4. What does strategic commissioning look like, and who is involved?
'Traditionally the starting point for forward planning for many of us is to consider what we've already got and then look at how to preserve, sustain or increase it. Strategic commissioning enables us - indeed expects us - to start somewhere else and ask a different set of questions:
- What exactly are we trying to achieve, and for whom?
- How successful have we been?
- What do we need to do differently for a better result, and how are we going to resource that?
'The fact that we're also expected to do this collaboratively with those organisations, groups and people directly affected by our planning activity, but who have previously had little or no direct influence in relation to it adds to the challenge, but potentially makes success more likely for all of us.
'From a third sector perspective, it's the first time that there has been an explicit expectation that we are partners in this endeavor, rather than simply suppliers, interest groups or consultees and crucially, that this offer of partnership extends to the people for whom we provide care and support.'
Annie Gunner Logan, Director, Coalition of Care and Support Providers in Scotland
4.1 Most models of commissioning emphasise its cyclical nature, with strategic commissioning providing the context for procurement and contracting. The cycle is sequential and of equal importance to one another.
4.2 A key principle of the commissioning process is that it should be equitable and transparent, and therefore open to influence from all stakeholders via an on-going dialogue with people who use services, their carers and providers. Outcomes for people are at the centre of the model:
4.3 In order to ensure the effective engagement of stakeholders, the Act requires each Integration Authority to establish a Strategic Planning Group, which is described in detail below and in Annex A. The Strategic Planning Group will be concerned with a series of questions throughout the commissioning process, such as those illustrated below, based on work by Audit Scotland:
4.4 The process itself does not start or end with the publication of the strategic commissioning plan. Engagement with stakeholders and the involvement of the Strategic Planning Group are all part of a continual, iterative cycle.
4.5 The role of the Strategic Planning Group is in developing and finalising the strategic commissioning plan and in continuing to review progress, measured against the statutory outcomes for health and wellbeing, and associated indicators. The strategic commissioning plan should be revised as necessary (and at least every three years), with the involvement of the Strategic Planning Group.
4.6 Localities will also be key to effective strategic commissioning. The Act requires each Integration Authority to divide its geographical area into at least two localities, whose views must be taken into account as part of the strategic commissioning process. Localities, and locality planning, provide a route for strong local clinical and professional leadership, as well as a further opportunity for community engagement in strategic commissioning.
'Integration is about improving outcomes and tackling the disconnects that exist within health and between health and social care. Strategic commissioning provides a robust, coherent cross-system methodology for identifying the priorities for change in support of this. Its cyclical nature - analyse, plan, do, review - will bring the strategic plan to life.
'A co-production approach will be essential to effective strategic commissioning and finding common ground among the stakeholders on changes which need to be made will be central to the success of integration. Strategic commissioning gives a process for finding this common ground, a methodology for ensuring it is established on a solid foundation and links the agreed changes to improved outcomes.
'Over time, integration must be built on more mature relationships and transparency between all stakeholders. Strategic commissioning will be a critical part of the scaffolding which will support this movement and that is ultimately why it is so important.'
Allan Gunning, Director for Strategic Planning, Policy and Performance at NHS Ayrshire & Arran
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