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Commissioning

Knowsley

Joint commissioning arrangements

Knowsley Metropolitan Borough Council and PCT have established a Health and Social Care Commissioning Board to ensure integrated and appropriate commissioning decisions.

A high level of integration between the authority and PCT already existed prior to the introduction of the Health and Social Care Commissioning Board. This was due mainly to the appointment of the Director of Social Services to the Chief Executive post of the newly formed PCT in 2002, and the agreement that she retain her role as Director of Social Services, with the new post being jointly funded and accountable to both organisations. The authority actively encouraged this joint appointment, recognising the opportunity to work more closely with the NHS in tackling prevalent issues in Knowsley such as deprivation, poor health and inequality. The joint appointment was fully supported by the Strategic Health Authority, Cabinet of the council and board of the PCT, and a single leadership team was created for Social Services/PCT.

In 2004, a Section 31 partnership agreement (Health Act 1999) was established across the whole council and the PCT, enabling a more flexible joint approach to health improvement, where appropriate functions from both organisations could be delegated to the new partnership. The 'Health and Wellbeing Partnership Board', formed as part of the overarching Section 31 Agreement, uses the combined expertise of the authority and PCT to tackle health inequalities within Knowsley, working towards health improvement and preventative measures. A Health and Wellbeing Partnership Management board (which supports the main board) was established between the PCT, Council and partner organisations including the voluntary sector, enabling improved strategic commissioning arrangements and management of pooled budgets.

What prompted the organisation to develop this approach?

Given the level of integration which had already been developed, the change is described as "evolutionary" rather than "revolutionary".
The Department of Health commissioned 'Fitness for Purpose' review, which assessed the PCT's strengths and development needs, identified a need to strengthen particular areas of the commissioning process in Knowsley, particularly within the areas of acute, primary and specialist commissioning. The 'Fitness for Purpose' review and the requirements of Commissioning a Patient Led NHS acted as drivers behind Knowsley's decision to create a Health and Social Care Commissioning Board.
The aim is to ensure that commissioning decisions improve quality, accessibility and effectiveness of services in the Borough. The purpose of the Board is to manage and co-ordinate commissioning across Health and Social Care.
The scope of the Board's role encompasses all commissioning undertaken by Knowsley PCT, its Practice-based Commissioning consortia and by the Health and Social Care Directorate of Knowsley Council.
The Board is a sub-committee of the PCT's Professional Executive Committee and forms part of the wider commissioning network that includes the Knowsley Partnership, Health and Well Being Partnership, and Children and Young People's Strategic Partnership.

What has the work involved?

The introduction of a Governance and Accountability Framework to ensure transparency and fairness in service development, and to facilitate improved integration and effective partnerships between the PCT and practice based commissioners.
The establishment of lead commissioning arrangements (structures, processes, accountability).
An exploration of Practice-based Commissioning guidance and contestability.

How have things changed for the better?

Health and social care now share a common set of priorities and an agreed set of outcomes.
Improved strategic role in planning, designing and implementing the range of services required. Improved communication and accountability through the establishment of lead commissioning roles and arrangements. More streamlined decision-making through the establishment of the 'Health and Social Care Commissioning Board'.
Better able to influence the decision-making of Practice-Based Commissioners.
Clearer as to how to "commission our provider arm".
Demonstration of improved contestability of provider services, and should help to develop the market for health and social care locally. For more information download the Framework for Contestability.
Integration of planning and commissioning across health and social care has enabled organisations to address issues via a whole systems approach resulting in sustainable and inclusive development. Whole system approach to commissioning facilitates information sharing and analysis.
An improved, stronger link between strategic needs assessment and commissioning. Understanding the needs of the population now and for the future by using the wealth of information collected by public health, primary care, acute hospitals and the council should allow agencies to ensure that what they commission will meet those needs and should allow them to influence and shape the market.
The set-up of a joint procurement team has enabled the organisation to focus on "value for money", improve contract compliance and improve consistency in the tendering process.
Integration has contributed to the achievement of 3 stars for Knowsley Social Services and 2 stars for Knowsley PCT.

What have been some of the challenges/drawbacks?

Breadth of the agenda being dealt with by the Board and its subsequent information needs.
Members of the board are dealing with unfamiliar business and decisions. More difficult to 'keep people on board'. Important to make sure that the Board has a useful and real agenda.
Unable to identify other drawbacks at this early stage.

What lessons have been learnt?

The importance of initial preparation and groundwork - importance of developing a common language and model of commissioning from the outset.

How might this affect commissioning in the longer-term?

Will facilitate the achievement of improved and sustained efficiency and outcomes for service users.
Will allow Practice-based Commissioning to influence the commissioning agenda across health and social care.
Will enable linkage between PbC and council's strategic commissioning to improve peoples' lives in the Borough.