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This chapter examines the approaches and enablers for health and social care service design. It begins by discussing the steps in service design, the scale and circumstances that can affect approaches, and the key phases. The chapter then considers the impact of incumbent services and limited finance on design processes. Co-production is essential for effective design, and the success factors and approaches for implementing co-production with a range of groups, including people in communities and the voluntary, community and social enterprise (VCSE) sector, are explored. The importance of the VCSE alliance model is considered. To capture the efforts involved in the design process, the service specification is described and writing tips are provided. Finally, some of the key issues facing those designing services are examined, including capacity and demand, integrated services, workforce, and shared care records.
There are number of challenges facing health and social care in the future, but this chapter examines those that are key for future planning and readiness. The first challenge discussed is understanding the ageing population and how to plan and design services for the growing demand. The second is the technology revolution, and this covers the priorities of the NHS in the Long Term Plan, examples of change, and future planning. The third is the global pandemic, and the chapter unpicks some of the lasting impacts and how the NHS can ready itself for similar events with actions such as promoting flexibility in delivery and supporting communities to be self-sufficient. Finally, the environmental crisis is discussed in terms of its impact on the NHS, but also the impact of the NHS as deliverers of care services with a large carbon footprint. There is examination of the NHS commitment to sustainability along with suggested local actions and examples of change.
The NHS standard contract is a key tool for commissioners and this chapter looks at the components and schedules of this document. The discussion includes the parties involved, how to monitor the contract, adjusting a contract, implementing levers and incentives, determining length of contract term, and decommissioning. The other key contract arrangements used in health and care settings are discussed, including primary care contracts, grants, and social care frameworks.
This chapter moves from theory to the current commissioning models. It explores the reforms for health and social care in the Health and Care Act 2022 and outlines the tiers of the NHS and the integrated care systems established legally in 2022. It also covers those working in this relatively new structure, including commissioners and key partners. The chapter then guides the reader through stakeholder analysis and involving multiple voices – including people in communities – in commissioning. Finally, there is a brief examination of the differences between health and care systems in England and those in the other countries of the UK and in some other countries.
This chapter opens with why we need to measure and evaluate in commissioning. It outlines the types of evaluation measures and provides examples for a service. The next steps take the reader through how to design evaluation, including the benefits realisation process. This is inclusive of data collection, triangulation, presenting evaluation findings, and dealing with poor performance. Finally, the commissioner is encouraged to evaluate themselves.
The chapter opens with a brief description of the evolution of NHS tariff systems into the NHS Payment Scheme that is used today. There is exploration of the current system, including the principles of blended payment approaches and examples of their application. Then social care framework arrangements are examined along with joint funding arrangements. With financial resources becoming more stretched, this chapter outlines alternative ways of funding services and finding the money for commissioning improvement.
Are you a health and social care commissioner navigating the ever-changing commissioning landscape? With challenges such as limited funding, changing demands and global pandemics, we need to be clear on why, what and how we commission effectively.
This book offers you a warm welcome into the often-complex world of healthcare commissioning. Amanda J. Hughes shares personal insights from her commissioning career and practical guidance that will demystify the commissioning cycle and ease the journey as you strive to achieve the best outcomes for the population.
This book will help you to ensure valuable resources are directed to those with most need, that care is fair and accessible and that the solutions you put into place are sustainable for the longer term.
The definitions for equality and equity are shared and discussed as an introduction to examining the factors that contribute to avoidable inequalities. The chapter includes the current challenges and points out why they matter. Commissioners are directed in their efforts as the discussion unfolds to identifying and addressing inequalities. The chapter includes examination of the Core20PLUS5 approach and specific examples of how inequalities have been tackled. Other specific topics include unpaid carers and how they can be supported, plus the need for a diverse and inclusive workforce.
This chapter introduces the author and outlines the need for this practical resource to support commissioners. It also includes recommendations for how to use the book. The context for health and wellbeing is discussed and key terms are defined. There is also an overview of shifts in thinking within the health and care sector, such as the move towards a holistic approach and personalised care.
This final chapter summarises commissioning processes and good practice in a single model. Three output pillars – Access, Quality, and Sustainability – are presented. All three are supported by enabling bricks, which include many of the actions and processes covered in the book, such as population health, strong partner relationships, co-production, effective contracts, and evaluation. The more bricks in place, the more stable the pillars of outcomes-based commissioning.
