Julie Wood explores the need to do more at local level and how commissioners are working with provider partners to change their relationships and find bespoke solutions to local problems
The NHS long-term plan set out an ambitious path towards an integrated NHS that is sustainable, efficient and effective, with the principles of prevention and self-care at the core. Clinical commissioning groups have been on this journey for some time now.
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Back in 2017, commissioners across the country were already working towards “strategic commissioning”, something that was firmly endorsed by the long-term plan with its commitment to have integrated care systems covering the whole of England by April 2021.
Our members have always focused on improving outcomes for their populations, but in the last few years they’ve been working more collaboratively with partners across a bigger footprint than a single CCG.
This also means more CCGs merging and coming up with both formal and informal arrangements to work at a larger scale that makes sense for their populations.
Changing how CCGs work
By virtue of the work they already do – assessing population health needs, demand forecasting and increasingly seeking to contract for improved health outcomes – clinical commissioners are ideally placed to take on a leading role as stewards of the larger system.
We know that one of the successes of CCGs has been the leadership by clinicians and maintaining this at the heart of integrated system working will be critically important. But commissioners cannot do this alone, and we have seen how commissioners are working with provider partners to change their relationships and find bespoke solutions to local problems.
Much needs to be done at a more local “place” level, that involves clinical commissioners, working with their providers and local partners across health and care to deliver much more integrated and joined up care
However, the NHS will not be successful if it operates solely at this large, system level; there is much that needs to be done at a more local “place” level, that involves clinical commissioners, working with their providers and local partners across health and care to deliver much more integrated and joined up care.
LTP gives a new direction as to what needs a focus
Boosting “out of hospital” care, investing in primary care and community care through Primary Care Networks operating across neighbourhoods – all critical foundations of the model set out in the LTP, are the direction of travel CCGs have been trying to achieve for many years but haven’t always succeeded because of the other pressures both on their financial resources but also other national priorities, and “must dos”.
Over recent years, barely a week has gone by without headlines about waiting lists and waiting times or other access type standards for hospital-based care.
Of course, no one wants to see excessively long waits for treatment, but I wonder if we have always got the balance right between what needs to happen “in” hospital and what also needs to happen “out of” hospital to prevent or reduce a future need for care?
The LTP pleasingly puts “out of hospital” care front and centre, as well as signalling an intention to get serious about prevention and public health.
Bringing the “how” and the “what” together
This will require sensible discussions and agreements at “place” level about what needs to be done to deliver both “in” and “out” of hospital.
“Place” often matches up with the footprints of local authorities who currently hold the budget for public health services such as smoking cessation and weight management, for social care, as well as having control over wider determinants of health such as housing, leisure and tackling pollution.
Joint working by commissioners working with providers and local government partners to collectively determine how best to spend that health and care pound for that particular place are going to be critical.
The additional £20.5bn a year promised to the NHS by the prime minister is much needed and welcome. But the truth is that the financial settlement pledged will not solve all the problems facing the NHS – we still can’t do everything, and that’s before any sort of settlement for social care is seen, nor other critical areas like workforce are funded.
The LTP pleasingly puts “out of hospital” care front and centre, as well as signalling an intention to get serious about prevention and public health
The difficult decisions that clinical commissioners have had to make over recent years have not gone away, and they won’t, at least not for some time, if we are to get back on a sustainable footing and transform health and social care. The important difference for a future NHS is that it won’t be clinical commissioners alone making those decisions.
The LTP means that collaboration is key, seeing ALL those who commission and deliver care across a system, its constituent local places and neighbourhoods, sitting around the ICS “table” making decisions about how best to spend the money the NHS has for the best possible return on investment.
And as those decisions get made – we want to make sure that we keep clinical leaders at the heart of this – as they’re best placed to remember the “why” of the NHS – to improve health for all.