Hospital Dr News

New NHS commissioners have to get tough

CCGs must ensure that they make time for the hard edged transactional work, such as specifying contracts, service review, and decommissioning, in order to improve outcomes for people for long-term conditions.

These are the findings of a Nuffield Trust report which suggests that the work of convening, engagement and planning will continue to be critical, but the balance will need to be redressed.

The research revealed the ‘labour’ of commissioning to be extensive and resource-hungry, especially when designing and specifying services.

Researchers examined the ‘nitty-gritty’ of what commissioners do on a day-to-day basis, focusing on how they sought to develop and improve care for people with diabetes, dementia, and stroke.

The most striking finding was the sheer scale of the ‘labour of commissioning’ – the amount of meetings, discussions, planning, and analysis that goes into the review and commissioning of often small-scale service changes.

Indeed, the research raised uncomfortable questions as to whether this ‘labour’ was worth the outcomes secured for patients.

Commissioners were seen to act as the convenor of the local health system, bringing together different organisations and interests to plan and develop services.

What was less evident was the more transactional or hard-edged part of their role – using data to review and challenge existing service provision, halting the provision of services deemed to be ineffective, or contracting for new forms of care that would lead to significant change in how primary or secondary care are provided.

The full report Commissioning high-quality care for people with long-term conditions, was funded by the National Institute for Health Research Health Services and Delivery Research Programme.

Nuffield Trust director of policy, Dr Judith Smith, said: “What was less evident was a robust approach to assessing the performance, quality and impact of local services, and willingness to provide necessary challenge to existing local providers.

“With much less money available for NHS management the new generation of commissioners will need to pay close attention to the cost of their practice, display rigour in setting clear and measurable objectives for a programme of commissioning work, and ensuring that they can demonstrate that their effort is worth the candle.

“They need to be mindful of when they need to stop consulting and engaging, and move to the procurement phase of their work, in effect when to ‘stop talking and cut a deal’.”

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One Response to “New NHS commissioners have to get tough”

  1. Malcolm Morrison says:

    Did no one foresee these problems? They are pretty obvious for the ‘purchase’ of any significant service (or item of equipment)!

    One of the biggest problems in the ‘purchase’ of health care is agreeing a ‘standard’ of what is considered to be ‘effective’. What may be considered to be ‘effective’ by the individual sufferer may not be considered to be ‘cost-effective’ in relation to the ‘community’ – when balanced against other ‘effective’ treatments. But, with limted cash (or ‘resources’ such as staff), difficult decisons must be made – which will certainly not please all!

    When it comes to care for “people with long-term conditions”, there is nearly always an element of ‘social’ care – which comes out of a different (Local Authority) budget. So, there will always be ‘fights’ about how much is ‘health’ and how much is ‘social’ care – with many ‘grey areas’. GOOD ‘care in the community’ can be just as expensive, if not more so, than hospital (or ‘residential’) care; unfortunately, in the quest for the ‘cheapest’ care, people may suffer inferior care (and sometimes neglect) ‘in the community’.

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