NHS finances are almost at breaking point. Other purchasers of healthcare are also squealing – private medical insurers are struggling; premiums are rising to match costs and demand, to the point where products/individuals are choosing to save rather than pool their risk.
There isn’t a healthcare system in the world that does not take decisions about which services and treatments to provide and for whom. This rationing is a universal reality, so let’s accept it. For example, NICE make decisions every day on which drugs to make available on a cost/benefit basis.
But, if you’re a provider (or work for one) or a patient you tend to be biased in favour of the service that you provide or receive. Commissioners have to make difficult decisions and are influenced in all sorts of ways. Ideally they are fully informed of the clinical value of the services they commission and are not influenced by any particular provider organisation or professional group, however, the reality is much less simple. How can we, providers and clinical professionals, make it easier and support better decision making? Surely, the fundamentals have to include:
- Unreservedly accept that most of us (apart from highly specialised acute care) are competing for a diminishing pool of cash.
- Modernisation or reform; what you call it doesn’t matter, it is required. The effort should be focused on effectiveness and efficiency. It isn’t about the cheapest service, it’s the best value for money – why would health commissioning be any different.
- Data supports influence. Whilst visibility and information regarding performance is important for internal improvement it’s probably best not to share it with commissioners until you have optimised your service. It is also useful to benchmark yourself with others.
- Communication – learn to understand the needs and objectives of commissioners and how to speak their language.
In the world that Connect Health inhabits – community MSK services – commissioners have plenty of choice, which has driven patient-centred change. Over a decade, more patients are treated at less cost with better outcomes.
Competitive procurement processes are common and non-traditional providers have been welcomed for their willingness to accept the challenge to innovate to balance quality and cost in new ways. Most of these new providers are clinically owned and led, not large corporates.
The system needs material change. Providers can wait until they are told by others the ‘what’ and the ‘how’, or they can invest and lead the change. More than half of the procurements for NHS community MSK services in the last 12 months have been won by non-traditional NHS providers (i.e. the independent or voluntary sectors).