Abstract
Background: Over the years, several reforms and initiatives have been introduced in England to improve the local healthcare commissioning process in the NHS. Recently, on April 28, 2022, the Health and Care Bill received Royal Assent and became an Act of the UK Parliament. The Act abolished Clinical Commissioning Groups (CCGs) and replaced them with forty-two Integrated Care Systems (ICSs), each of which has an Integrated Care Board (ICB) that assumed the commissioning functions previously held by the CCGs. As a pioneering effort, with a particular focus on mental health services, this paper studies how commissioning of third-party service providers in Buckinghamshire, Oxfordshire & West Berkshire (BOB) and Cambridgeshire and Peterborough (CPICS) ICBs operate and develops an evaluation framework to assess their value of money. These two ICBs were deliberately selected as they are at different points in their strategic healthcare commissioning journeys. This comparison serves as an effective example of the distinct approaches and strategies ICBs employ at different stages of their commissioning journeys and provides valuable insights for policymakers and health administrators seeking to improve mental health service delivery.
Methods: The study employs a case study approach, focusing on BOB and CPICS ICBs to gain an in-depth understanding of the commissioning of third-party mental health service providers. A mixed-methods approach will be used, combining quantitative data analysis with qualitative insights. Quantitative data on patient outcomes of third-party service providers will be collected from local charities and councils to calculate value for money. Qualitative data will be gathered through semi-structured interviews with key stakeholders, including ICB leaders and mental health service providers.
Results: Given the local nuances, ICBs are ought to have some flexibility in how they commission health service providers but are bound to follow national guidelines including NHS Long Term Plan, National Institute for Health and Care Excellence (NICE) and Mental Health Investment Standard (MHIS) guidelines, and legal requirements to ensure services are equitable, integrated, and effective. They are also expected to be guided by local health needs assessments and the quality and capacity of available third-party service providers. This study, however, highlights the lack of structured framework for local healthcare commissioning within the context of integrated care. Decision-making and priority-setting appears to lack methodological rigor, often shaped by social value judgements and political tensions. This underscores the need for a framework of commissioning that adheres to a rigid, orderly logic to enhance efficiency, transparency, and accountability.
Key Words: commissioning; integrated care; new models of care; policy impact; England