Pioneers of reform: realising a new vision of ICB strategic commissioning

• Commissioning is how integrated care boards (ICBs) and their partners ensure £164 billion of public money (19 per cent of public sector spending in England) is best used to improve health. Although commissioning is further away from patients’ eyes than provision of care, it determines what services are delivered, by whom, for whom, where and why. 
  
  
• The Secretary of State has tasked ICBs to be ‘pioneers of reform’ through ‘strategic commissioning’, driving the three shifts for health services: from hospital to community, from illness to prevention and from analogue to digital. This is to help the NHS better manage rising demand for services without consuming an ever-growing share of national wealth. 
  
  
• Current commissioning arrangements can often involve transactional contracting with individual providers. For ICBs and their partners to pioneer this reform, commissioning needs to evolve. This is essential to putting the NHS on a sustainable financial and service footing. 
  
  
• This report, commissioned by NHS England and developed independently by the NHS Confederation, is based on engagement with ICS leaders and system partners. It seeks further understanding of what strategic commissioning is and proposes six shifts in the approach to commissioning that ICSs need to make to drive public service reform and ensure a sustainable health and care system for the future: 

1. Reactive to proactive – pushing beyond reactive service management to keeping people healthy by better understanding and then proactively addressing populations’ health needs. 
   
   
2. 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.
   
   
3. Competition to collaboration – replacing organisational silos with genuine partnerships across local government, the VCSE sector and the breadth of the NHS. 
   
   
4. Transactional to transformational – moving beyond just managing contracts for episodes of care to transforming services and commissioning pathways for population cohorts in partnership with providers and the public. 
   
   
5. Cost to value – achieving return on investments, not just managing costs. 
   
   
6. Compliance to leadership – empowering local leaders to lead, innovate and listen, rather than just look upwards for instruction. 

• The transition to strategic commissioning will require a phased implementation process and rely on developing the right skills and capabilities for both individuals and organisations. This includes developing diplomatic and data analysis skills and supporting system leadership.
  
  
• NHS England’s forthcoming strategic commissioning framework should reflect the principles and proposals outlined in this report and be accompanied by an implementation plan to drive change. Form must follow function. The announced 50 per cent cut to ICBs’ running and programme costs must be carefully managed to ensure they are able to deliver on the government’s ambitions for transformation and risks slowing down the move towards strategic commissioning.

This report also sets out recommendations for a phased implementation process.