![Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context Cover](/_next/image?url=https%3A%2F%2Fsciendo-parsed.s3.eu-central-1.amazonaws.com%2Fubiquity%2F68406ce7da18af458e768404%2Fcover-image.jpg&w=3840&q=75)
Figure 1
Former commissioning decision-context & cash flow.
Percentages (%) in the figure refer to proportion of the total NHS England budget.
(a) Some have other joint commissioning structures, such as Health, Education and Social Care, Social Care boards.
(b) Since April 2019, NHS England and NHS Improvement work together as a single organisation [33].
(c) NICE, the NIHR and the Academic Health Science Networks could also offer some technical support to CCGs and providers.
Source: National Audit Office (2018) [34] ; Health and Care Bill (2021) [7]; Health and Social Care Act (2012) [15]; King’s Fund (2020, 2021) [16, 28]; Tikkanen et al (2020) [35]; NHS England & NHS Improvement (2021) [19].
Figure 2
Commissioning decision-context after the abolishment of CCGs.
Percentages (%) in the figure refer to the proportion of the NHS England budget.
(a) Integrated Care Partnership members must include representatives from the local authorities and from the Integrated Care Boards. Beyond this, members may be from other organisations, including housing and education providers [38].
(b) Financial allocations to each Integrated Care Board will also include resources for a range of functions currently held by NHS England and NHS Improvement (e.g. other primary care budgets) [38].
(c) In some ICSs there might be more than one Health and Wellbeing Board. The Health and Care Bill maintains current arrangements for these boards, but does not define the relationship between them and the ICS partnerships [7, 32].
(d) With the 2022 Health and Care Act, Integrated Care Boards are now allowed to “take on delegated responsibility, where appropriate, for commissioning specialised services but within a framework of continued national accountability, national standards, national service specifications and national clinical policies determining equal access to the latest treatments and technologies” [17, p2].
Source: The Health and Care Bill (2021) [7], The Health and Care Act (2022) [5], and NHS England guidelines (2021–22) [36, 41].
Figure 3
Bottom-up investment decision process within a CCG.
* When explaining this process, some participants referred to the ICS while others to the CCG role.
Source: Based on interviews conducted between April and July 2021.
Table 1
Ideal criteria for prioritization of interventions.
| CRITERIA | # PARTICIPANTS |
|---|---|
| Health outcomes e.g. ‘mortality and morbidity assessments’(No.5) ‘QALYs’(No.17), ‘HbA1c’ (No.2) | 24 |
| Quality of care e.g. ‘Best possible health and care experience’ (No. 1), ‘better access, like reducing waiting times’ (No. 16); ‘‘getting the pathway right’(No.22) | 18 |
| Cost/budget considerations e.g. ‘financial implications of the programmes’(No.14); ‘financial burden of the condition’(No.2); ‘saving money’(No.15) | 12 |
| Efficiency e.g. ‘value for money’(No.12); ‘cost effectiveness of that service’(No.25) | 7 |
| Equity e.g. ‘how well resources are distributed to different groups in the population’ (No.10); ‘reduce unwarranted variation’(No.3); ‘equality’(No.24) | 6 |
| Compliance to policies/priorities/guidance e.g. ‘national directives’ (No.20), ‘integration with social care services’ (No.1); | 5 |
| Size of the population e.g. ‘make a difference to a large amount of people’(No.15); ‘high prevalence conditions’ (No.12) | 3 |
| Others e.g. ‘meeting a completely unmet need’(No.18); ‘whole system benefit’(No.26); ‘focuses more on prevention’(No.8) |
[i] Note: In total, the 26 participants responded to this question.