NIHR POLICY RESEARCH UNIT IN HEALTH AND
SOCIAL CARE SYSTEMS AND COMMISSIONING

Current projects

Researching on the developing architecture of system management
Researching on the developing architecture of system management

03 January 2019 – 31 December 2021
Contact: Professor Pauline Allen

The aim of this study will be to investigate the further development of STPs, ICOs and ICSs or their successors under the NHS Long Term Plan ‘LTP’ in order to find out how effective these new forms of collaboration are in achieving their goals, and what factors influence this.

At local system level there is an increasing emphasis on developing integrated systems such as ICSs where commissioners and providers take on collective responsibility for resources and population health. In addition to specific local aims, ICSs are intended to: ensure that care is delivered in appropriate and accessible settings; use limited local resources efficiently; and demonstrate improvement in population health. ICOs are envisaged as a further stage of development of ICSs, where a single organisation will be formed out of the current range of stakeholder organisations. System integration is a key goal of NHS policy and will continue to be salient for the next few years as the details of the relevant structures and governance arrangements develop. Understanding system management and oversight and exploring the role of commissioning and incentives in such systems will be important for supporting policy development and practice.

  • To understand how local leadership and cooperative arrangements with stakeholders (statutory, independent and community-based, including local authorities) are governed in the light of the ICS governance recommendations in the LTP. How statutory commissioning organisations including local authorities are facilitating local strategic decisions and their implementation; and whether different types of commissioning function are evolving at different system levels.
  • To understand whether ICSs and ICOs or their successors are able to allocate resources more efficiently across sectoral boundaries and bring their local health economies into financial balance.
  • To understand how individual organisations are reconciling their role in an ICS or its successor with their individual roles, accountabilities and statutory responsibilities.
  • To understand how national regulators are responding to the changes in modes of planning and commissioning and actual service configurations, in the light of the changed priorities for these regulators set out in the LTP.
  • To understand which mechanisms are used to commission services in ICSs or ICOs or their successors, in particular how competition is used to improve quality and/or value for money of services; and how more complex forms of contract (such as alliancing) are being used, how local organisations are reconciling new service configurations with current/evolving pricing structures, and thus how financial incentives are being used.
  • To understand how locality priorities, including those of local authorities, are reconciled with the wider priorities embodied in STPs, ICOs and ICSs, in particular how co-ordination is achieved between STP and ICS/ICO plans, local priorities and existing programmes of work such as any local new models of care.

Please check back here for interim and final reports as the project progresses, as well as related academic papers.