Health Service Focus

Commissioning environment has never been more challenging

NHS England’s director of commissioning support services strategy Bob Ricketts CBE discusses the challenges facing commissioners in the next year.

The next year will be a period of “transition” for commissioners in a landscape that has never been as challenging in terms of rising demand and increasingly intolerant public and political expectations for the NHS.

Speaking during the recent Commissioning Show, Bob Ricketts CBE, NHS England’s director of commissioning support services strategy, said one of the biggest challenges is variation in outcomes.

“The biggest thing for me is that service models – whether in secondary care, primary, specialist, you name it – feel very much stretched and past their sell-by dates,” he said.

Ricketts said the variation in outcomes on liver disease, coronary heart disease and diabetes are “unacceptable”. “We need much smarter, data-driven commissioning,” he said. “A key enabler of excellent commissioning is excellent commissioning support.”

Lead Provider Framework

During his presentation to a packed exhibition hall, Ricketts discussed how the commissioning support Lead Provider Framework (LPF), launched in February, will help deliver this. The goal is that every commissioner, small or large, should be able to access “affordable commissioning support”.

Since the launch of the LPF, 10 CCGs have already bought services off the framework and it is expected that, by the end of August, more than 80 CCGs will have done so, for end-to-end commissioning support or other substantial requirements – “quite a chunk of the potential pipeline”, as Ricketts put it.

Following what was described as a “really difficult” accreditation process, nine providers, including three private companies or consortiums and six CSUs (Central Southern, South West and South having since merged), were approved on the Framework.

But two CSUs – Yorkshire & Humber, and North West, which serves CCGs across Cheshire, Merseyside and Greater Manchester – were denied accreditation to provide the full range of ‘end-to-end’ support services on LPF (known as Lot 1), though they did get onto Lot 2b (supporting continuing healthcare and individual funding requests). But both CSUs have confirmed they are to close, with staff to be transferred.

“This is going to be a real year of transition for commissioners and staff in the system,” Ricketts told the audience. He added that NHS England is trying to pace the demands on CCGs, while at the same time stabilising the system for all 10,000 CSU staff members.

Talking about the providers who were successful, he said: “In terms of quality, every one of those providers should be able to do everything, from back office through to needs assessment, all the way to outcomes-based commissioning and contracting,” said Ricketts.

Using LPF is the quickest and simplest way for CCGs to comply with EU procurement law and get best value, Ricketts added. It takes two to three months to buy from the LPF, but there is free, professional, tailored support to CCGs that use it.

Joined-up, place-based care

Good commissioning should incentivise pathways that deliver high-quality and joined-up care, Rickett said – which the LPF can help deliver, not least because it is available to local authorities and all other public sector bodies, not just the NHS.

Good commissioning also has to be place-based and make the best use of resources, while ensuring social values are taken seriously, he added. “It is about including, not marginalising, NHS partners – whether they are commercial, voluntary sector or social enterprise. They all have a role to play.”

But, he said: “I’ve seen some places where they’ve taken the outcome-based commissioning ‘sledgehammer’ and used it to crack a peanut. What we need to do in this area is make sure it is deliverable and proportionate.”

To ensure this happens, Ricketts said NHS England was providing a lot of support, standardised evidence-based documentation and robust contracts.

“We are encouraging people to go for longer-term partnership contracts. I really think it is a bad idea to opt for short-term contracts,” he said. “The best thing to do is to go for a longer-term approach.”