Partner organisations in Lancashire and South Cumbria have been working collaboratively to develop how commissioning of health and care services work since August 2017. This work emerged from the acknowledgement that the NHS Five Year Forward View has led to changes in the roles and functions of commissioners. This has since been recognised further in the NHS Long Term Plan which is an endorsement of the work taking place in Lancashire and South Cumbria.
Our desire across Lancashire and South Cumbria is to focus on collective efforts to improve the health and wellbeing of the whole population, improve outcomes and quality of services and work towards the financial sustainability of local services. Increasingly this is blurring the boundaries between commissioners and providers.
A Commissioning Development Framework was published, and approved by the Joint Committee of CCGs, which recommends that we adopt a “place-based approach” to the evolution of commissioning in Lancashire and South Cumbria. Place based commissioning means:
- Commissioning organisations (health and local government) should work together to govern the common resources available for improving health and care in their area
- The approach taken to developing local systems of care should be determined using a common set of design and operating principles
- Changes to the roles of commissioners are needed to support the development of systems of care across Healthier Lancashire and South Cumbria and in local Integrated Care Partnerships (ICPs)
The development of our approach to working across Lancashire and South Cumbria, in our five local partnerships and neighbourhoods reflects a really positive change in the way NHS, Local Authorities and partners work together.
This work is developing and any decisions will be taken by the Joint Committee of CCGs which is held in public.
The new commissioning system story so far
August 2018 marked a one-year milestone in Lancashire and South Cumbria’s journey towards a new commissioning system. Key to our experience is the importance of putting the right people alongside the best processes and using the most honest approach to make improvements in a complex area.
You can access an article which describes that journey, focusing on the lessons learnt in the ﬁrst year of what will ultimately be a long-term plan for change. We talk about the importance of ‘buy in’ and co-production as well as the need for clear project design and the incorporation of bespoke ways to make decisions based on data and evidence as well as passion and governance.
What is commissioning?
NHS England describe commissioning as:
Commissioning is the continual process of planning, agreeing and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.
There is no single geography across which all services should be commissioned: some local services can be designed and secured for a population of a few thousand, while for rare disorders, services need to be considered and secured nationally.
Who commissions services?
Across Lancashire and South Cumbria most services are commissioned by Clinical Commissioning Groups (CCGs), however some services are determined by NHS England and these are same across the country.
Reviewing commissioning policies
As part of our development work in this area we are trying to ensure fair access to services for everyone who lives in Lancashire and South Cumbria. To do this we are reviewing clinical policies to make sure each CCG offers the same access and levels of treatment, this will end what has been called 'the postcode lottery'. This process is called commissioning policy development.