- Date published
- September 2009
- Pages
- 6
- Download publication [63kb PDF]
Background
The Health Select Committee is undertaking an enquiry into commissioning, examining the following questions:
- 'World-Class Commissioning': what does this initiative tell us about how effective commissioning by PCTs is?
- The rationale behind commissioning: has the purchaser/provider split been a success and is it needed?
- Commissioning and 'system reform': how does commissioning fit with practice-based commissioning 'contestability' and the quasi-market, and payment by results?
- Specialist commissioning
- Commissioning for the quality and safety of services.
On the Health Select Committee’s website you can read the terms of reference of the enquiry, the transcripts of the evidence sessions held on 22 October and 14 January, the lists of witnesses attending the next two sessions on 28 January and 4 February, and the volume of written evidence submitted by those who responded to the enquiry.
The Health Foundation submitted written evidence to the committee in September 2009.
Health Foundation response
For the past four years, we have been working with two of the leading centres in the UK to build our understanding of the role of value for money and efficiency in achieving the best quality healthcare. The evidence we submitted to the enquiry draws on the findings of their research.
Professor Gwyn Bevan and his team at the London School of Economics (LSE) are testing, in the NHS, a way to prioritise investment in health services which combines technical value for money analysis, epidemiology and stakeholder engagement. The award-winning approach provides an audit trail, empowers senior managers to justify difficult decisions and engages the local community who feel a sense of ownership of the decisions taken. Following its successful development at NHS Isle of Wight it is now being trialled with NHS Sheffield.
The Health Foundation recommends that the Department of Health promotes socio-technical approaches to support decision making and that these are more widely adopted by primary care trusts (PCTs) to enable the engagement of stakeholders, ensuring decisions are transparent, based on data and take account of the greatest potential impact on the health of the population.
Professor Peter Smith and his team at the University of York are developing a sound technical approach to measuring the efficiency of PCTs in its bid to discover whether value for money has been secured from the significant extra investment in the NHS since 1997. As more extensive and longer time series of data become available, this sort of analysis will yield increasingly useful insights into PCT performance and efficiency.
The Foundation recommends that strategic health authorities (SHAs) closely scrutinise which services are being commissioned through the interpretation of more detailed data sets than the national programme budgeting data.
Finally, there is a need for strong leadership on commissioning by the Department of Health following the departure of Mark Britnell. The Health Foundation recommends that this is given priority by the Department.
Conclusion
The Health Foundation thinks that the Department of Health should promote socio-technical approaches to support decision making and that these are more widely adopted by PCTs. Such robust decision making will become increasingly important as resources get tighter.
The results of comparative research show that overall PCTs are commissioning efficiently. We recommend that SHAs closely scrutinise which services are being commissioned through the interpretation of more detailed data sets than the national programme budgeting data. The availability of more extensive data over longer time series will enable more detailed analysis of PCT performance and efficiency.
The Health Foundation is supporting further research into value for money in the English health system. This includes research into the cost effectiveness of different components of treatment and care, using national data as the basis of the study.
The Health Foundation will also be supporting the further development and dissemination of the decision conferencing and multi-criteria decision analysis approach. We will work across geographical areas through application across SHAs and through formal and informal commissioning networks.
