'Public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve. We must prioritise expenditure on public services which prevent negative outcomes
from arising. And our whole system of public services - public, third and private sectors - must become more efficient by reducing duplication and sharing services wherever possible. Experience tells us that all institutions and structures resist change, especially radical change. However, the scale of the challenges ahead is such that a comprehensive public service reform process must now be initiated, involving all stakeholders."
The Christie Commission Report
Commission on the future delivery of public services, June 2011
'Strategic commissioning is the fulcrum around which the future planning and aspirations of the local partnerships to meet the outcomes of the local populace will be set. Thorough analysis of joint strategic needs can identify population need, meaning services can be reshaped to meet needs more closely now and in the future. That gives services, in partnership with service providers, the space to innovate and inspire and to more effectively target resources at prevention.'
Peter Macleod, Director of Social Work at Renfrewshire Council
2.1 The Act places a duty on Integration Authorities to develop a "strategic plan" for integrated functions and budgets under their control.
2.2 Each Integration Authority must produce a strategic commissioning plan that sets out how they will plan and deliver services for their area over the medium term, using the integrated budgets under their control. Stakeholders must be fully engaged in the preparation, publication and review of the strategic commissioning plan, in order to establish a meaningful co-productive approach, to enable Integration Authorities to deliver the national outcomes for health and wellbeing, and achieve the core aims of integration:
- To improve the quality and consistency of services for patients, carers, service users and their families;
- To provide seamless, integrated, quality health and social care services in order to care for people in their homes, or a homely setting, where it is safe to do so; and
- To ensure resources are used effectively and efficiently to deliver services that meet the needs of the increasing number of people with long term conditions and often complex needs, many of whom are older.
2.3 By developing strategic commissioning plans for all adult care groups, Integration Authorities will design and commission services in new ways in collaboration with their partners. Strategic commissioning plans should incorporate the important role of informal, community capacity building and asset based approaches, to deliver more effective preventative and anticipatory interventions, in order to optimise the potential to reduce unnecessary demand at the 'front door' of the formal health and social care system.
2.4 Services cannot continue to be planned and delivered in the same way; the current situation is neither desirable in terms of optimising wellbeing, nor financially viable. With the full involvement of all stakeholders, and the creation of a single system for strategic commissioning of services, Integration Authorities can now think innovatively about how services might be provided in the future.
2.5 The focus should be less about how it is done now and more about how it should be done in future. This might mean, through a robust option appraisal process, that the Integration Authority makes decisions about disinvesting in current provision of services in order to reinvest in other services and supports that are required to meet on-going and changing demand.
2.6 Regulations supporting the Act set out the services that must be included in integrated arrangements, and therefore the scope of strategic commissioning in local areas. Broadly, strategic commissioning will cover, at least, adult primary and community health care and social care, and those aspects of adult hospital care that are most commonly associated with the emergency care pathway.
'If we believe that Health and Social Care Partnerships will be able to meet all resource claims placed upon them, then strategic commissioning is crucial for ensuring that needs are met efficiently and equitably.
'The development of robust processes will be required in order to defend the shift in resources implied by reshaping the balance of care. Partnerships are well placed to do this but it can only happen in any significant way with sound strategic commissioning.'
Professor Cam Donaldson, Yunus Chair in Social Business & Health, Glasgow Caledonian University