Health Service Focus

All set for an integrated future at The Commissioning Show

NHE’s Luana Salles and Rosemary Collins look back at this year’s Commissioning Show, co-located with Health+Care, and reflect on how NHS organisations are preparing themselves for full-scale service collaboration.

As a practical example of the nationwide push for integration between health and social care, and for the first time ever, the Commissioning Show, for which NHE was the official media partner, was fully incorporated into this year’s Health+Care conference. 

The show, which took place on 29-30 June in London’s major exhibition centre ExCeL, brought together CCG leaders and representatives to engage in debate, showcase best practice and new commissioning models, and offer the latest insight into how major national changes – such as devolution, Vanguards and STPs – will affect commissioners. 

And, as a result of the show’s co-location with the wider conference, attendees were also able to join forces with key stakeholders and the 9,000-strong health and social care professional community in order to evaluate how true collaboration and shared practice between providers and commissioners can be achieved over the coming years. 

Amongst the rich programme on offer to CCGs during both days of the show were sessions centred on population healthcare, mental health commissioning, collaborative community practice re-design, the new assessment framework, and debates around the future of clinical commissioning and CCGs as a whole. 

A wide-reaching first day 

These were kicked off on the first day by Sir Muir Gray, co-founder of NHS Right Care, director of Better Value Healthcare and one of the most well-known senior health figures in the UK. 

Sir Muir discussed the importance of population healthcare in commissioning, a subject he covered in detail in the last edition of NHE. He wrote that, as a veteran of 22 structural reorganisations in the NHS, he has long lost faith in them – because he believes they try to focus linearly on a complex issue that can only be solved by looking at the whole population served. 

Leading a pre-lunch debate on mental health was Dr Caroline Dollery, who also appeared in the last edition of NHE in an exclusive interview discussing the future of specialised commissioning. She was joined at the show by two NHS England representatives: its former clinical director for mental health, Dr Geraldine Strathdee, and its deputy head of mental health and senior programme lead, Phoebe Robinson. 

Some attendees broke out for lunch while others stayed to watch a session on the introduction of biosimilars into health services, led by Dr Paul Cornes – who was later replaced by two healthcare heavyweights: NHSCC’s co-chair, Dr Graham Jackson, and NHS England’s new national director of commissioning operations, Matthew Swindells. 

Dr Jackson and Swindells sat down to debate what they believed were the five priorities, threats and opportunities (PTOs) for CCGs in this financial year. Outspoken as ever, the NHSCC co-chair said the PTOs – listed as engagement, health promotion, transformation, delivery and assurance – could be turned into an anagram that spells out ‘DEATH’: a “subliminal message about the future of CCGs which may or may not be true”, he joked. 

“Is death actually coming? If you’d asked me this last Wednesday [the day before the EU referendum], I would’ve said absolutely not, I was absolutely convinced CCGs were here for the Parliament. This time last week I thought that was going to be 2020; of course, we may have a general election before the end of this year, in which case nobody knows what’s going to happen. It doesn’t matter, but it’s really crucial that clinical commissioning is not lost,” he told the audience. 

Despite this introduction, his overall message was strikingly genuine rather than teasingly anxious about the future: while he acknowledged CCGs were “the current vehicle” which may not be there forever, Dr Jackson stressed that they bring a crucial locality focus based on population need and were generating fantastic outcomes for patients despite future uncertainties. 

He underlined the importance of public health and end-of-life services, of participating in STP planning, of educating people to use services responsibly, of sorting out “critical” health inequalities, and of engagement – especially from MPs, suggesting commissioners “get them on your side very, very early on”. As most other speakers, he also emphasised the need to transform services given that no more money is coming in. 

Clinical commissioning 

Ian Dodge, another NHS England national director, this time of commissioning strategy, returned to the theatre in the afternoon to discuss whether clinical commissioning was in terminal decline or rebirth. He was joined by Tower Hamlets CCG’s Jane Milligan and Croydon Health Services NHS Trust’s Michael Bell. 

During the conversation, Bell said the STP process raised “really serious questions” about the longer term viability of both CCGs and the commissioner/provider split. “What was a very good idea a decade, two decades ago, is possibly not the model that will see us moving forward in the future,” he argued. “I think, clearly, the future of CCGs as currently constituted is going to be part of that debate, and I certainly wouldn’t be putting bets on 200 or thereabouts CCGs existing in 18 months’ time.” 

But echoing Jackson’s views on clinical commissioning, he said that it was “really important” not to make clinical commissioning synonymous with CCGs, adding it was vital that new pathways are clinically-driven. “That’s the bit I think we really need to hold on to as we move forward into the future,” Bell said. “CCG structures that we have remarkably actually lasted four years, which is probably longer than any of us would’ve given them back in 2013. But actually, the principle behind clinical commissioning, which was around the engagement of clinicians, is really important.”

Regional spotlights 

The second day of the show brought a string of more niche debates to the clinical commissioning theatre, then chaired by NHSCC’s chief executive, Julie Wood – including a conversation about accountable care in East Sussex and the role of biosimilar medicines in the NHS. Regional leaders also came together in the morning to reveal more about three radical new models of scaling up general practice: Lakeside’s super-practice, as a result of the Vanguard programme; Our Health Partnership’s super-partnership; and Dudley CCG’s GP Chain.

After lunch, the chair of the National Association of Provider Organisations, Dr Phil Yates, took to the stage to talk more about the role of GP federations in transforming hospital care and delivering services at scale, as well as what CCGs could be doing to further support them. Dr Yates ran through how these federations co-exist with super-practices and can move towards alliance contracting rather than formal competition procurement. 

The cherry on top of the eventful day – which, in true spirit of integration, gave a platform not only to commissioners, but also to trust leaders and council directors – was NHS England’s head of CCG planning and assessment, Keziah Halliday. She advised attendees on how to get to grips with the new CCG assessment and improvement framework for 2016-17, published on 31 March – which she argued linked back with the Five Year Forward View and is not static, but will change over time. 

Amongst the major changes in the new framework are online ratings to show patients how their local services are performing across six areas – cancer, diabetes, mental health, dementia, learning disabilities and maternity care – which NHSCC’s Wood suggested may actually help sharpen up the work of some CCGs. 

CCGs as a part of the wider conversation 

But despite the jam-packed two-day programme hosted in the clinical commissioning theatre, the subject of CCGs, and where they sit within the wider healthcare agenda, permeated nearly all sessions hosted in the 11 other theatres spread throughout the exhibition centre, as well as the many conversations hosted in the gallery suites. 

This included debates on what must change to allow CCGs to survive and flourish in times of cash constraints, new integrated models and devolution deals; lessons to be learned from the major £800m UnitingCare deal collapse; and a look at regional examples of whole-system integration, such as of mental health reform in the West Midlands and the business case being developed in London to test the waters for an accountable care organisation. 

And in the afterhours of the first day, CCGs came together to attend the prestigious Healthcare Transformation Awards, hosted by NHSCC’s Dr Jackson and Wood in partnership with Health+Care. The awards, designed to recognise “all that’s good in commissioning and delivering for patients”, handed out seven accolades to CCGs from all parts of the country. These recognised excellence in the areas of medicines optimisation, reducing variation, clinical commissioning leadership, service redesign and integration, transforming primary care and innovation in diabetes. 

Integrating the Commissioning Show with Health+Care was intended to reflect a new focus on place-based commissioning rather than activity-based planning; a symbol of the collaborative approach that is taking over health footprints as providers and commissioners work towards the shared goal of transforming services effectively and sustainably. 

And that is exactly what the joined-up event delivered: for the first time, CCG leaders were able to share the stage of their national conference with all other health and care leaders, proving, in practice, that there can no longer be barriers to service transformation as the NHS begins to step into the future.

Healthcare Transformation Award winners 

• Commissioning For Outcomes And Reducing Variation: NHS Oxfordshire CCG for their Outcomes Based Contract for Adult Mental Health Services 
• Innovation In Service Redesign: Barnsley CCG for Rightcare Barnsley 
• Clinical Commissioning Leadership: Surrey Downs CCG 
• Innovation In Diabetes Care: Ipswich and East Suffolk CCG for their integrated Diabetes Pathway 
• Medicines Optimisation: Kernow CCG and Cornwall & Isles of Scilly LPC for their POPPIES project
• Successful Service Integration: Stockport CCG for their Enhanced End of Life Care Support programme 
• Transforming Commissioning Of Primary Care: Blackburn with Darwen CCG for its Quality and Outcomes Enhanced Services Transformation

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