Commissioning for improved outcomes

Dr Paul Husselbee, Chief Clinical Officer of NHS Southend CCG introduces a narrative from and for clinical commissioners about the challenges and opportunities within outcome-based commissioning:

The NHS and local commissioners across England face enormous challenges – how to deliver better for less; how to protect the fundamental principle of universal healthcare free at the point of delivery; how to shift the focus towards prevention; how to empower citizens with more control over their own care; and how to create a culture which is open to innovation and new ideas.

So, as clinical leaders we now need to lead our local health economies to use the challenges we face, financial and otherwise, as a platform to drive the systemic and behavioural changes needed to secure continuous improvement in health outcomes for our local populations. To state the obvious; this is a challenge for us as clinicians, but it is also a real opportunity for us to make the system work better through our new commissioning partnerships.

I personally have learnt over the last 12-18 months the power of working in partnership with my health and care colleagues locally – providers, other commissioners, local authority colleagues and others  – to co-design our vision for the future of our health economy, with an opportunity to truly put citizen outcomes at the heart of everything we do .

Over the past year the NHS Commissioning Assembly – and in particular the work of the Quality Working Group (QWG) made up of local clinical commissioners working hand in hand with area, regional and national directors in NHS England on the quality  and outcomes agenda – have  been focused on how commissioners can really drive continuous improvements in outcomes across the whole commissioning system.

The first phase of this work involved supporting NHS England in putting in place a mechanism that enables commissioners to articulate what they are trying to achieve for their local populations in terms of the outcomes that really matter to the public over the medium and long term.

Everyone Counts: Planning for Patients 2014/15 to 2018/19, published in December 2013, asked that all CCGs, together with their NHS England area teams are now jointly planning for improvements in seven overarching outcomes and setting quantifiable levels of ambition. For the first time, commissioners are being asked to plan on a five year trajectory.  And this has given us the chance to compare ourselves against each other in terms of outcomes and to learn from each other.

But to realise this opportunity we all need to understand how we make our ambitions to improve outcomes for everyone in our communities, a reality.  We need to understand both how to agree and set outcomes measures around the areas that matter most to our communities, and then how we can contract for these outcomes.

What is apparent is that ‘commissioning for outcomes’ is a spectrum – from designing services and judging providers in terms of the outcomes they secure, to contracting on a purely outcomes basis. But throughout the spectrum, ‘commissioning for outcomes’ means focusing less on what is done to people, and more on the results of what is done.

While few of us would disagree with the principle of commissioning for better outcomes, actually making this a reality is a real challenge – outcomes can be more difficult to measures and improvements take longer to become visible; and contracting on an outcomes-basis can be  more complex.

This is a journey – some commissioners are already well on their way, either in their thinking or in actually contracting for outcomes on the ground.  Yet others are at the start of their journey and are looking for encouragement and confirmation that they are not alone. That is why the NHS Commissioning Assembly are taking a keen interest in supporting commissioners in this area.

To kick off the work, a Task and Finish Group has  produced this narrative to stimulate discussion around what the opportunities and challenges are in commissioning for outcomes. This is the first step.

Over the coming year we want to work together to help the pioneers go further, faster and to support those at the beginning of their journey to learn from what has worked.  So we will develop practical support, resources and learning and work to overcome some of the more systemic barriers commissioners are facing.

For more details and support materials see:

Paul Husselbee

Dr Paul Husselbee is Chief Clinical Officer (CCO) of NHS Southend CCG and has been a GP in Southend for 23 years, having been born and brought up in the town.

He is also co-chair of the Quality Working Group of the NHS Commissioning Assembly, was a member of the Keogh Review Board and sits on the Quality and Clinical Risk committee, a sub-committees of the Board of NHS England.

He has been CCO in Southend since October 2012 – a small CCG with around 180,000 patients, co-terminus with Southend Unitary Local Authority and served by a single acute hospital. He has always had a keen interest in the managerial side of the health service, previously being GP advisor to Southend University Hospital, then Co-Chair of the PEC of Southend PCT.

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