The Place Project: Delivering integrated neighbourhood services – understanding commissioning and service design within places
Understanding the crucial role commissioning must play in the delivery of integrated neighbourhood services
Introduction
Introduction
It is very important that health and care staff working in different organisations (such as GP practices, district nurse teams, Local Authorities etc) work together effectively so that they can provide high quality care to everyone as they get older. We know that providing care which meets the needs of local people is challenging. We need to know what sorts of problems people have, and we need to know what sort of services will best help them. We need some way of getting organisations together that decide what services are needed with organisations that deliver services so they can agree what they will do and how much this will cost. Finally, we need to be able to check the services, to make sure they are good enough and that people are getting the right care. All of these things taken together are called ‘commissioning’, but this really just means making sure that the NHS gives people the right types of services.
In 2022 a new Act of Parliament changed the organisation of the NHS in England. The responsibility for making sure health services were provided was moved away from local ‘Clinical Commissioning Groups’ and given to much larger Integrated Care Systems. There were around 200 Clinical commissioning Groups and most of them were responsible for making sure the NHS provided services for around 200-400,000 people. Integrated Care Systems are much bigger. They tend to cover an area of many as 1-3 million people, and there are 42 of them in total. Examples include Greater Manchester and West Yorkshire – much bigger than a single town.
When this change was made, the people in charge knew that Integrated Care Systems were too big to make some of the day-to-day decisions about services. Things like GP practices and district nurse services need to be organised more locally, so that every part of the country gets services which are right for their local area and people. Because of this it was decided that the big Integrated Care Systems would have smaller committees which would be responsible for making sure that the right local services are provided for local towns and villages. These are called ‘Places’.
We are not sure how this is working out in practice. We don’t know exactly which things Places have been given responsibility for, and we don’t know what they are doing to make sure everyone gets the local services that they need. We don’t know how they are making sure that different organisations work well together. In this project, we will find out about this, so we can tell the Department of Health and Social Care and NHS England what is working well and what could be improved. We want to know how the people working in Places are managing to help the different types of NHS organisations (e.g.. GPs, mental health services, social care etc) to work together effectively.
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The main aim of this research is to explore what sort of work the committees in Places need to do to make sure that the NHS provides everyone with joined up care that meets all of their needs. We aim to tell the Department of Health and Social Care and NHS England what sort of help and guidance they need to give to Integrated Care Systems to make sure they work properly.
The objectives are:
- To understand what commissioning processes and structures are required to deliver integrated care.
- To explore how Integrated Care Systems are organising their work and what sort of responsibilities they are giving to Places.
- To understand how Places are doing the practical work of deciding what services are needed, arranging for them to be provided, helping different organisations to work well together and checking that services are good enough.
- To consider what policy or guidance may be required to support Places in their role.
First, we will look at the evidence that has been published about how health organisations can be helped to work together to provide joined up care. Second, we will then look at what we know about what sort of things need to be done to make sure people get the right services. Putting these two things together, we will come up with a list of things which we think the people who work in Places need to do to make sure that the best possible health and care services are provided in a ‘joined up’ way. If we can, we will write a short report that makes some suggestions about what sort of difficulties people might experience when trying to do their jobs, and how things might be improved.
We will then look in detail at what is happening in three Integrated Care Systems in different parts of England. In each one we will speak to some of the senior managers in charge to find out what they think the Places in their System should be doing. We will then talk to people in each of two Places in each System (6 Places in total) to find out how they are trying to make sure that local people get joined up and efficient services. We will compare the different Places to see if there are things which some Places are doing which might be helpful to other Places. We will try to find out if there are any special things that people are doing. For example, people might be trying to put all the money for different types of services into a big pot, rather than giving different organisations their own share of the money. Or they might have special contracts which give one organisation overall responsibility for providing services, and then allow them to decide what other organisations should be doing to help.
We will bring all this information together and tell the Department of Health and Social Care what is working well and what is not working so well in making sure local services meet local needs. We will also suggest things which might need to change. For example, Integrated Care Systems might need more guidance about how to pass responsibility down to local Places, and about what support Places need. We will also write some academic papers about what we have found and talk about it at conferences.
We will have an advisory group made up of people who work in the NHS, people responsible for making policy decisions and members of the public. The advisory group will make sure that the project will be useful to the Department of Health and Social Care and to Integrated Care Systems.