COVID-19 will fundamentally change the way the NHS deliver services, and how they are commissioned.  We have seen this in practice with the use of digital solutions to keep services running during the pandemic.  The NHS is currently undergoing a reorganization, and the deadline for all of England to be part of an Integrated Care System (ICS) by April 2021 remains in place. 

Integrated Care Systems are designed to deliver healthcare to populations, which vary in size.  Some populations are relatively small, at approximately 700,000, where others are considerably larger, in excess of 2 million.  It is anticipated that smaller populations will not take on some of the more specialist commissioning, which other larger populations will. Flexible budgeting to be able to move funds to where they need to be targeted will be an important aspect of commissioning on a local level going forward.  Louise Patten, Chief Executive, NHS Clinical Commissioners, suggests that this can be achieved by aligning with local government commissioners and empowering local providers with a delegated, single, transparent budget.

Commissioning at scale has played a vital role for the NHS in managing their response to the pandemic.  Louise Patten said that this emphasized that some commissioning is best done at scale, as decisions can be made.  However, if this were to continue, it would mean that certain services commissioned at scale would not be tailored to suit the needs of local communities.  As the NHS is working to tackle the problem of health inequality in the UK, it will be important to get the balance right to ensure the health of local populations.

Data analytics and data sharing will have a huge role to play in the future of commissioning in the NHS.  It gives services access to real-time analysis of the effectiveness of the services they provide, and these insights really can put the patient at the heart of localized commissioning. Anne Marie Morris, MP, cited the biggest challenge facing the NHS reorganization as being the culture change, and the history of the reluctance in the NHS to share data. 

"What are the changes that need to happen to share the data in the way that it needs to happen, and how is that moderated to ensure the quality of data?"

Anne Marie Morris MP

Louise Patten highlighted the need for the NHS to embrace the digital advancements that have happened during the pandemic and to share best practice from these innovations to ensure that they continue to grow.  She shared an example of how data was successfully used to support the community of a health service that she worked with, where it was discovered that for some patients to attend an appointment, they needed to stay overnight because of a lack of public transport enabling patients to travel home safely at certain times.

At the onset of pandemic, the NHS responded with an acute refocus and re-prioritization to care for people who were chronically ill with COVID-19.  Dr Karen Kirkham, Senior Medical Advisor, Primary Care Provider Transformation, NHS England and NHS Improvement highlighted that this saw collaboration and information sharing amongst clinicians while attempting to cope with successfully treating a new virus.  Within two weeks, clinicians were "working without waiting rooms", and total triage was embedded in every consultation.

Across the nation, data played a key role for health services in their response to the pandemic. Ellen Rule, Director of Transformation and Service Redesign, Gloucestershire CCG provided some insight into how they used data to support the delivery of their services.  They focused forecasting on peak and overall demand for hospital beds (critical care, acute and community), including the timing of when peak demand was likely to occur.  They then used these predications, along with real-time data as it emerged, to manage their resources.

The benefits of data sharing to manage resources and support innovation have become apparent more now out of necessity rather than better management.  The NHS has, in the past, struggled with the adoption and spread of innovation.  Professor James Kingsland, National Primary Care Home Clinical Director, advised that lessons must be learned from the past as the service moves forward.  He emphasized the need for the dissemination of data to support clinicians:

"If teams don't have access to data analytics, they can't understand the needs of a local population, and this hinders commissioning."

Professor James Kingsland 

Post Contributor:

Caitriona Fitzsimons Digital Reporter