As the system begins to recover and refresh it may be time to take stock of our approach to commissioning, and return to the essentials of what commissioning means and how we can approach it in a way that provides the best value, responds to needs equitably, and is sustainable into the future. This article by Dr Eugenia Cronin, a consultant in public health explores where to start.
Sustainable commissioning in a rapidly changing world
Dr Eugenia Cronin, Consultant in Public Health
Sustainable commissioning is about ‘future-proofing’ health care. This means ensuring better outcomes for patients both now and in the future, despite increasing resource constraints .
Commissioners of health services are tasked with getting the best outcomes for their populations through the services they commission. The task is increasingly complex, as we are faced with growing needs and demand, and now – the enormous human cost and logistical challenges of the Covid-19 pandemic.
The pandemic has shone a light on the resilience of services, and it has accelerated changes in the way we deliver them – ‘necessity being the mother of invention’. We have seen clinical staff rapidly reskilling in critical care, a growth in remote clinical consultations, and a massive rise in digital solutions. We are yet to see how much of this we will keep.
Questions of resilience in the context of the pandemic have tended to be framed in terms of capacity in hospital beds, and ICU beds more specifically, and this is understandable given many acutely ill people have needed urgent and intensive medical treatment.
There is a clear risk that approaching resilience by focusing primarily on acute hospital beds or occupancy rates reinforces the default of hospital-focused responses to system-wide issues.
As the system begins to recover and refresh, its stewards will need to recognise interdependencies between the sectors that make up the health and care system, and build and strengthen relationships. Fundamentally, they will need to learn more about the populations they serve, inequalities in the extent to which needs are met, and opportunities to promote health and wellbeing – and prevent illness.
The pandemic has exposed ‘deep inequalities and stark differences in life expectancy’ in the populations we serve. How much illness and death due to Covid-19 could have been avoided if fewer people carried through their lives the burden of chronic conditions? Many such conditions (diabetes, obesity, heart disease) are preventable.
It may be time to take stock of our approach to commissioning, and return to the essentials of what commissioning means and how we can approach it in a way that provides the best value, responds to needs equitably, and is sustainable into the future.
But where do you start when there is so much change? We start with the basics: assessing needs, and planning and prioritising. These are the things that tend to be forgotten when we are focusing on the business of contracting. But they are essential.
We have to assess population need properly or we risk producing services which:
- don’t produce the outcomes we expected
- don’t serve populations equitably
- don’t support people to take responsibility for their health armed with the skills and information to do so
- are over-used (or under-used)
- don’t connect with other services
- are evaluated poorly by patients and staff
- duplicate other services.
PCC is offering an online workshop running over two weekly sessions to explore these issues, using real-life examples and delegates’ own commissioning challenges.
These highly interactive sessions will be delivered by Dr Eugenia Cronin, a consultant in public health who advises the public sector on strategies to deliver sustainable services in challenging financial times, and is grounded in local system development and good practice.
Joint Commissioning Panel for Mental Health (2015) Guidance for commissioners of financially, environmentally, and socially sustainable mental health services
Warren, S (June 2020) https://www.kingsfund.org.uk/blog/2020/06/covid-19-resilience-more-than-hospital-beds King’s Fund
King’s Fund (June 2020) https://www.kingsfund.org.uk/press/press-releases/covid-19-stark-differences-life-expectancy