World class commissioning has to include deciding when current services no longer fit the bill. Helen Mooney looks at how to decommission services successfully
As Paul Corrigan, health adviser to former prime minister Tony Blair and most recently director of commissioning at NHS London, recently said: “You cannot have world class commissioning without world class decommissioning.”
PCTs have to understand the needs of the individual and where they live; unless they understand that they will procure the wrong things
Notwithstanding the recent confusion over the health secretary’s preference for NHS providers, primary care trusts should now be in the throes of decommissioning services so they can successfully become world class commissioners.
The government has tasked them with flexing their muscles to stimulate the market. It is a case of not if but when they will decommission some provider services. But this does not mean simply riding in roughshod, cutting back and dumping services, as has happened in the past.
To become a world class commissioner PCTs will be expected to exercise a collective intellectual approach to decommissioning. In some cases they may decide currently held contracts are no longer fit for purpose and retender for existing services. However, in many cases services will need to be retailored and redesigned to ensure they are fit for purpose both now and for the future needs of their local populations.
A sophisticated approach will see PCTs working alongside service providers to jointly ensure that services are improved and are what their local communities both need and want.
Calm decision making
Getting the right services in place will also help PCTs to weather the financial storm in public services over the coming years. To do this now makes for calm decision making and more effective planning for the long term.
NHS Birmingham East and North chief operating officer Andrew Donald admits decommissioning is not easy. “We have to make sure we are forming explicit partnerships with providers and deciding what we need to stop doing and make sure that actually happens at the start of the process,” he says.
Mr Donald says PCTs are constantly commissioning and decommissioning parts of services but to decommission services successfully a number of key things need to happen.
“PCTs need to have drawn up a strategic plan, which they have been obliged to do under world class commissioning; that strategy is the underpinning base to commissioning and decommissioning.
“They should be sharing that strategy with providers so it does not come as a surprise: you can’t do it successfully without partnership and in communicating with providers you have to be explicit and have a robust business case and an outcomes analysis.
“And you have to consult and engage local people and service users on your proposals,” he explains.
In considering decommissioning PCTs must understand they need to describe the value of any new proposals to the public. They need to recognise the value of services provided outside of the traditional hospital setting and why the service will be better and they also need to ensure they have the full support of clinicians in making changes.
Mr Donald says strong commissioning and decommissioning will ultimately move the NHS away from a “chaotic to a sophisticated managed system of care”.
The charity Turning Point provides social care services to local communities and contracts with a number of PCTs. Chief executive Lord Adebowale warns that too often decommissioning is confused with cutting services.
“PCTs have to understand the needs of the individual and where they live; unless they understand that they will procure the wrong things,” he says.
“To understand the needs of the community they must engage with that community, they need to understand what they want from their point of view and build services they would use right down to the colour of the walls. Nine out of 10 times once they have done that they will have an end service which looks different and is cheaper to provide… slash and burn will not work.”
He continues: “PCTs need to ensure the client is at the centre of the debate and understand why what they are proposing is going to make the difference rather than already having the plan in place.”
10 top tips
- Understand the impact on the relevant provider of services and involve them in proposals at an early stage
- Engage the local population and service users in planning and ensure that the service is designed with them and with them in mind
- Develop a strategic plan for the PCT which incorporates proposals for decommissioning
- Engage and involve clinicians in the discussion - their support will be crucial
- Deal in fact - have a well developed financial and clinical case for your decision
- Consider whether it is possible to introduce new services to compensate for services that are being decommissioned
- Ensure that no sector of the provider market is given unfair advantage during the process
- Retain an auditable documentation trail regarding all key decisions
- Carry out an impact assessment to identify the anticipated or actual impacts of the change to services
- Ensure that reasonable timescales are determined and applied across the whole process