Pioneers of reform: realising a new vision of ICB strategic commissioning
Six shifts to achieving strategic commissioning
- Reactive to proactive – pushing beyond reactive service management to keeping people healthy by better understanding and then proactively addressing populations’ health needs. This requires ICBs to improve quantitative data analysis capability by harnessing digital technology and to utilise local partners’ and communities’ qualitative insights to improve service design and understand need.
- Downstream to upstream – shifting a greater share of resources from downstream acute services to anticipatory interventions in the community and better support for longer-term and complex conditions. This requires changes to pathways’ design, Integrated Neighbourhood Teams to help deliver anticipatory interventions, and new contractual payment mechanisms to shift resources.
- Competition to collaboration – replacing organisational silos with genuine partnerships across local government, the VCSE sector and the breadth of the NHS. Care should be wrapped around patients, rather than passing them between different providers. This requires collective resource management, shared accountability and an integrated workforce.
- Transactional to transformational – moving beyond just managing contracts for episodes of care to transforming services in partnership with providers and the public. Commissioning whole pathways for population cohorts should become the norm. This requires robust change management capabilities and joint decision-making through effective governance.
- Cost to value – achieving return on investments, not just managing costs. This requires moving from just activity-based contracts to population outcome measures and multi-year planning.
- Compliance to leadership – empowering local leaders to lead, innovate and listen, rather than just look upwards for instruction. This requires fewer national targets (focused on what, not how), new system leadership capabilities and learning networks which help take the best of the NHS to the rest of the NHS.