care in particular;    

·  the significant potential for improved service quality and value for money arising from commissioning; 

·  how good commissioning can engage in productive conversations that can lead to better outcomes for patients, clients and the community.

There are sections on specific skills needed for good commissioning, the challenges many face and how to approach them, and what makes a good commissioning manager.

Chapter 1

Introduction

Welcome to this introductory text for professionals involved in, or responsible for, health and social care. The content will also be of potential value to managers operating elsewhere in organisations engaged in commissioning or providing public services.

Commissioning is not new. Its roots can be traced back to the 1979 Conservative administration which introduced a number of initiatives, including compulsory competitive tendering (CCT), purchaser/provider arrangements in social care, service level agreements, direct service organisations (DSOs) and GP fundholding. The Labour administration elected in 1997 abandoned DSOs and GP fundholding; however, not much later, they introduced other initiatives, such as Primary Care Groups and, later, World Class Commissioning in the NHS that encouraged or required a distinct commissioning role. The journey to commissioning continues with the coalition government and the Health and Social Care Act 2012. This act requires each GP practice to belong to a Clinical Commissioning Group (CCG) which are authorised to take over responsibility for commissioning budgets from Primary Care Trusts (PCTs). In recent years, many public sector organisations have started to work in more commercial ways with the private sector, and have adopted principles and practices typically associated with commissioning.

Alongside more commercial ways of working, there has been increased public service collaboration, including Local Strategic Partnerships, health and wellbeing partnerships, youth offending teams and community safety partnerships. Interest in collaboration has been stimulated by a heightened concern to tackle complex, cross-cutting problems, often referred to as wicked issues, to improve outcomes and reduce waste through end-to-end service redesign and achieve cost savings through shared support services.

Whilst much has been made of the potential impact of the Health and Social Care Act 2012 on the health service, local government in general, and social care in particular, will be significantly affected in two respects.

Firstly, there is a requirement to form Health and Wellbeing Boards that will include representatives from social care and other parts of local government as well as health. Health and Wellbeing Boards are responsible for producing both a Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy, as well as developing joint approaches to commissioning and providing.

The second aspect is the transfer of public health functions and staff into local authorities which will give health high visibility alongside social care and bring it within the direct influence of locally elected politicians.

The practice of commissioning is emerging and can be expected to develop further over the next five years and beyond. Structures, frameworks and processes introduced as a result of the Health and Social Care Act 2012 will need to evolve. What is already clear is that a wide range of stakeholders will need to develop technical competence in commissioning and the ability to lead in collaborative contexts.

This text is intended to help all involved in commissioning:

•   understand its distinguishing characteristics;

•   appreciate how it continues to be affected by changes in the publist1ic sector generally and health and social care in particular;

•   recognise its significant potential to improve service quality and value for money;

•   engage in productive conversations that will lead to better outcomes for patients, clients and the community.

The content of this text is informed by the authors’ shared beliefs that:

•   at its most powerful, commissioning is a form of whole-system strategic management involving collaboration between publist1ic sector organisations, companies, the voluntary sector, service users and citizens;

•   commissioning is a process by which health and wellbeing outcomes can be improved and the outlook for individuals and communities transformed;

•   whilst commissioning has much to offer individual publist1ic sector organisations, its real impact will only be felt when this is undertaken in collaboration across the whole community;

•   commissioning is not the same as purchasing or procurement – it is a more strategic, collaborative process that requires creativity, strategic thinking, performance management and technical and leadership competence to enablist1e continuous improvement;

•   all health and social care stakeholders need to understand and participate in commissioning – it is not a process that should be limited to planners or business managers working in commissioning organisations;

•   GPs, social workers and other professionals, whether involved in provision or commissioning, need to develop associated technical competencies as well as be ablist1e to practise leadership in new collaborative contexts;

•   an awareness of self and self leadership is vital for collaboration, effective commissioning and high performance;

•   the capacity to create resonance in others is vital to leading a high-performing service, organisation, cluster and community.

It remains to be seen whether the parallel development of the two worlds of the NHS and social care will continue to be parallel or whether they may, at some point, converge. In our view, for the sake of delivering the best, integrated support to our population, we hope that convergence will win out in the end – we need the best of both worlds.

Chapter 2

Introduction to commissioning

C H A P T E R O B J E C T I V E S

By the end of this chapter you should be able to:

• define commissioning and appreciate the potential benefits of this approach to public service leadership;

• understand the origins of commissioning and how it compares with other management processes;

• appreciate key commissioning roles and relationships;

• understand the importance of collaboration to successful commissioning, alternative approaches and key activities.

What is commissioning?

To some extent the public sector has always undertaken activities associated with commissioning, not always very well or necessarily in an integrated way. This is changing. The last 30 years have seen organisations, structures, relationships, processes and behaviours evolve in ways that encourage and facilitate commissioning. Increasingly, commissioning has been associated with joint working or collaboration within, between and beyond public sector organisations. Understanding of commissioning has developed and continues to evolve in response to shifts in the wider environment and experience.

Commissioning has developed at different speeds and in different ways across the public sector. Currently, a range of approaches can be seen, including those that:

• are little more than advanced procurement;

• are ad hoc, yet quite sophisticated commissioning events or projects;

• are, or will become, embedded. For example, Essex County Council has declared its intention to become commissioning-led (Gordon and Probert 2012: 33).

Varying definitions of commissioning reflect this range of approaches and the characteristics of different parts of the public sector, as shown in Table 2.1.

Table 2.1 Commissioning definitions

The Institute of Commissioning, quoted by the Institute for Government, defines commissioning as: securing the services that most appropriately address the needs and wishes of the individual service user, making use of market intelligence and research and planning accordingly (Institute for Government 2010: 4).

The Audit Commission defines commissioning as: the process of specifying, securing and monitoring services to meet people’s needs at a strategic level. This applies to all services, whether they are provided by the local authority, NHS or other public agencies or by the private or voluntary sectors (Care Services Improvement Partnership 2006: 2).

The Department for Communities and Local Government (2009: 9) considers commissioning as being: the means to secure best value and deliver the positive outcomes that meet the needs of citizens, communities and service users.

Commissioning by Children’s Trusts has been defined as: the process for deciding how to use the total resource available for children, young people and parents in order to improve outcomes in the most efficient, effective, equitable and sustainable way (Commissioning Support Programme 2009: 3).

The National Offender Management Service sees commissioning as: the cycle of assessing the needs of courts, offenders, defendants, victims and communities then designing, securing and monitoring services to meet those needs, while making the best use of total available resources (Ministry of Justice 2011: 3).

In 2007 the NHS introduced World Class Commissioning, in respect of which the core task of Primary Care Trusts (PCTs) was stated as being to: invest locally to achieve the greatest health gains and reductions in health inequalities, at best value for current and future service users (Department of Health 2007d: 1).

With the demise of PCTs and the advent of Clinical Commissioning Groups, commissioning is now seen as: the process of arranging continuously improving services which deliver the best possible quality and outcomes for patients, meet the population’s health needs and reduce inequalities within the resources available (NHS Commissioning Board 2012: 5).

Similarities between definitions suggest that commissioning:

• is a cycle rather than an event;

• should be driven by needs and outcomes;

• is a whole process involving specifying need, securing supply and monitoring outcomes;

• should result in continuous improvement and best value;

• is strategic in nature and undertaken on behalf of a client group, locality or community.

The last point is debatable for, although commissioning is often strategic in nature, there is a view that it can apply at different levels, including that of individual service users. The Confederation of British Industry (CBI) and the Local Government Association (LGA) identify at least five levels at which public sector commissioning occurs (CBI/LGA 2009: 10): individual, locality, service, strategic and regional/national, whilst the Department of Health suggests three levels: citizen, operational and strategic, with the overall aim being to empower citizens with support needs to make use of, and further develop their capacity to self-direct their care, and where possible, to directly shape the support they receive (Department of Health 2010c: 16).

For many organisations, the application of commissioning is becoming more strategic. For example, joint commissioning involves two or more agencies pooling their resources to implement a common strategy for providing services (Audit Commission 1998: 2) and collaborative commissioning with two or more agencies coordinating their strategies for using their resources (Audit Commission 1998: 2).

Key roles

Historically, public sector organisations delivered many services ‘in house’. Services provided direct to clients, such as older people’s services in local authorities, tended to be grouped so they could be more easily managed. Frequently, support activities that could have been contracted from the private sector were also provided in house, such as cleaning and gardening. The manager of a residential home, for example, would have no option but to employ and manage a gardener, rather than enter into a grounds maintenance contract with a provider. Over the years, in-house activities such as catering and cleaning have been market-tested and many of these are now provided by contractors. More recently, even the services these activities used to support are likely to have been outsourced.

Commissioning has caused two roles to emerge – commissioning and providing – and the relationship between these two roles is ...

Table of contents

• Cover Page
• Halftitle
• Title
• Copyright
• Contents
• List of figures
• List of tables
• Foreword
• About the authors
• 1 Introduction
• 2 Introduction to commissioning
• 3 Commissioning in the NHS
• 4 Commissioning in adult social care
• 5 Key challenges for health and social care
• Conclusion
• Appendix 1 Glossary of terms
• Appendix 2 NHS Constitution
• Appendix 3 Nolan principles of public life
• References
• Index