Strategic commissioning

There are many models of strategic commissioning, most describe a cyclical process of activities and have many common features. For example:

The requirement to assess the needs of a population.
A strong emphasis on analysing 'gaps' in the effectiveness of existing provision, and developing plans or strategies to meet those needs within available resources.
A need to try to influence the market and purchase services from providers.
The need to monitor and review the impact of services.

See national commissioning models for more details of nationally published models. Whilst the various models help to develop thinking about commissioning and put a framework around the activity, good commissioning lies in the effectiveness of the tasks underpinning the framework.

Elements of strategic commissioning

Strategic commissioning can be thought of as having four key elements - analyse, plan, do and review - which are sequential and of equal importance, i.e. commissioners should spend equal time, energy and attention on all four elements. Some of the activities that might be undertaken under each element of the strategic commissioning cycle are described below.

Throughout all activities described below there is a need to consider carefully how the perspective of different stakeholders is taken into account, including providers and potential providers. However, of special importance in the context of personalisation, there need to be clear mechanisms for service users, carers, and their representative organisations to be heard in the process of commissioning. A strategic approach to commissioning and a clear process will help to provide transparency and a level playing field for all those involved. Good commissioning needs to fit closely with diversity policies.

Analysis - understanding the purpose of the agencies involved, the needs they must address, and the environment in which they operate. This element of the commissioning cycle involves activities such as:

Undertaking population needs assessment.
Service review and market analysis across agencies to understand existing and potential provider strengths and weaknesses, and identify opportunities for improvement or change in providers.
Identifying resources needed and risks involved in implementing change and/or continuing with the status quo.

Planning - identifying the gaps between what is needed and what is available, and planning how these gaps will be addressed within available resources. This element of the commissioning cycle involves activities such as:

Undertaking a gap analysis to review the whole system and identify what is needed in the future.
Designing services to meet needs.
Writing a commissioning strategy/prospectus which identifies clear service development priorities and specific targets for their achievement.

Doing - ensuring that the services needed are delivered as planned, in ways which efficiently and effectively deliver the priorities and targets set out in the commissioning strategy. This element of the commissioning cycle involves activities such as:

Supply management and capacity building (market facilitation) to ensure a good mix of service providers, offering patients/service users an element of choice in how their needs are met.
Developing good communications and managing relationships with existing and potential providers.
Purchasing and contracting of services and de-commissioning services that do not meet the needs of the population group.

Reviewing - monitoring the impact of services and analysing the extent to which they have achieved the purpose intended. This element of the commissioning cycle involves activities such as:

Pulling together information from individual contracts or service level agreements.
Developing systems to bring together relevant data on finance, activity and outcomes.
Analysing any changes in legislative requirements, population need and reviewing the overall impact of services to identify revisions needed to the strategic priorities and targets.

Sources of further help - external links

Joint Strategic Commissioning Learning Development Framework. November 2012 (Institute of Public Care for the Scottish Government and the Joint Improvement Team Scotland). The joint commissioning of older people’s services is a key focus of the support that the Joint Improvement Team provides to Community Health and Social Care Partnerships and their partners - local authorities, NHS boards, third and independent sectors. Developing a coherent joint commissioning strategy is fundamental to delivering on the Scottish Government’s key policy objective of re-shaping care for older people. At a time of substantially increasing numbers of older people, coupled with reducing resources, it represents an important tool that can provide rigour and transparency to the decisions taken by commissioners, and confidence to a public who otherwise see changes taking place that they do not understand. In order to assist those responsible for improving joint commissioning skills and capacity across health and social care partnerships, the Scottish Government and the Joint Improvement Team Scotland commissioned the Institute of Public Care to produce a Learning Development Framework focusing on joint commissioning.

Monitoring poverty and social exclusion 2012. November 2012 (Joseph Rowntree Foundation). The 'low-pay, no-pay' jobs market keeps millions in poverty and holds the economy back. This annual monitoring poverty report analyses trends to tell the story of poverty in the UK today. A set of 50 indicators covers a wide range of issues, ranging from low income, worklessness and debt, to ill-health and education. The report reveals the extent of in-work poverty and the dynamic nature of poverty, caused by people cycling in and out of work and an underemployed workforce. For the first time, the report examines the impacts of the current Government’s policies on poverty and exclusion. It also examines welfare reform: who will be affected and what the impacts will be. The report is an essential resource for policy-makers and researchers who need to understand the challenges of tackling poverty in the future.

Commissioning the Future: Workshop materials to start a new conversation. July 2012 (Think Local Act Personal). This series of five workshop scenarios have been designed to help those involved in strategic commissioning to rehearse and explore new ways in which the public care market might develop. The Commissioning the Future pack offers all those involved in strategic commissioning - including providers of services, people, carers and commissioning officers - an opportunity to: rehearse the issues they face; do this outside the context of a particular negotiation, contract or agreement; play different roles than they do in 'real life' to explore issues from a range of perspectives. Each exercise represents real issues faced by all involved in commissioning public care and will support commissioners, providers and people who use services and carers to adopt the key skills and behaviours advocated in Stronger Partnerships for Better Outcomes.

Oversight of user choice and provider competition in care markets. December 2011 (House of Commons Public Accounts Committee – Fifty-seventh Report). The Committee of Public Accounts is appointed by the House of Commons to examine the accounts showing the appropriation of the sums granted by Parliament to meet the public expenditure. The Department of health will shortly issue a White Paper on reforming social care delivery. The changes the Department makes must address concerns about giving users a real choice, overseeing the market to ensure competition and stability, and putting in place arrangements and contingencies to deal with major provider failure. On the basis of a report from the Comptroller and Auditor General the Committee took evidence from the Department on the current arrangements for the oversight of user choice and provider competition in care markets.

The Institute of Public Care provides two online planning systems for England:

Projecting Older People Population Information (POPPI), for data about people aged 65+.
Projecting Adult Needs and Service Information (PANSI), for data about people aged 18-64.

Both systems display the latest ONS population projections by gender and age band, for England, the Regions, Councils and council districts. Latest ethnicity data is also provided. Data can be downloaded into spreadsheets.

National prevalence information from published research and surveys that are likely to affect the needs of the population are applied to the data, including conditions such as learning disabilities, mental health problems, dementia, heart attack, stroke, bronchitis/emphysema, falls - A&E attendance and hospital admissions. Some census data is also included.

POPPI and PANSI bring together relevant information for commissioners and provide a consistent starting point for Joint Strategic Needs Assessment.

The Yorkshire and Humber Public Health Observatory offers a range of local public health intelligence and links to national datasets, as well as geographic and demographic information, and makes them available via interactive web-based tools.

The Association of Public Health Observatories provides models for estimating the prevalence of hypertension, diabetes, coronary heart disease and chronic obstructive pulmonary disease, with further models in development.

Health needs assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. The Health Development Agency published Health Needs Assessment - a practical guide in 2005.

The BMJ has published a series of six articles describing approaches to and topics for health needs assessment: Health needs assessment: from theory to practice, and how the results can be used effectively (non subscribers to BMJ have free access to the article but must complete the registration form).

Health impact assessment (HIA): Health impact assessment (HIA) gateway helps to identify the potential health consequences of a proposal on a given population, and recommend ways to maximise the positive health benefits and minimise potential adverse effects on health and inequalities of the proposal. The site provides further information about HIA and links to reports, completed HIA case studies, HIA toolkits, training courses, and contact details.

Dr Foster Intelligence: Dr Foster Intelligence is a partnership between Dr Foster and The Information Centre for Health and Social Care. Publications include 'The Intelligent Commissioning Board' while other resources include a tool to show the productivity of PCTs and hospitals graphically.

For guidance about building better relationships between commissioners and third sector providers see the voluntary sector compact website including the Funding and Procurement Compact Code of Good Practice.

The Government's Small Business Friendly Concordat Good Practice Guide supports the small business friendly concordat, which was prepared for local authorities in support of the National Procurement Strategy for Local Government.

The Social Enterprise UK is the national platform for social enterprise, sharing best practice and aiming to influence policy in order to create an enabling environment for social enterprise.

The Government's Civil Society themed page has information on the voluntary sector compact, social enterprise and public service delivery.

Capacity builders works in partnership with government and other bodies to help voluntary and community organisations work more effectively.

The Kings Fund is an independent foundation working for better health. Relevant publications include Social enterprise and community based care and Designing the 'new' NHS: ideas to make a supplier market in health care work.

The Audit Commission published Take Your Choice - a commissioning framework for community care - in 1997. Although now ten years old, this guide for social services departments still offers some useful support especially about mapping markets and getter a better service from providers.