Everywhere we look; every report, strategy, mandate, and opinion piece in health and care advocates for integrated care. How we best enable service integration – as a means to improve patient experience and outcomes, and deliver value and efficiency – is the subject of ongoing debate.
The King’s Fund today released a report, Commissioning and contracting for integrated care, which explores novel models being employed, and the ways in which services are being commissioned and contracted for, to facilitate integration.
We welcome the report, and the sentiment that commissioning for outcomes should be one of the core elements of any contractual framework. The report highlights that novel and innovative contracting models can drive better integration of care services, and that this drive for novel models is not only supported by the regulatory framework within which commissioners function, but is also advocated for by national bodies and policy makers.
However, the final remarks of the report might leave the reader somewhat confused. Initially, we are presented (for the most part, in a rather positive light) with case studies from five early innovator sites, exploring the benefits, learnings from, and limitations of the various contractual models chosen. But to conclude, we learn that change, because it is driven by visionary leaders, and requires initial external support, is considered to be neither ‘replicable nor sustainable’ on a national level.
We feel that vision and leadership should be considered a prerequisite for, rather than a barrier to large-scale change. Instead of looking to this as a reason not to embark on a programme of innovation, we must consider how we can cultivate more leaders to drive change nationally.
We certainly agree that for widespread transformation to happen, skills and capabilities within the NHS must be built upon. Initially, specialist expertise will be required, and investment in terms of time and resources will be needed. But as the report itself points out, the more widespread that these models become, the more costs will fall, as experience and learning are shared amongst commissioners.
The report calls for
‘opportunities for commissioners to learn and share their experiences through learning communities’.
This is happening. Cobic facilitates a free networking forum – The Cobic Club – to allow commissioners and providers interested in outcomes-based commissioning (OBC) to share experiences and learning, and access resources. We also work with and via CSUs to support skill development and learning around OBC, and to offer practical support with implementation. For example, Cobic was recently selected as one of a number of suppliers to provide consultancy services under the Elis Framework – a mechanism which allows participating CCGs to quickly access specialist expertise, from suppliers who have been pre-approved thus minimising the impact of lengthy procurement processes.
Cobic, and other specialist organisations are involved in developing the skill base of commissioners. Experts are contributing to professional development of senior leaders through initiatives such as The Cabinet Office’s Commissioning Academy, and to the development of future commissioners by sharing learning with postgraduate students through formal course modules.
There is certainly work to be done to ensure that change can be implemented on a large scale. For example, shared learning amongst provider organisations, to improve interorganisational governance structures, will better enable these groups to understand and manage risk, monitor spending and performance.
But this cannot be a reason to abandon innovation. If we ensure that skills and competencies are developed, and learning is shared, change will be both replicable and sustainable.