What is Commissioning?
According to The Kings Fund (2023), commissioning is defined as the process by which health and care services are planned, purchased, and monitored. Every local authority has a duty under the Care Act (2014) to ensure a diverse and high-quality care market that supports population and individual well-being. This is achieved through engaging, coproducing, and consulting with all relevant stakeholders throughout the cyclical commissioning process.
In social care, commissioning refers to the ongoing process through which local authorities identify, procure, and oversee services for people with lived experience in their communities. Its primary aim is to address the care needs of people who require care, ensuring they receive the necessary support for the best social and health outcomes while helping delay future care requirements. This approach covers all social and health services, whether the local government, local authorities, the NHS, other public bodies, or the independent sector deliver them. It plays a crucial role in the health and social care sector, with commissioners shaping people’s lived experiences and influencing local communities.
Joint commissioning refers to arrangements in which public bodies collaboratively undertake the planning and implementation cycle for services. This can be for an entire population or specific groups with particular needs, such as people with disabilities who require complex support or people facing challenges like homelessness. The primary goal is for people to be actively engaged in their commuities, to achieve better outcomes and more integrated care by bringing together different stakeholders in a system to drive transformational change.
⇒ Read more about How We Can Support Commissioners in Reducing NHS Waiting Lists.
Commissioning Types
There are various evidence-based service models for commissioning, all of which follow a similar process. Additionally, commissioning can be divided into two categories: strategic and individual. Both types of commissioning are crucial for creating a responsive, sustainable, and person-centred social care system that can adapt to changing needs and preferences while promoting independence and quality of life for people with lived experience.
Strategic Commissioning
This type of commissioning focuses on the overall local or regional market when considering the population’s needs at a macro level. This type of commissioning involves creating and commissioning new services based on analysing the overall need and reviewing and monitoring current services. The aim is to consider long-term value for money and improved health and social care outcomes for a group of people, with the byproduct of early intervention leading to lower future costs.
Individual Commissioning
Individual or micro-commissioning focuses on procuring the right services for people at an individual level. The emphasis is not only on well-being but also on value for money through meeting outcomes. This is where an individual case commissioner considers the complete picture of a person needing care and follows a process to ensure that the right services surround the individual. The individual commissioning process should include monitoring of outcomes for each person to ensure needs are being met effectively. The activities involved in individual commissioning are similar to those in strategic commissioning but are applied individually.
What is the Commissioning Cycle?
The commissioning cycle is a systematic process involving planning, purchasing, and monitoring health and care services. It plays a crucial role in the health and social care sector, with commissioners being responsible for people’s lived experiences and the shaping of local communities around public care.
The cycle is generally divided into four stages: Analyse, Plan, Do, and Review.
Analyse
The first stage of the commissioning cycle is analysis. This involves gathering relevant data at both the population and individual levels and analysing implementation risks. It involves thoroughly examining all the factors surrounding macro or micro-level needs before moving on to the planning stage. Without comprehensive analysis, there is a risk that projects will be ineffective, resulting in unnecessary costs for local authorities (LAs) and integrated care boards (ICBs) while failing to meet the actual needs of our communities.
During the analysis stage, we must gather evidence-based data, anticipate emerging needs or trends, identify gaps, explore appropriate funding streams, and assess existing assets within our local communities. These efforts together provide a broader understanding of the needs.
Key activities in this stage include:
Gathering evidence-based data
Horizon scanning for new needs or trends
Identifying gaps in service provision
Researching the correct funding streams
Looking at assets already present within local communities
These activities help build a comprehensive picture of the needs within the community and identify opportunities for developing commissioning strategies to meet the specific needs.
Plan
The planning stage involves determining how identified gaps or needs can be met through available preexisting services and services that may still need to be created or commissioned in an area. This requires a deep understanding of the local market and translating the data gathered in the “analyse” stage into tangible actions and priorities in a solid commissioning strategy. A key aspect of planning involves workforce shaping and development. Commissioning services, particularly at the more complex end, becomes highly challenging without a skilled workforce. Therefore, clearly understanding the available skills and workforce capacity is essential.
Key activities in this stage include:
Forecasting future needs and services
Seeking out creative solutions and providers
Market shaping
Workforce shaping and development
Setting success indicators and contingency plans
Do
The third stage is the implementation of the agreed plans, whether on a macro or micro level. This phase includes market development, identifying suitable providers, and establishing or securing contracts to deliver specific services. Local authorities often utilise procurement portals to invite interest from businesses, suppliers, or charities to tender for the required services.
During implementation, commissioners ensure clear communication among all parties, share and manage risks, conduct fair and efficient procurement processes, and develop and closely monitor the service as it is launched.
Key activities in this stage include:
Effective communication between all parties
Sharing and managing risks
Ensuring effective and fair procurement processes
Close monitoring as the service launches
Review
The final stage of the commissioning cycle is the review. All publicly commissioned services must undergo regular reviews to address the identified needs and outcomes of people or groups. This cycle stage is crucial, providing valuable insights into what works well and highlighting areas needing improvement, such as best practices, legislation, guidance, etc. It enables commissioning teams to adjust their strategies and implement more effective plans as the population’s needs evolve.
Key activities in this stage include:
Evaluating whether outcomes were met
Assessing the impact on people’s lives
Assuring quality of services
Demonstrating value for money
Evaluating the impact on long-term health and social care inequalities
The review stage allows commissioning teams to learn from what’s working well and might not be working and adjust their strategies towards more effective plans as population needs evolve.
⇒ Read more about What Case Commissioners Look for in Social Care Providers.
Factors For Evaluating Each of the Stages
During the stages of the commissioning cycle, there are questions that commissioners must ask themselves, looking at the tangible outcomes of each stage:
1. Are the outcomes met?: This involves assessing whether the project has met its intended outcomes. The evaluation checks if the services commissioned have effectively addressed the needs identified during the analysis and planning stages of the commissioning cycle.
2. What is the impact on people’s lives and well-being?: The impact on people’s lives and well-being is another significant factor. This evaluation checks if the commissioned services have improved the well-being of people and the community, as defined by the Care Act. The well-being indicators encompass several aspects, including the individual’s personal dignity, physical and mental health, and protection from abuse or neglect. They also cover having control over daily life, involvement in work, education, training, or recreational activities, and ensuring social and economic well-being. Additionally, domestic, family, personal relationships, the appropriateness of living conditions, and the person’s contribution to society are all important elements.
3. Is there quality assurance?: This involves assessing whether the commissioned services meet the required quality standards. Regular reviews and monitoring of the services are conducted for this purpose.
4. Can the value for money be demonstrated?: This factor evaluates whether the commissioned services provide good value for the money spent. The assessment is done by comparing the cost of the services with the benefits they provide in terms of improved well-being and health outcomes.
5. Has there been an impact on long-term health and social care inequalities?: This involves assessing whether the project has contributed to reducing community health and social care inequalities.
These factors are essential for evaluating each project in the commissioning cycle. They ensure that resources are used effectively and that the commissioned services meet the current and future needs of the population.
Coproduction and Consultation
Coproduction and consultation are two integral aspects of the commissioning process, aiming to involve people and identify grassroots needs and community requirements. Coproduction, as defined by The Coproduction Network for Wales, is a process that allows citizens and professionals to share power and work together in equal partnership.
This collaboration creates opportunities for people to access support when needed and contributes to social change. In health and social care, coproduction involves all stakeholders in a person’s care or a community working together to co-design and create services that meet the needs of people accessing the service.
On the other hand, consultation is a distinct method of engaging with the market, aiming to inform people about upcoming proposed plans and seek feedback on their implementation. As defined by NHS England, consultation involves people, the public, and stakeholders in decision-making about health services. The goal is to enable them to gather feedback and insights to ensure that services are person-centred, effective, and meet community needs.
Both coproduction and consultation offer numerous benefits. These include:
- Delivering services more smoothly
- Designing services more accurately and relevantly through feedback
- Ensuring transparency in the launch of new initiatives
- Building greater trust between statutory bodies and their communities
- Expanding social networks to spread awareness of new initiatives and gather feedback
- Promoting genuine collaboration that prioritises the best interests of the whole community
- Fostering shared ownership and accountability for outcomes and successes
⇒ Read more about the emerging challenges in healthcare service provision.
Commissioners and Care Providers Collaborating to Resolve Commissioning Cycle Issues
The commissioning cycle in the health and social care sector often faces challenges related to service viability, including:
Financial stability
Workforce shortages
Compliance with regulations
A collaborative approach between commissioners and care providers is essential to address these issues.
Financial Viability
Financial viability is a significant concern in the commissioning cycle. Providers often need help with financial instability due to fluctuating funding sources, which political priorities, emerging health priorities, and economic changes can influence.
Private/independent providers often face market competition and cash flow interruptions, which can impact their ability to deliver commissioned services and hinder growth efforts to meet community needs.
Voluntary sector providers who rely on charitable donations and government grants face challenges in maintaining consistent service levels due to fluctuating funding. The increased demand for free services further strains these providers.
Workforce Shortages
Workforce shortages can negatively impact both private and voluntary sector organisations.
Independent providers may struggle to offer competitive salaries and benefits, leading to high turnover rates and potential disruptions in service provision. This creates difficulties in recruiting and retaining a stable workforce.
Voluntary sector providers face challenges recruiting unpaid volunteers, especially as people grapple with a cost-of-living crisis, limiting their time to contribute freely.
Compliance and Regulation
Compliance with regulations in a heavily regulated sector can drain resources for the government and independent and voluntary sector organisations. Providers need to maintain their administrative duties, which comes at an additional cost, potentially negatively impacting the viability of day-to-day operations.
⇒ Read more about How Healthcare Providers Can Demonstrate Value to Case Commissioners.
Addressing the Issues
To address these issues, collaboration between commissioners and providers is crucial. This includes access to stable funding mechanisms, support with regulatory processes, support for workforce development, and adjustable strategies to meet evolving community needs. As commissioners, they are responsible for supporting both independent and voluntary organisations with services needed for their viability. This collaborative approach can help resolve the issues faced in the commissioning cycle and ensure the provision of quality health and social care services.
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