NHS Providers have today published a report Provider Voices: where next for commissioning? with interviews with leaders from a range of trusts as well as from local government, local commissioning and the voluntary sector. Our chief executive Julie Wood reflects on these interviews in the blog below which was also published on the NHS Providers website today.
Where next for commissioning? sets out a number of interesting reflections, which in many ways accord with our own paper The future of commissioning published some nine months ago, based on the experiences of our member CCGs in the shifting commissioning landscape.
Balancing economies of scale with the need for strong clinical and patient engagement; a diverse rather than a single model of clinical commissioning; and an increase in the strategic role of commissioners are themes that resonate in both.
It is heartening that while our respective members are looking at this through a different ‘lens’, with the bulk of the reflections in the NHS Providers publication coming from five leaders in the provider sector, there is significant agreement about what’s important in transforming care and delivering improved population health outcomes. There’s also agreement that to achieve these we need changes to the system – though neither we nor our members would welcome wholesale re-organisation which would only serve as a distraction.
This Provider voices piece suggests commissioning is often perceived by providers as the ‘dog that doesn’t bark’. In my view it is fairer to critique the system rather than those people trying to make it work to deliver improved health and care outcomes – who despite the difficulties posed by this system are still making a huge difference to their patients and populations in many areas, such as diabetes care, early intervention in mental health and prevention, to name a few as our publications have demonstrated.
Clinical commissioners have responsibility for the whole population
Clinical commissioners, unlike their provider colleagues, have responsibilities for their whole population rather than a subset who receive a particular service within a specific organisation. They have to look across a whole range of providers and when the resources they have at their disposal are not able to stretch across all that need them difficult choices must be made. This can pitch them against their local provider trusts.
Going back to the critique in the NHS Providers piece then, when we look at what lies underneath the criticism it is actually of the internal market and its over-emphasis on the transactional contracting and procurement elements within the wider commissioning process. Clinical commissioners would agree with this critique and are as frustrated as their provider colleagues that their scarce time and energy is too often spent focusing on issues that aren’t going to transform care for their local patients and populations.
So we need change – but what change and what is the future for commissioning?
Looking at what the NHS Providers report identifies as constituting commissioning, it is clear these are necessary for any advanced healthcare system. Identifying and prioritising population needs, planning and redesigning services close to people, allocating resources to those who provide care and holding them to account for delivery are all crucial functions which we need to continue.
Keeping clinical leadership is essential
We also must not lose the essential clinical leadership in commissioning that for those of us who were leading previous commissioning organisations before 2013, has been a key ‘jewel in the crown’ and must not be compromised.
But do we need clinical commissioning to continue within the current construct of organisations? No we don’t – but let’s remember that the statute is not where the system now is.
Since the time of the interviews in the NHS Providers report we’ve seen substantial change. Working with partners across health and care in sustainability and transformation partnerships, and through the development of accountable care systems, commissioners are embracing new ways of working. They provide us with a welcome opportunity to get all the system players in a place owning the issues and coming up with the right solutions for the population within that place, collaborating rather than competing over the use of the scarce NHS pound.
These new ways have been welcomed by our members as having the potential to allow them to focus on their strategic ambitions to deliver improved health and care outcomes for the myriad of needs across their population.
We need more pace
However we are at a time of transition and NHSCC, alongside our NHS Providers colleagues, must work hard during this period to ensure that our respective members’ need to operate in two potentially competing worlds is minimised as much as is possible without tripping into major top down re-organisations.
We also need more pace. As the NHS Providers report states commissioning is indeed at a crossroads – currently we’re hearing from our members that many feel stuck at this point and want to transition.
If we are now shining the light on the right things that will transform rather than those that serve to distract – and that light is the development of place based integrated systems, then we need to properly move towards it to ensure we get there.”
16 June 2017