One of the biggest challenges in any sector is turning strategy into action and impact, knowing where to focus effort and in what order. Specialist commissioning in England is trying to reposition itself in the context of exponential development and innovation in precision medicine, health technology and novel therapies for rare diseases, the main focus of specialised commissioning as well as a system shift to population health risk management. Providers of specialist services are starting to respond to this challenge by designing new models of integrated care. One example is the Accountable Cancer Network involving The Christie, the Royal Marsden and University College London Hospitals. Earlier detection is a key aim of such models but even these innovators recognise the current provider networks need to be expanded, potentially beyond the health system, to do this really effectively.
System integration is the primary mechanism through which the Five Year Forward View, including that for specialised commissioning will be achieved. Currently providers and commissioners are being asked to develop their plans for system integration within the 44 Sustainability and Transformation Plans. Specialised commissioning is playing in to a small number of these as a proof of concept to understand how this could work in practice.
I would argue, that asking many providers and commissioners to address multiple operational challenges, including significant financial deficits, as the same time as building the infra-structure for integration is a huge ask. For system integration to move beyond the conceptual, there needs to be a component of the system responsible and accountable for the mechanics of integration. Both providers and commissioners have a role to play but they have other priorities that need their focused effort as we transform.
If you look at the services provided by commissioning support units (CSUs), they are, on paper, ideally placed to act as a system integrator providing the managerial support to specialist commissioners and providers in terms of performance management driven by business intelligence, innovation in contracting including risk and gain-share, transformative use of technology and organisational development support to a transforming system workforce. When you compare the traditional skill sets that sit within CSUs and those in the best performing system integrators internationally, there are significant gaps in skills that would need to be addressed, notably population health analytics, actuarial skills, integrated information systems to support care management, coordination and financial modelling for risk and gain-share.
We have many of the capabilities needed to act within the system integrator role but some need to be developed, probably in partnership with providers from outside the NHS who have delivered these models in other countries or in other sectors, such as criminal justice. Above all, use the right talent in the right place to deliver this ambitious agenda.