Can we afford to exclude the voluntary sector from commissioning support?

The official 'market' for commissioning support has been described as the biggest new industry in the UK, worth an estimated £1 billion. With this amount of NHS money at stake, it is essential that this market drives excellent patient outcomes and provides value for money.

While some clinical commissioning groups (CCGs) are developing in-house commissioning support functions, some are going to the private and voluntary sector for support and over £500 million is going to commissioning support units (CSUs).

However, the future shape of this market is far from certain. A column in the Financial Times last week revealed that discussions are taking place between NHS England and private equity companies around joint ventures with CSUs, and the suggestion of a wholesale takeover was mooted.

My question is: where is the voluntary sector in this discussion?

I don’t think the voluntary sector will ever be able or want to provide ‘end to end’ commissioning support, however the NHS can’t afford to miss out on the value that we bring

A report published today by the Nuffield Trust, in partnership with NHS England, Macmillan Cancer Support, ACEVO (Association of Chief Executives of Voluntary Organisations) and Neurological Commissioning Support, shows that while the voluntary sector brings real value to this market, there are some challenges to increasing its participation.

Voluntary organisations need to demonstrate their impact more clearly and CCGs and CSUs should be more open to working with the sector. The report includes practical steps that each of these groups can take to strengthen their relationships with one another.

Macmillan, like many other voluntary sector organisations, has been supporting commissioners for many years. The sector is usually assumed to only provide advice on user engagement or experience.

While representing and facilitating the patient voice in the system is absolutely critical, we – and other organisations – also offer a much broader range of services, some of which lead to large-scale, transformational service redesign. This is informed by evidence-based best practice, condition specific expertise and data, intelligence and insight.

An example is Macmillan’s current work in one of the newly selected pioneer sites in Staffordshire. The project involves five CCGs, two local authorities and the local public health team from Public Health England and will be developing a prime provider model for cancer and end of life services to redesign the services and provide integrated delivery that is focused on patient outcomes.

I don’t think the voluntary sector will ever be able or want to provide ‘end to end’ commissioning support, however the NHS can’t afford to miss out on the value that we bring. We know there are challenges, and these are discussed in the Nuffield Trust’s report.

The new NHS architecture is confusing for many, and there is a great deal of local variation between CCGs and CSUs. And just like these organisations, the voluntary sector is a diverse bunch.

We are small and large; national, local or both; and some providers, some funders. We know that engaging with numerous voluntary sector organisations can be overwhelming to CCGs who are already struggling for headspace. But these challenges are surmountable.

The value and expertise of the voluntary sector must be used to full effect in the new system, and we all have a responsibility for making this happen. This includes NHS England ensuring that their commissioning strategy promotes and does not limit voluntary sector involvement.

I believe that commissioners can only get the essentials right – commissioning which drives positive patient outcomes and experience, at value for money – if the voluntary sector is part of the process.

Duleep Allirajah is Head of Policy at Macmillan Cancer Support. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.