Future insights
During the course of our we work we keen to develop key insights for the future in a particular policy area, and to share these more widely. One of the aims of this web site is therefore to make these insights available to the wider health and social care community.
We would also welcome articles submitted by you, if you feel that other people would benefit from insights you have gained as a result of systems thinking and whole system working. If you wish to discuss this further, please contact Peter Lacey at peter.lacey@thewholesystem.co.uk.
We anticipate adding more items over time, but for now we hope that the following articles will be of interest:
Commissioning
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‘Exercise imagination and take risks’ was the challenge heralded by the Commission for Social Care Inspection in its document ‘Relentless Commissioning’ (2006). This suggests the need to rethink what and how we commission – a message as relevant to health as it is to local authority commissioners.
National expectations of the changing role of the Local Authority as ‘place shaper’ and strategic commissioner of services for the whole of its population, and the radical shifts that are taking place to achieve a ‘double devolution’ from centralist ‘purchasing and contracting’ mechanisms to the influence and control of commissioning decisions at a locality and individual level through Practice Based Commissioning and Individual Budgets are driving change at an ever increasing pace.
The role and activities of Local Authorities and PCTs in undertaking their commissioning responsibilities will therefore change radically over the coming years. This requires them to be ready in terms of organisational competencies and the understanding they develop about the needs of local populations.
Working with both health and social care organisations the challenge of developing the commissioning agenda is clearly very high on people’s agenda. The desire to undertake commissioning in an increasingly joint way is not however, simply about doing what we’ve done before together! There is a need to radically re-think and re-construct the commissioning language and organisational fitness for purpose.
Whilst working with clients it has become clear that an approach that clearly places form after function will make most progress. Starting by thinking about aligning systems, processes and people in new organisational structures without first clearly identifying the functions undertaken in a modern commissioning organisation will not made the necessary headway.
WSP have assisted organisations in identifying and populating these key functions as well as identifying organisational competencies necessary to fulfil them. Strategic commissioning in the new world also depends on new ways of developing and using ‘intelligence’, an approach ably assisted by a range of analytical and systems modelling projects demonstrating the benefit of aligning the new commissioning agenda with an intelligent commissioner approach.
The future will be one in which:
- There are challenges of ‘individualisation’ alongside the need to root commissioning decisions in local communities and neighbourhoods where appropriate;
- There is a clear premium on the use of ‘intelligence’ to inform commissioning decisions – taking a major step forward and capitalising, for example, on improved needs analysis and impact modelling but ultimately dependant on the skills and insight of commissioners developed as a team in the context of whole system.
Future insights that will challenge any organisation seeking to improve its commissioning would therefore be:
- How to retain the strategic commissioning drive whilst delegating other functions;
- How to reflect and support the localisation agenda driven by practice based commissioning on the one hand and direct payments/individualised budgets on the other;
- How to develop and enhance its intelligence functions.
WSP are currently working with Wigan Council and Ashton, Leigh and Wigan PCT in a way that seeks to meet these future challenges in an innovative and locally sensitive manner. Equally the work with North East Lincolnshire Council and PCT in developing a Care Trust has at its heart a response to these future challenges. Other projects seek to assist organisations in developing their own commissioning functions, competencies and strengths.