Joint commissioning for integrated care
What is joint commissioning?
The shaping, influence and support given to the local health and care sector by the commissioning system, which includes providers of care, local people and communities.
Local Government Association 2022
Traditional notions of commissioning are no longer guiding their way of working. Instead, these areas are focusing on new ideas around how commissioners can add value to local systems: bringing stakeholders together to make decisions; fostering close operational partnership between commissioners and providers; simplifying financial arrangements; and offering improvement support to providers.
King's Fund 2020
Commissioning is the process through which public bodies assess the current and future needs of their local populations, make decisions about which needs will be met and which ones will not be a priority, identify the most effective approaches to address these needs, and then invest in the associated services through contracting with appropriate providers. Commissioning is a cyclical activity in which monitoring and evaluation data from service provision is used to assess impacts and review service models to review the quality of providers and identify opportunities to improve the overall model. People with lived experience of such needs and professionals with practice insights should be actively engaged throughout the commissioning process.
Joint commissioning refers to arrangements in which public bodies look to undertake this planning and implementation cycle collaboratively – this could be for a whole population or in relation to people with particular needs (such as those with a complex disability) or facing common challenges (such as being homeless). This can involve the organisations ‘pooling’ their related budgets so that the funding available to meet these needs is shared or ‘aligning’ budgets so that the funding is more transparent but is still held by the individual organisation. Increasingly, commissioners are looking for additional public or social value from their investments alongside the delivery of the core service specification.
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Video transcript Open
Joint commissioning for integrated care is when local commissioners are collaborating to bring together health and social care services, and where they share the responsibility for planning and delivering better care outcomes.
This can involve organisations working in partnership at all stages of the commissioning process, from the assessment of needs, to the planning and procuring of services, and the monitoring of outcomes.
The activities of joint commissioning can be both strategic and tactical.
They involve deciding how local services can best be delivered to meet the needs of local people, who should provide the services and where, how the services will be paid for, and what outcomes will be expected.
Overall, joint commissioning aims to:
- Deliver personalised services, by involving people in their own care and care decisions;
- Transform people’s experiences from fragmented care to coordinated care through service re-design and improved care pathways;
- Improve care outcomes by expanding prevention and early intervention services, especially at home or in the community; and
- To produce efficiencies, by reducing waste and service duplication.
Emerging evidence from case studies suggests a number of factors are associated with successful joint commissioning.
These include:
- System leadership: active partnerships of commissioners and providers, with a shared vision for integrated care and good working relationships
- A single joint commissioning team with clearly articulated responsibilities
- The pooling or alignment of local health and social care budgets
- Processes for joint commissioning: including dialogue with local providers, involvement of clinical professionals and service users, as well as asset-based approaches to draw on other community resources, such as the voluntary sector.
Joint commissioning is a key enabler of integrated care.
For commissioners, strong working relationships and taking a strategic, whole system perspective are essential to doing joint commissioning well.
Explore joint commissioning
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Guidance Open
- Healthy foundations: integrating housing as part of the mental health pathway (Mental Health Network 2022)
- Building the right support: an analysis of funding flows (Department of Health and Social Care 2022)
- Palliative and end of life care: statutory guidance for Integrated Care Boards (ICBs) (NHS England 2022)
- Integrated health and social care for people experiencing homelessness (National Institute for Health and Care Excellence 2022)
- Strategic collaborative planning and commissioning: a guide (Local Government Association 2022)
- 2022 to 2023 Better Care Fund policy framework (Department of Health and Social Care 2022)
- Top tips for implementing a collaborative commissioning approach to Home First (Local Government Association 2021)
- The future of commissioning for social care (Social Care Institute for Excellence 2020)
- Commissioning for a better future: useful resources. Social Care Innovation Network, Phase II (Social Care Innovation Network 2020)
- Commissioning out of hospital care services to reduce delays: discussion paper (Institute of Public Care 2020)
- How to bring budgets together to develop coordinated care provision (Better Care Fund Support Team 2019)
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Practice examples Open
- Evaluation of the local care approach: summary of key findings (Cordis Bright 2021)
- Thinking differently about commissioning: learning from new approaches to local planning (King's Fund 2020)
- Using financial reform to enable change in Bradford (NHS Confederation 2020)
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Measuring success Open
- Outcomes-based commissioning: a framework for local decision-making (NHS Midlands and Lancashire Commissioning Support Unit 2020)
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Research Open
- Defining pooled 'place-based' budgets for health and social care: a scoping review (International Journal of Integrated Care 2022)
- Aligning healthcare, public health and social services: a scoping review of the role of purpose, governance, finance and data (Health and Social Care in the Community 2021)
- Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context (International Journal of Integrated Care 2022)
- Home-care providers as collaborators in commissioning arrangements for older people (Health and Social Care in the Community 2020)
- Challenges in integrating health and social care: the Better Care Fund in England (Journal of Health Services Research and Policy 2019) (behind paywall)
- Does pooling health and social care budgets reduce hospital use and lower costs? (Social Science and Medicine 2019)
- Evaluating the design and implementation of the whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link (Health Services Research 2019)
- Co-commissioning of public services and outcomes in the UK: bringing co-production into the strategic commissioning cycle (Public Money and Management 2019)
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Latest evidence Open
These are the latest resources from Social Care Online, the UK’s largest database of care knowledge and research.
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Webinar: The next practical steps for Integrated Care Systems
- Social Care Institute for Excellence, 2021 -
Webinar: The benefits, capabilities and governance of Provider Collaboratives
- Social Care Institute for Excellence, 2021 -
Webinar: Effective Clinical and Care Professional Leadership Guidance
- Social Care Institute for Excellence, 2021 -
Webinar: Thriving places - Delivering services with and for our communities
- Social Care Institute for Excellence, 2021 -
Webinar: Quality engagement plans
- Social Care Institute for Excellence, 2021 -
Webinar recording: Finance - Delivering better value through system collaboration
- Social Care Institute for Excellence, 2022 -
Approaches to reducing health inequalities to tackle elective recovery
- Social Care Institute for Excellence, 2022 -
Webinar: Voluntary sector partnerships and Integrated Care Systems
- Social Care Institute for Excellence, 2021 -
Integrated care systems, digital and data
- Social Care Institute for Excellence, 2022 -
Multidisciplinary teams: Integrating care in places and neighbourhoods
- Social Care Institute for Excellence, 2022
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Webinar: The next practical steps for Integrated Care Systems
Why does joint commissioning matter for integrated care?
Commissioning collaboratively as a system enables benefits to be realised for the whole system but this needs to deliver for all in terms of improved outcomes and experiences for people, cost avoidance, cashable savings, and better access to services.
Local Government Association 2021
Funders investing in services which are not sufficiently joined up through their basic design and care processes has been a common reason why individuals do not experience integrated care. In the past contracts generally held services accountable for successfully delivering only their aspect of care with restrictive rules about how flexibly funding could be used. Integrated care is facilitated by commissioners seeking to design and invest in pathways which are person-centred and then hold organisations jointly accountable for the overall experience of individuals and families. Such contracts provide a more supportive context for professionals and services to have the opportunity and incentives to collaborate.
Joint commissioning provides a process through which people with lived experience, communities, and professionals can be actively engaged in setting the overall priorities for an area and designing pathways which reflect local needs and opportunities. This includes the development of performance management frameworks which consider not only activity and quality of individual services but also the extent to which people experience more integrated care based on what local people say matters most to them. Joint commissioning looks for opportunities to use the financial and workforce resources available to support local populations in the most effective means possible through ensuring that service models are well co-ordinated and provide continuity of support.
What does joint commissioning need to succeed?
The key message from citizens is that whilst safety is important, approaches must be based on human rights, equality, and justice. Change needs to be about independent living, the right to an 'ordinary' life, equity of outcomes and choice and control for all people. The voice and experience of citizens must be central and so commissioning for the future must be shaped by their specific concerns and hopes.
Social Care Institute for Excellence 2021
Procurement processes are being simplified wherever possible. Areas are using competitive procurement as a tool of last resort. At the same time, financial arrangements between commissioners and acute providers are being simplified – through block or aligned incentive contracts – to tackle incentives that create tension within the system.
King's Fund 2020
Joint commissioning needs to be based on a common vision for an area which has been developed with local people and communities, and has involved providers and professionals. This vision and its underpinning values can then be translated into shared outcomes which are the basis for agreeing new service models and specifications. Collaboration and co-production should be embedded throughout joint commissioning, including within accountability processes, tendering of contracts and investments, and in monitoring and review. Transparency in what resource is available and how this is used, and sharing of risks and successes, are important enablers to building and maintaining trust between funding organisations and with providers.
Alongside developing the overall design and pathways, commissioners must also ensure that there is sufficient capacity and relevant skills within health and social care staff to deliver these successfully. This involves them liaising closely with local providers to understand their workforce issues and with training organisations to ensure that any skill gaps can be met. In relation to allocating contracts and thereby funding to providers, joint commissioners consider more collaborative approaches which bring together different providers alongside the traditional procurement processes based on individual competition. Micro-commissioning, i.e. of individual support packages is often completed by frontline practitioners and related support teams and it is therefore important for such staff to be encouraged and skilled to commissioning such packages collaboratively.
Joint commissioning is a highly skilled and complex practice in which commissioners are enablers of transformational change through bringing together different stakeholders in a system to achieve more integrated care. There is though no one route through which people move into commissioning roles and it is important therefore for relevant training, peer support, and developmental reviews to be provided for commissioners. Ensuring that commissioners from different organisations are encouraged to collaborate through regular meetings, shared offices and/or joint training and development will encourage new ways of working together.
What is the evidence for outcomes and impact?
Our findings also highlighted the need to strengthen the evaluation culture and capacity, and ensure that evaluations are effectively embedded in the local commissioning process. Robust evaluations, particularly of integrated care programmes, have proved to be not only beneficial but also highly valued by commissioners and providers.
International Journal of Integrated Care 2022
Securing significant local change to health and social care services (either separately or together) will always be difficult and require sustained and detailed attention on many fronts. Competent commissioning may help ensure appropriate monitoring and review of current services, the design and planning of necessary changes, and setting of priorities for funding.
Health Services Research 2019
Much of the research to date is more definitive of the context and processes which support joint commissioning rather than the impacts which can be achieved. Being clear on what outcomes are expected and maintaining commissioner oversight of the implementation processes relating to models of care can help to ensure that new ways of working become embedded in local practices. Local case studies suggest that with a shared strategic vision, a culture of openness and collaboration, and good analytical support it is possible for joint commissioning of new integrated models to improve experience and quality of care, and to make aspects of the health and social care system such as hospital discharge and support for people in care homes more effective. The evidence is mixed on the ability of joint commissioning and in particular pooled budgets to impact on key metrics such as admission of people to hospital, with some studies suggesting that such activity can increase in the short term due to unmet needs being identified.