Commissioning integrated care in a liberated NHS

This report explores how commissioners can play a key role in developing more joined-up and efficient services.

Nuffield Trust Director of Policy Dr Judith Smith on the findings of the research study which explored the role of commissioners in promoting integrated care

Policy-makers, clinicians and managers have been increasingly interested in finding ways of achieving closer integration of care within the NHS, which would reduce inefficiencies and fragmentation and so improve quality of care for patients and reduce costs.

Much of the research and initiatives to date have focused on providers of care working together, in particular health and social care integration, and primary and secondary care integration. NHS reform plans have highlighted the key role of commissioners in bringing about improvements in the performance of the NHS, in particular through the development of clinical commissioning groups and the NHS Commissioning Board.

Commissioning integrated care in a liberated NHS seeks to shift the focus of analysis of integrated care to the role of commissioners – the planners and purchasers of NHS services – in promoting integration.

PCT commissioners have struggled to put providers sufficiently at risk in relation to developing better and more efficient care

The research includes a national survey of primary care trusts and strategic health authorities, approaches to individuals at the Department of Health, NHS Confederation and NHS Alliance, a literature review of international payment approaches in health, and the establishment of an advisory group of managers and clinicians with an interest in integrated care. It sought to identify examples of commissioners driving integrated care, for example by commissioning care pathways rather than paying for episodes of care; promoting integration by working with providers; and developing new forms of payment.

The research, the findings of which are set out in the research report, has uncovered a number of barriers to more joined-up and efficient services. Both the report and accompanying research summary make recommendations for how the coalition Government could address these as part of the next stage of NHS reform.

This is the second in a series of reports that Nuffield Trust is publishing as part of its research project: The quest for efficiency in the English NHS, a comprehensive programme of work that aims to help the NHS respond to the financial challenges ahead by examining how health services can improve productivity and deliver more for less.

Commissioning integrated care in a liberated NHS will be of interest to policy-makers, commissioners, managers and academics with an interest in commissioning and its role in developing integrated care.

Suggested citation

Ham C, Smith J and Eastmure E (2011) Commissioning integrated care in a liberated NHS. Research report. Nuffield Trust.