Strategic Commissioning is the main process for understanding, planning and delivering better health and social care outcomes, but it is recognised that a substantial amount of work can be needed to deliver this process effectively. Strategic Commissioning is embodied in legislation and public policy; in some services a Strategic Commissioning model has been in place for many years.
Well-planned Strategic Commissioning offers the opportunity to increase the value and financial sustainability of care by making the most effective use of available resources and the most efficient and consistent delivery. This ensures that the balance of resource is spent where it achieves the most, and focuses on prevention and early intervention.
The process of going about Strategic Commissioning can often prove challenging. Several national audit reports in recent years have highlighted deficits in local strategic commissioning capacity. The materials collated here provide a point of reference and practical support to Partnerships in addressing the demands of strategic commissioning. They are based round the Strategic Commissioning cycle of analyse, plan, do and review.
Practical support for the process of commissioning is available in several forms:
For further information contact hcis.StrategicCommissioning@nhs.net
Strategic Commissioning Online Learning Resource
This short, modular learning resource sets out commissioning in the context of Scottish public policy. It is intended to introduce commissioning and provide:
- An understanding of the importance of strategic commissioning
- Familiarity with the basic principles of the commissioning cycle
- An outline of the key characteristics of successful strategic commissioning
- Opportunity and means to reflect on activity underway in your partnership.
Introduction to Strategic Commissioning
In the first of a series of three webinars we will explore approaches that assist partnerships to address their Strategic Commissioning requirements. The webinars will be used to help identify Partnerships’ commissioning support needs and develop practical solutions.
Strategic Commissioning is often quoted as “all the activities involved in assessing and forecasting needs, links investment to agreed desired outcomes, considering options, planning the nature, range and quality of future services, and working in partnership to put these in place.”
We will unpick this definition, and provide an overview, with reference to published studies and practical experience of commissioning processes, tools, and approaches. While there are variations in the presentation of the commissioning cycle, they include the same logical process and are concerned with whole groups of people, including:
- assessing the needs of a population, now and in the future
- setting priorities and developing commissioning strategies to meet those needs in line with local and national targets
- securing services from providers to meet those needs and targets
- monitoring and evaluating outcomes
- consulting and involving a range of stakeholders, service users and communities in the whole process
Through the series of webinars, we will explore these in more detail, with future sessions addressing the tools and techniques to support data analysis, and using findings to develop coproduced models of support and make compelling cases for change.
Dates and times
23rd January 2017 – overview of commissioning and understanding partnerships’ need for support
22nd February 2017 – informing decisions – using data to help you ask (and answer) the right questions
29th March 2017 – coproduction and the compelling case for change
Look out for details of the Commissioning Conference, coming soon.
Developing Effective Strategic Commissioning
Strategic Commissioning is about planning and delivering services and support for people. It includes identifying the needs of individuals and communities, enabling people to decide what will best address those needs and working together with agencies to put the right services and support in place. Joint Strategic Commissioning – A definition – June 2012
The Public Bodies (Joint Working) Scotland Act 2014 has highlighted the importance of Joint Strategic Commissioning (referred to there as Strategic Planning) to achieve the right outcomes for people. The Act requires the NHS, local authorities, and other key partners – including people and carers to work together to produce a Strategic Plan for adults by April 2016.
The material gathered here offers initial guidance in relation to the development of effective Strategic Commissioning by Partnerships. They deal with the need for, approaches to, and effects of Strategic Commissioning, with examples drawn from a range of services.
Joint Strategic Commissioning Learning Development Framework
The idea of Strategic Commissioning is not new, nor does it relate specifically to any one group or location. In 2012 JIT produced a development framework which explores the skills needed to deliver effective joint strategic commissioning of older people’s services. The framework prompts consideration of the skills, roles and culture needed for effective Strategic Commissioning. In particular, the material on skills analysis remains relevant.
Understanding commissioning A practical guide for the culture and sport sector
This sport based view of Strategic Commissioning shares many similarities with the approaches recommended for health and social care. The guide is accessible, and raises interesting questions about the incorporation of sport and culture into the activities of partnerships.
Transforming the Delivery of Health and Social Care
The Kings Fund investigated the key determinants of the need for change, and evaluates these in relation to the current and future structure of the Health and Care system. The paper reflects the condition of the English Health and Care System in 2012, but provides a useful example of overarching analysis of need that might be used to drive change elsewhere. The later part of the review considers the management of fundamental change within NHS and provider organisations.
In addressing the challenges of efficiency and value for money, the Health Foundation identified four research projects to explore original ideas on system efficiency and value for money. These cover the effects of technology on delivery of care, analysis of the effectiveness of resource allocation, evaluation of good commissioning practice on long term outcomes, and research into the factors which influence the uptake of new approaches.
Management of increasing expectations is dealt with in The Art of Exit, which considers the creative aspects of service decommissioning. Given the limitations on resources, including time and people as well as money, that all services face, this paper presents a considered view of the advantages of decommissioning, that is stopping the services that do not contribute to long term outcomes.
Saving money by doing the right thing
This paper deals with shifting the pressures of increasing demand to more local solutions, and resolution of issues at first point of contact thereby avoiding cycles of ‘failure demand’ which result in increasing pressure on service capacity. The paper draws heavily on the vanguard method to consider the implications of managing value in services that are defined locally including the example of the Buurtzorg approach to care.
The paper explores evidence from English PCTs in relation to priority setting tools, their merits and the barriers faced in deploying them. It explores the policy, governance, and technical challenges of establishing effective prioritisation, recommending a partnership approach, which incorporates shared decision making. Although the focus is on clinical services, the paper provides an extensive discussion on the implications for future strategic commissioning challenges.
Strategic Commissioning Support
iHub and ISD support the Scottish Government Health and Social Care Delivery Plan 2017, recognising the requirement to “increase the value from, and financial sustainability of, care by making the most effective use of the resources available to us and the most efficient and consistent delivery, ensuring that the balance of resource is spent where it achieves the most and focusing on prevention and early intervention.”
Collectively, National Bodies will provide support to strategic planning and commissioning to the Integration Authorities (IAs) and NHS Boards in a collaborative way. The collaboration between HIS and ISD to bring together analytical and improvement support will be core to this. Support from ISD and ihub will be coordinated through a single point of contact, simplifying access to practical assistance for Partnerships.
The support offered is based on good practice in service planning and redesign and follows the tested ihub approach, bringing consistency with other programmes of work. Support includes planning (analysis and modelling of current and future use), design, implementation and evaluation.
The support is available to strategic planning groups, locality planning and community planning groups. It includes support with a co-production approach, using methodologies which support the ability of communities and their representatives to engage meaningfully and equitably in the process. This support will extend to communities, service users and carers representation using Our Voice or similar to enable effective engagement.
Support will be provided from the ihub within HIS through access via the IAs relationship manager with access to tailored and responsive support team or strategic commissioning support team and linked to the relevant programmes of improvement support where appropriate. Support will be provided from ISD through the LIST analysts already deployed.
Current examples of practical support include
|Examples||Description and Outputs|
|Delayed Discharges, Bed Days||Focus on Delayed Discharge, looking at who is delayed, where they are from and to look at pathways and reasons for admissions in first place.|
|Unscheduled Care -A&E, Emergency Admissions||Analysis of potentially avoidable admissions and repeat attendees to Emergency Departments. Contributing analysis and evidence to a clinically led, short-life working group focusing on evaluating the scope and potential methods for reducing avoidable emergency admissions.|
|Performance reporting and frameworks||Collaboration between HIS and partners within the H&SCP to develop secondary care baseline data measurements and control charts by locality to identify the impact of the test of changes.|
|Modelling and flows||Contribute to system dynamics modelling project to model current model of care for older people and people with complex care needs. Test out changes in system simulation and make recommendations for changes to the system.|
Project rates of emergency admissions, emergency bed days and average occupied beds between now and 2035 using NRS population projections to estimate new beds required. Delayed discharge bed days projections for 65+ population in 2016/17 broken down by Month.
In developing these support arrangements iHub and ISD intend to adopt a phased approach to interaction with Partnerships:
Create the conditions for change and use local evidence and qualitative / quantitative data analysis to agree collaborative pathway redesign.
Develop the leadership and engagement between e.g. HSCPs strategic planning group(s) and acute service leadership for a shared vision for shifting the balance of care.
Phase 2: Design, model and appraise options to deliver required outcomes.
Develop locality based co-produced options of alternative provision.
Develop options appraisal for consultation with community / service users.
Work with acute team to estimate effects such as
- service change and flow to estimate effects on bed usage
- changes / increase in community based services required
- identify savings from service change, and net cash release
Phase 3 Work with Strategic Planning Group & Acute to develop joint implementation plan for re-provision of service capacity to community to ensure pathway change seamless for service users
Phase 4 Evaluate change and ensure process improvement tools incorporated into implementation plan and identify where unintended consequences causing pressures.
For further information contact hcis.StrategicCommissioning@nhs.net
Strategic Commissioning is the term used for all the activities involved in assessing and forecasting needs. It links investment to agreed desired outcomes, and involves:
- Considering options
- Planning the nature range and quality of future services
- Working in partnership to put these in place
Very often, commissioning is described as a cyclical process. The Institute of Public Care’s model describes both commissioning and associated procurement and contract management activities – thereby making the links between asking ‘what do we want?’ and ‘how do we get it?’.
Health and Social Care Partnerships
Benefits of programme
A number of national audit reports in recent years have highlighted continuing deficits in local strategic commissioning capacity. The impact of this deficit is that resources and investment are not closely aligned with delivering improved outcomes and that models of care and support continue to reflect a lack of sufficient investment in community based preventative measures.