Health Service Focus

Breaking down silos at the Commissioning Show

NHE’s Luana Salles and Josh Mines report from this year’s Commissioning Show, co-located with Health+Care, which served to highlight that isolated working is now a thing of the past.

Clinical commissioning, like the rest of the health and care landscape, is radically changing. Rather than focusing on institutions, CCGs are increasingly teaming up with other organisations to design system-wide support targeted at whole populations. With STPs and accountable care systems beginning to take root, healthcare delivery will be much more geared towards geographical footprints that engulf multiple CCGs, trusts and local authorities. As such, commissioners need to revolutionise their approach to outcomes-focused healthcare in order to thrive. 

This year’s Commissioning Show, situated once again at the heart of the major Health+Care Show in London’s ExCeL on 28-29 June, brought together thousands of health representatives to discuss just how this revolution will happen. Delivered in partnership with NHS Clinical Commissioners (NHSCC), the Commissioning Show analysed the big challenges that face the NHS until 2020 and beyond. 

The show was opened by NHSCC co-chair Dr Graham Jackson, who argued there will no longer be a single model of clinical commissioning going forward. Rather, all models will be locally-driven and regionally defined, demonstrating commissioners’ unique value in leading the specific communities they serve; CCGs will therefore become “hubs for strategic, whole-system and place-based commissioning”. 

Dr Jackson’s keynote was followed by sessions whose wide-ranging themes served to prove just how indispensable CCGs will be to the changing landscape of the NHS. NHS England’s New Care Models programme director, Louise Watson, sat with STP and CCG leads to discuss how new services are seeking to transform community care (read more on page 37); Jo Webster, Wakefield local STP lead, and Helen Hirst, Bradford District & Craven local STP lead, looked at how commissioners are responding to local needs across West Yorkshire and Harrogate; the two were then joined by the CCO of NHS Northumberland CCG, Dr Alastair Blair, to debate accountable care organisations; and James Sanderson, director of personalisation and choice at NHS England, closed the day off with a lively discussion on the importance of patient empowerment and responsive and flexible services. 

The Commissioning Show’s second day was kick-started with a session on patient engagement as the “critical source” of commissioning intelligence. Dr Al Mulley of the Dartmouth Institute, part of the prestigious Dartmouth College, ran through how shared decision-making and patient interaction is a “rich source of information for better commissioning”. 

The rest of the day was enriched with talks and panel sessions on the RightCare programme, which was recently celebrated as one of the major avenues through which STPs are tackling bed shortages; the ongoing revolution shaking the grounds of care homes, with case studies from projects taking place in Wakefield and Gateshead; and the need to tackle inequalities across maternal and infant health, with a particular look at the early wins from the Cheshire and Merseyside Women’s and Children’s Services vanguard. 

Tearing down the walls 

As was the case last year, the Commissioning Show was co-located with the broader Health+Care Show – but this does not mean debates on CCGs and the interface between commissioners and providers were restricted to the Clinical Commissioning Theatre. 

In his keynote speech during the first day of Health+Care, Matthew Swindells, national director for operations and information at NHS England, told delegates that there is still a significant number of STPs “squabbling over last year’s invoices” and trying to decide whether the hospital or the CCG should foot the bill for a missed operation. Instead of working in silos, the NHS needs to “move away from protecting institutionalised interests and into protecting the needs of the public”, said Swindells. 

“We have set the exam question for the best part of two decades as: how do you optimise your institution? And now we’re saying the exam question is: how do I optimise for my population, and how do I therefore park egos at the door and recognise each other’s problems in order to be able to solve the really hard problems that we can’t solve on our own?” he asked attendees.

In his address, Stephen Dorrell, chair of NHS Confederation, claimed that some STPs are standing out from the rest largely due to the pre-existing relationships on which they can build – both within the “traditional silos” of the NHS, such as the acute, community and primary sectors, but also between commissioners, providers and local government. 

During the second day of the conference, Sir David Behan, chief executive of the CQC, revealed that commissioning will also come to play a big role in his organisation’s inspections under its new five-year strategy. While the inspectorate only used to look at providers, it will use Section 48 powers from the Health and Social Care Act to assess the way commissioning operates across localities. This is part of a larger plan to move away from institutions-based regulation and towards more targeted, place-based inspections that consider how the whole system is working together. At the time of publication, Sir David was awaiting formal letters from the health and communities secretaries giving him the go-ahead to take that work forward. 

In this same session, Wendy Thomson, managing director of Norfolk County Council and lead for the Norfolk and Waveney STP, said her local authority was doing much the same thing: putting an emphasis on the whole patient pathway. “You don’t have to discharge someone from hospital if you didn’t admit them in the first place,” she said during the panel debate. “We should be looking at all the ways we can support people at home, in their community. We are working with our partners around promoting independence. There’s huge amounts in our community that can be supported to look after people at home before they appear at the door of the hospital.” 

But Dr Phil Moore, chair of the NHSCC Mental Health Commissioners Network and deputy chair (clinical) at Kingston CCG, challenged her definition of ‘patient journey’, arguing that patient care isn’t linear. “What happens is patients are looked after by a matrix of services at various times in their life journey, rather than passing from one to the other,” he pointed out. “We have to change our mentality in the way we approach this to much more of a matrix model than a journey model.” 

Delegates at the show also heard from health minister Philip Dunne for the first time since his reappointment. While dodging any substantial announcements ahead of the chancellor’s Autumn Budget, he did confirm that the government remains focused on the four pillars of performance, financial sustainability, workforce and patient safety, and praised the health system for ending the last financial year in a much better economic position (more on page 30). However, Dunne did not forget to reiterate that the coming months and years will be challenging nonetheless, and touted STPs as the “best game in town” to deliver the kind of transformation needed to stay afloat.

The rest of the two days featured enthusiastic keynotes and debates from the likes of Lord Carter of Coles, NHS England mental health director Claire Murdoch and her predecessor Dr Geraldine Strathdee, NHS Providers boss Chris Hopson and Jacob West, national care model lead – Acute Care Collaboration and Primary and Acute Care Systems, amongst many other high-profile heavyweights. 

Despite the event’s thematic splits, with its 13 theatres signposted for specific conversations, it was clear from the constant flow of delegates from one area of the show to the next – and the overlapping themes in each of the debates, regardless of whether they were chaired by providers, commissioners or councillors – that the imagined line demarcating artificial silos that exist in the NHS is now but a needle in a haystack. Health+Care has made it clear that, as we move towards uncharted territory and unfamiliar models of care, well, at least we’ll be doing it together.

FOR MORE INFORMATION

W: www.healthpluscare.co.uk