2 - Understanding commissioning

Summary

Aim

The aim of this chapter is to provide an overview of the commissioning process for health and social care, drawing on the well- known commissioning cycle model. The chapter covers what commissioning is, how it is beneficial, and how it works in practice.

Commissioning explained

The following is a definition of health and social care commissioning that I like – it is provided by NHS England (2024g):

Commissioning is the continual process of planning, agreeing, and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.

The objective of commissioning for health and social care is, in simple terms, to ensure we have the right health and social care services, for the people who need it, when and where they need it. And these services must be safe, good quality, value for money, and sustainable. That's a quite a lot to get right, and that's why commissioning can be a complex and lengthy process.

Typically, the commissioning process goes through stages of strategic planning based on local needs, designing and procuring services, and monitoring and evaluating services to make sure the aims are being achieved. These stages are described in detail later in the chapter.

The benefits of commissioning

There are many benefits of commissioning. The obvious one is that health and social care services are provided for people who need them. But if that was the only objective, then we would not need commissioners – we could just hand over all responsibility to providers and leave them to get on and deliver services. However, this would not be fully effective, due a number of reasons, explored next.

Why we need commissioners

It would be easy to question why we need commissioners, especially as national health and social care policy is promoting collaboration across multiple partners with a wider share of responsibility than we have previously been used to. However, I would argue that as partner collaboration increases, unbiased and effective commissioners are more important than ever. Good commissioners, with a focus on improving whole population health and wellbeing, have a varied role, including the responsibilities outlined next.