PM Healthcare - Summer 2022

14 PM Healthcare Journal • Improving health and tackling inequalities • Funding these priorities to provide good value as well as health outcomes 2. Service transformation, via provider organisations and others, achieved through partnerships and collaboration at place level 3. Better analysis of local conditions to understand how to use resources to improve outcomes, rather than managing contract performance between organisations Commissioning at scale, or not Many commissioning functions are now unified within ICS boundaries, which is the preferred model. However, we also have place-based partnerships backed by devolved funding and other initiatives that will require flexibility in local areas to work effectively. ”The decision will need to be made as to whether individual services are best delivered at the system level or at place – a balance between localism and the efficiencies of working at scale.” How commissioners choose to work will therefore depend upon a range of factors, often depending upon the size of the ICS, how effectively the place-level is working and also the role of the local authority. As we might imagine, there will be considerable variety in commissioning arrangement as ICSs get up to speed (which is, of course, the point). Support services And not forgetting, behind ICSs we have commissioning support units (CSUs), providing support services (a kind of back-office function). It is expected that CSUs will continue their work with ICSs. Specialised commissioning Specialised services have been commissioned centrally by NHS England since 2013. Now, ICSs will take over the majority of this work. (These are services for rare conditions that may be complex, infrequent and expensive to treat). ICSs are expected to be able to provide some system-level nuance to specialised commissioning, redesigning system level services and improving the development and provision of specialised services with linked care pathways. This is quite a departure from the previous rationale, where it was thought that only at the national level could specialised commissioning work effectively. Four principles have been established to support the devolution of specialised services, summarised below: 1. All specialised services will continue to be subject to NHS England-led national service specifications and evidence-based policies 2. Commissioning and decision-making for specialised services will be led at the appropriate population level – ICS, multi-ICS or national – depending upon the service provided 3. Clinical networks and provider collaborations will drive quality improvement, service change and transformation across specialised services 4. Funding of specialised services will shift from provider-based allocations to population-based budgets, supporting the connection of services back to ‘place’