As commissioners strive to meet multiple agendas and move towards whole-system integrated care pathways, the need for a dynamic and varied commissioning support service (CSS) market continues to grow.
Voluntary sector organisations (VSOs) and small medium sized enterprises (SMEs) are now joining commissioning support units (CSUs) and some of the more established independent sector providers, such as the big four consultancy companies, in the emerging market to meet the need for specialised niche services.
Here we discuss the contributions of VSOs and SMEs in the second part of Mapping the Market, produced by The Commissioning Review’s parent company, Cogora, in conjunction with NHS England.
The publication, launched at a reception at the NHS Expo in Manchester in March this year, contains 25 VSO and SME profiles which discuss their offerings, thoughts as to the emerging market and the challenges they face.
With business intelligence being key to transforming care in a climate of limited funds, like the independent sector and CSUs, VSOs and SMEs are taking important strides in this area.
Within the SME sector, myClinicalOutcomes, is able to combine information collected remotely from patients to national survey patient reported outcomes measures (PROMs) or the Friends and Family test to configure a deep understanding of care quality.
Co-Founder, Tim Williams says: “Built to support follow-up for patients with long-term conditions, or for those who require intermittent post-operative review, we can query patients about their health status regularly over the entire care cycle, provide information about what the data means and information about other similar patients and local services, all of which are key to long-term engagement and an understanding of quality of care.”
VSOs on the other hand, are able to provide valuable condition-specific information which both contextualises
and goes beyond publicly available sources of data.
For example, Cancer Research UK has launched an Intelligence Portal which allows CCGs or local authorities to access local data through user friendly infographics, accompanied by tailored intelligence statements including statistical significance, their policy and advocacy position, and suggestions to move forward.
Asthma UK has invested in the development of an asthma dashboard which provides a series of high level indicators looking at quality and cost based around hospital admissions and prescribing. They then look at detailed indicators including patient views, prevalence, admissions and practice level variance.
Interim Director of Nations, Regions and Services, Linda Edwards says: “This is very helpful in identifying asthma ‘hotspots’ around the UK. Sixteen CCGs are currently signed up to our Compare Your Care programme, which allows them to access information about services in their local area and compare it to services and outcomes in other areas.”
In the context of integrated care and the better care fund, VSOs and SMEs also make clear contributions. With strong roots in supporting local authorities, commissioners and strategic clinical networks as well as their extended reach into the community, VSOs can help each to navigate the structures of the other to allow a better flow of information.
Operations director of Alzheimer’s Society Greater London, Kate Moore says: “We have examples of working very closely with statutory partners and bringing our evidence base and experience to developing a whole-system care pathway that then results in co-ordinated and integrated commissioning activity and service provision.” Within the SME sector, Dr. Associates provides a specialist transformation capability that facilitates health economies to work together. Director Dan Rixons says: “We design and facilitate multi-stakeholder transformation events to engage health and social care and local authorities with commissioners to co-create services and reconfigure strategies…”
Each of the sectors also has their respective areas of strength. For VSOs, this includes expertise on the most up-to-date treatments and services for their patient population as well as a large evidence-base of trialed and tested service delivery methods, a precious resource in the face of ailing NHS funds.
Macmillan Cancer Research and the British Heart Foundation use pump-prime modelling where a certain amount of funds are invested to develop a service with an agreement that the funding will be taken over by the NHS once the service is underway. Similarly, the Alzheimer’s Society evaluates the services it provides as a service provider to build a robust evidence-base, which in turn informs commissioning development.
With patient advocacy being the mantra for VSOs, they also serve a crucial function in engaging patients and their carers in the co-design of services. Diabetes UK has a service targeting hard to reach groups such as Black, Asian and Minority Ethnic (BAME) Groups while Turning Point has used their Connected Care tool, which is both peer-led and community-led, to engage over 100,000 people across a variety of geographical areas and conditions.
Director of strategic Projects at Turning Point, Beverly Priestly said: “Part of why this is so successful is because having carried it out so extensively, we’re very good at tapping into what is needed, who we need to get on board and reaching out to local networks.”
Through a pilot commissioned by Birmingham City council, Connected Care has developed a new approach to help patients navigate health and social care boundaries to access the services they need.
Director of North of England of the Stroke Society, Elaine Roberts says that through their continual engagement with the community, they are able to offer information to commissioners up to two years from patients leaving hospital, which is when they often fall of “the cliff-edge,” helping to inform future planning or service review.
While VSOs have largely focused their CSSs around specific conditions, SMEs have an increasingly innovative array of models of care including variations of outcomes-based commissioning models, value-based modelling as well as multi-systems approach to commissioning support.
For example, Outcomes Based Healthcare work with healthcare providers to define outcomes which matter to patients, organising processes of care around them and determining appropriate measures for outcomes. A key component of their work is also providing education and undertaking academic research into value-based healthcare.
Eight-Ninths, who aim to inspire in-depth change, look not only at the transactional, but also at “the relational, psychological, spiritual and social dimensions of healthcare.”
Despite the significant opportunities the CSS market brings, the two sectors are not without their challenges. While very keen to provide an input, a common theme for both SMEs and VSOs is that the CSS market is proving difficult to navigate. As well as current restructures causing difficulties in finding the right point of contact within commissioning bodies, there’s also a question around whether approaching CSUs or CCGs directly is the best course of action.
Both sectors are keen to work with CSUs however as being unlikely to be eligible to be a lead provider of CSS on the lead provider framework, this increases routes for access. The commissioning support lead provider framework procurement process, which was launched in February, also offers an opportunity for organisations to partner with one another to provide end-to-end services.
VSOs also find themselves in the slightly strange position that despite having supported commissioners for years in the ways outlined above, the formalisation of a market means that they are now having to think about commissioning support in the language of the new accompanying frameworks. With many VSOs also having a service delivery arm, there is also the challenge of balancing their interests as a service provider and their role as a commissioning support provider in an advisory capacity.
However, a formal market also means that opportunities now arise for more formal recognition of their support as well as monetary contributions to their cause, whereas in the past, offering advice freely has always been a means to an end to provide the services that patients and their carers say they need. How payment systems evolve for VSOs though will require some careful thought as many organisations will be new to the concept.
Roberts of the Stroke Society says: “For any organisation such as ours, a challenge is walking the tight rope between being a provider as well as potentially offering commissioning support… Charities therefore need to be aware of their value and the knowledge of the information we have at our fingertips while also being aware of these tensions outlined above. But in turn, so do the commissioners in respecting our right to have a view on behalf of our constituents and in recognising our value in being able to contribute on an equal footing to the decision making and not as a lesser partner that doesn’t have cost implications in monetary terms. Many VSOs are very well run businesses and our skills and expertise can come at a price, but with the balance always, of doing what is best for our community.”
As the CSS market continues take shape, offering both challenges and opportunities for providers, how organisations will orient themselves and collaborate to best suit the needs of commissioners remains to be seen.