At today's Westminster Health Forum Keynote Seminar, The future of health commissioning in England, 21st May, 2018. Ian Dodge, National Director of Strategy and Innovation at NHS England is cautiously optimistic for the NHS. As Ian Dodge points out, the esteem that the NHS is held remains high. This is evident in the celebrations on its 70th year; the Chelsea flower show has chosen an NHS theme and Dame Kelly Holmes recently launched the collaboration between NHS and Park Run, who will jointly host NHS70 parkrun day on Saturday 9th June.

In England, the population rely on the NHS to guide them when managing their health. The current process of procuring health services is undergoing reform in order to meet the changing needs of the population. In line with the move towards a person-centred sustainable care system, the NHS are increasingly giving patients a wider variety of choice to manage their care needs.

A case study presented today by Mike Bonetto, Co-Founder of Tenfold Health, gives an illustration of successes achieved abroad with healthcare reform. In Oregon, a budget shortfall forced the transformation of the healthcare system. A review found that there was fragmentation of care, inefficiency and duplication of support. The goals of the reform were to improve health, lower costs and provide better care. Rather than adopt the traditional state budget balancing method (cuts), the reform restructured the care system into Coordinated Care Organisations (CCOs) that had the flexibility to commission services based on the needs of their population, providing they met their financial commitments. CCOs have the ability to make upstream investments, such as providing housing deposits, gym memberships and tobacco prevention. The initiative proved to be both cost effective and sustainable. Health Reform Policy to Practice: Oregon as a Case Study for a Path to a Comprehensive and Sustainable Health Delivery Model by Ronald Stock and Bruce Goldberg gives an in-depth account of that journey.

In Manchester, a case study for reform in England, they have adopted a ten-year strategy, Our Manchester Approach. As highlighted by Dr Carolyn Kus, Executive Director of Strategic Commissioning for Manchester Health and Care Commissioning, prior to the reforms Manchester had, "Some of the worst health outcomes for our people," when compared with the rest of England. Their approach was to bring together the health and social care system to support the 530,000 population. Their aim is to have a fitter, healthier and more resilient population with high standards and quality services.

Our Manchester Approach is underpinned by four principles; better lives, listening, recognising strength (with individuals and communities working together), and working together to build better relationships and create conversations. They have found that having a joined-up health and social care budget is much easier to work with. More broadly, it is hoped that the reforms will help to cultivate a much richer pipeline with a view to supporting a much faster uptake of innovations within the NHS.

Dr Charlotte Augst, Director of the Richmond Group Partnership, highlighted the resource of charities, who have spent years developing proven strategies (e.g. End of life care by Macmillan). She suggested that charities with specialisms should be invited to contribute when reconfiguring services.

Two of the biggest challenges currently faced by the NHS are resources and workforce. It has proved increasingly more difficult to attract suitable candidates to apply for roles within the NHS, and a major implication of this is that a reduced workforce causes closure of beds. Other factors, such as a reduction in time commitment from GPs, and GPs retiring early due to the pensions cap are having an impact. This year, a programme to recruit 2,000 GPs from abroad was launched to address gaps in service provision. Stephen Childs, Managing Director, North of England Commissioning Support Unit, commented that the, "Recruitment challenges are unprecedented, there is some way to go to address the issue."

Dr Etheldreda Kong, Chair an Co-Clinical Director of NHS Brent Clinical Commissioning Group, emphasised that commissioning roles should be promoted as a rewarding career option for clinicians and clinical leaders. She suggested introducing these options early in GP training, with small pieces of work as tasters supported by a leadership programme, soft skills development, mentoring and coaching.

James Sanderson, Director of Personalised Care at the NHS, provided an update on the progress of the Integrated Personalised Care Commissioning (IPC) programme. As of 1st March, 28,040 people are in receipt of Personalised Health Budgets. The aim of this scheme is to give people maximum control over the system so that services can be tailored. He noted that, in Warrington, 100% of people in receipt of personalised health budgets in End of Life care chose a service that wasn't commissioned. He went on to say that this illustrates that commissioning services that people need or care about are better value to people.

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Caitriona Fitzsimons Digital Reporter