Meeting the challenge: commissioning support units are being encouraged to build partnerships with other organisations. Photograph: Graeme Robertson/Getty Images
Many NHS staff have already been looking beyond business-as-usual, to really get to grips with the challenge of major clinical service change.
There is no silver bullet. Health services will continue to experience increasing demands, both demographically and societally driven. Against this backdrop, the challenges of maintaining and improving quality standards and improving things for patients, at the same time as reducing spend, have been brought into sharp relief by recent events in Staffordshire and elsewhere.
But how does the NHS affect the cultural and practical changes to patient behaviours? How do they achieve the investment in technology and other resources? How, without surrendering control of the clinical decision-making agenda, do they seek the funding and additional, commercial and other skills that they require?
To meet this challenge, commissioning support units (CSUs) are being encouraged to start building partnerships with other NHS, commercial and third-sector organisations, who can bring fresh thinking and wider expertise to the NHS.
For clinical commissioning groups (CCGs) as customers, dealing with a CSU-led commissioning support partnership may also help to simplify contractual arrangements. CCGs will also be looking for ways to better align the incentives of commissioning support organisations with their own successful delivery of the quality, innovation, productivity and prevention (QIPP) agenda. A broader CSU partnership, where there is greater ability to invest, manage risk and explore outcomes-based risk and reward contracts may be the way to move towards this.
Between 2008 and 2011, my team partnered with NHS Ashton Leigh and Wigan to deliver Transforming Commissioning Saving Lives, one of the first large-scale commissioning transformation programmes under the national framework. Ashton Leigh and Wigan undertook the programme in response to a number of challenges; mounting financial pressure to reduce acute activity, poor health outcomes (compared with national benchmarks), and commissioners struggling to gain control in a health economy dominated by the local hospital trust.
Working together, we devised and implemented a number of strategies to improve commissioning of clinical care services, to both enhance performance and achieve savings. We undertook organisational development and leadership coaching – working with the chief executive and his team and in joint programmes with the local authority.
We worked closely with commissioning managers, clinical commissioners, patients, doctors, nurses and health systems partners to redesign local stroke services, commissioning a pathway to diagnose and manage patients following a transient ischemic attack (TIA) or mini stroke, and to provide holistic and person-centered health and social rehabilitation for people who have had a full stroke.
This resulted in a reduced average length of time a patient spends in hospital – from 56 days to 12 days. It achieved £14.39m worth of savings. But it also achieved more long-term, fundamental changes through the skills and knowledge transferred.
My experience leads me to believe successful partnerships can offer significant benefits to both the public sector service delivery organisation (for example, a local authority or, in this case, a CSU) and the private or third sector partner. They offer greater resilience in terms of both capacity and capability.
Partnerships also mean that risks can be shared and that investment can be attracted from partners who are more able to fund new technology and other resources. And lessons can be learnt from the experience of other parts of the private and public sector about innovative ways to get service users and their families engaged, and providers of healthcare services doing things differently.
Matthew Harker is director of healthcare consulting at Capita.