What is Commissioning in Health and Social Care?

Commissioning is the process through which health and care services are monitored, purchased, and planned. Commissioning covers a variety of actions which include: the assessment of needs, prioritisation of needs and services, planning said services, the procurement of the necessary services, and monitoring quality service delivery. 

The concept of commissioning in health and social care was introduced to the NHS in the early 1900s, when reforms suggested the separation of service purchasing from delivery. Since then, commissioning has changed due to structural changes and the remit of organisations that commission care.  Commissioning now is less transactional and is more focused on partnerships.  

Who Does Commissioning? 

Commissioning for health and social care means the purchasing, planning and monitoring of services to meet the needs of the population. The arrangements currently in place come from the Health and Care Act 2022, which reshaped the responsibilities at national and local levels. 

Integrated Care Systems 

England has 42 Integrated Care Systems (ICSs), which are made up of: 

• Integrated Care Partnership (ICP): This is a statutory committee that brings together local government, NHS bodies, VCSE organisations and more to create integrated care strategies. This strategy will address public health, health, and social care needs, drawing upon local assessments and community input. 

• Integrated Care Board (ICBs): The statutory NHS commissioner, ICBs now hold most of the commissioning duties that were previously managed by CCGs, and some functions have delegated from the NHS. They allocate a majority of NHS budgets, produce 5-year delivery plans and are accountable to the NHS for performance and spend. While ICBs are able to delegate tasks to place-based partnerships, they retain accountability formally. 

The new formation of this commissioning structure emphasises collaboration. Local authorities will nominate at least 1 ICB board member, and providers will work under provider selection regimes to support partnership working. All NHS bodies also must meet the Triple Aim duty, to improve population health, enhance the quality of services, and use resources sustainably. 

Local Authorities 

Council commissions publicly funded adult social care services, from home care to residential care. They will also commission many other public health services, including sexual health services and addiction support, which are funded through ring-fenced government grants. Local authorities play a critical role in shaping the market and the continuity of care services under the Care Act. 

Place-Level Commissioning 

ICS policy promotes subsidiarity; decisions should be made as close to communities as it is possible to do so. Place-based partnerships bring together NH bodies, councils and local organisations to pool budgets and resources, aiming for “one place, one budget”. These partnerships operate, often, as committees of the ICB and will focus on integrated care, improving health outcomes and tackling inequalities. 

National Commissioning 

NHS England retains a large majority of responsibility for specialised services, such as for rare cancers, some public health programmes including immunisation and screening, and care for prisons and the armed forces. A majority of functions are conducted through regional teams, which also ensure ICB performance. Commissioning Support Units (CSUs) provide analytical, transformation and ICT support to ICSs and the NHS. CSUs still provide analytics and back-office support, but are being phased out as part of structural reforms. 

The Commissioning Cycle 

The commissioning cycle is a structural process for planning, reviewing and purchasing health and social care services. It ensures that resources meet the needs of the population to deliver quality outcomes. The cycle will typically follow four primary stages: 

• Analysis: Commissioners will gather evidence-based data, and will identify gaps, anticipate trends and assess risks. Doing so creates a clear picture of the needs of the community and the available assets, forming the foundation for effective strategies.  

• Planning: Use of insights from the analysis enables commissioners to design solutions, shape their local markets and plan the capacity of the workforce. This includes setting up priorities, success indicators and contingency plans that form the foundation of effective strategy. 

• Doing: Implementation involves developing markets, selecting providers, and securing contracts. Commissioners will manage risks, maintain consistent communications and oversee the fair procurement of processes. Close monitoring is required during launch to help make sure that the services meet the standards agreed to. 

• Reviewing: Regular evaluation checks whether or not outcomes have been achieved, while also assessing the impact on people’s lives and ensuring quality. Reviews can highlight best practice, value for money and areas in which improvement is required. This enables commissioners to adapt their strategies as needs change. 

Looking Ahead to Strategic Commissioning 

In social care, commissioning is moving beyond transactional purchasing towards strategic and needs-focused, outcome-based planning. Local authorities and ICBs work together to shape sustainable markets, address challenges for the workforces and embed preventative care into care pathways.  

Strategic commissioning means the co-production of solutions with people who draw upon care, making use of robust cost modelling and data to ensure fairness and transparency is consistent.  

Strategic commissioning also involves pooling budgets at a place-based level and tackling inequalities through integrated approaches. For social care commissioners, success depends upon the ability to balance affordability with safeguarding continuity and the building and maintenance of resilient provider relationships in the long term  

CareCubed can help you with strategic commissioning. CareCubed uses localised ‘real-world’ data to provide a benchmark that can inform the cost of care for all ages across the UK’s Health and Social Care landscape. The tool supports transparency in discussions and helps to reinforce positive outcomes through informed negotiations. 

Find out more about how adding CareCubed to your commissioning roster will help you to optimise your processes by contacting us today.