By Niamh Chhugani
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.
The strategy and a number of the policies currently being consulted on call for a different way of operating to be more responsive to health technology innovation. The agile specialist commissioner is the future.
The Accelerated Access Review has a vision to provide a quicker and simpler way of finding innovations that can improve efficiency and patient outcomes. The In-Year Service Development Policy and the Funding Experimental and Unproven Treatments Policy both challenge traditional ways of working across the specialised commissioning ecosystem.
Scaling up the “commissioning through evaluation” approach across the NHS in England needs to be supported by a development programme for clinical researchers, commissioners and potentially patient participants that gives them the tools to design the right evaluation methodologies, consent and metrics. Central to this methodology will be a rapid cycle evaluation approach that is rooted in the real world and uses improvement science to understand the impact of a technology in context.
This a huge culture and mindset change for many. Being explicit about the link between an agile approach to innovation and the positive impact that this could have on access and patient outcomes may help to shift the dial. Having patients as part of the network that is collaborating to accelerate access will help to bring this in to sharper focus. This approach in turn will help to rebalance the power between clinicians and patients as patients become active partners in their healthcare, exerting choice and control in decision-making about their own care, fulfilling the personalisation ambition of the strategy.
There is a huge opportunity here for specialised commissioning to be the demonstrator for the whole health ecosystem on how to use innovation and agility to accelerate change at the front lines of care.