Joint Commissioning in Health and Social Care: An ...

1 National Institute for Health Research Service Delivery and Organisation Programme Joint Commissioning in Health and Social Care: An Exploration of Definitions, Processes, Services and Outcomes Helen Dickinson, 1 Jon Glasby, 1 Alyson Nicholds, 1 Stephen Jeffares, 2 Suzanne Robinson, 1 and Helen Sullivan, 3. 1. Health Services Management Centre, University of Birmingham 2. Institute of Local Government Studies, University of Birmingham 3. Centre for Public Policy, University of Melbourne Published January 2013. This project is funded by the Service Delivery and Organisation Programme Queen's Printer and Controller of HMSO 2013. This work was produced by Glasby et al.

2 Under the terms of a Commissioning contract issued by the Secretary of State for Health . Project 08/1806/260. Address for correspondence: Dr Helen Dickinson Health Services Management Centre University of Birmingham Park House 40 Edgbaston Park Road Birmingham B15 2RT. Email: This report should be referenced as follows: Dickinson H, Glasby J, Nicholds A, Jeffares S, Robinson S, Sullivan H. Joint Commissioning in Health and Social Care: An Exploration of Processes, Services and Outcomes. Final report. NIHR Service Delivery and Organisation programme; 2012. Conflicts of Interest: The authors have no financial or other competing interest that might have biased this work.

3 Relationship statement: This document is an output from a research project that was funded by the NIHR Service Delivery and Organisation (SDO) programme based at the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) at the University of Southampton. The management of the project and subsequent editorial review of the final report was undertaken by the NIHR Service Delivery and Organisation (SDO). programme. From January 2012, the NIHR SDO programme merged with the NIHR. Health Services Research (NIHR HSR) programme to establish the new NIHR Health Services and Delivery Research (NIHR HS&DR) programme. Should you have any queries please contact Copyright information: This report may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.

4 Applications for commercial reproduction should be addressed to: NETSCC, HS&DR. National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre University of Southampton Alpha House, Enterprise Road Southampton SO16 7NS. Queen's Printer and Controller of HMSO 2013. This work was produced by Glasby et al. under the terms of a Commissioning contract issued by the Secretary of State for Health . 2. Project 08/1806/260. Disclaimer: This report presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health .

5 If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and not necessarily those of the NHS, the NIHR or the Department of Health . Criteria for inclusion: Reports are published if (1) they have resulted from work for the SDO programme including those submitted post the merge to the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. The research in this report was commissioned by the SDO programme as project number 08/1806/260. The contractual start date was in October 2009. The final report began editorial review in March 2012 and was accepted for publication in January 2013.

6 The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The SDO editorial team have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report documentation. However, they do not accept liability for damages or losses arising from material published in this report. Queen's Printer and Controller of HMSO 2013. This work was produced by Glasby et al. under the terms of a Commissioning contract issued by the Secretary of State for Health . 3. Project 08/1806/260. Contents Contents .. 4. List of tables .. 8. List of figures.

7 9. Glossary of terms/abbreviations .. 10. Acknowledgements .. 10. Contributions of authors .. 10. Executive Summary .. 12. Background .. 12. Aims .. 12. Methods .. 13. 13. Conclusions .. 15. 1 Introduction and background .. 16. Aims and objectives .. 17. Theoretical insights .. 18. Structure of the report .. 20. 2 Literature 21. Introduction .. 21. Search Strategy .. 21. The nature of the evidence base .. 23. Defining Joint Commissioning .. 26. Policy context .. 26. Structures, practices and processes of Joint Commissioning .. 30. Scales of Joint 30. Structures of Joint Commissioning .. 32. Practices and processes of Joint Commissioning .. 34. What should Joint Commissioning achieve?

8 35. Interpretive analysis: making sense of Joint Commissioning .. 39. Queen's Printer and Controller of HMSO 2013. This work was produced by Glasby et al. under the terms of a Commissioning contract issued by the Secretary of State for Health . 4. Project 08/1806/260. Joint Commissioning as prevention .. 42. Joint Commissioning as 43. Joint Commissioning as efficiency .. 44. Chapter Summary .. 45. 3 Methodology .. 47. Introduction .. 47. Surfacing programme theories and meaning .. 47. Case Study selection .. 51. Phase One: POETQ .. 53. Q Methodology .. 54. Selecting the Q statements .. 56. Coding Framework .. 59. The POETQ survey .. 60. Data Analysis .. 61.

9 Use of POETQ as part of case study .. 64. Phase 2: Site Visits and Interviews .. 65. Analysis: Phase Two .. 69. Ethical considerations .. 73. Limitations .. 74. Chapter summary .. 75. 4 Phase One Findings: Meanings of Joint Commissioning .. 76. Introduction .. 76. Overview of case study sites .. 76. Survey response 78. The National picture .. 81. Ideal World Commissioning .. 83. Efficient Commissioning .. 84. Pluralist Commissioning .. 84. Personalised Commissioning .. 85. Pragmatic Commissioning .. 86. What does success mean for these viewpoints? .. 86. Queen's Printer and Controller of HMSO 2013. This work was produced by Glasby et al. under the terms of a Commissioning contract issued by the Secretary of State for Health .

10 5. Project 08/1806/260. Viewpoints and professional groupings .. 89. The local picture .. 91. Case Study A .. 91. Case Study B .. 93. Case Study C .. 94. Case Study D .. 95. Case Study E .. 96. Bringing the viewpoints together .. 98. Chapter Summary ..100. 5 Phase Two: Joint Commissioning in Practice ..102. Introduction ..102. How do people talk about Joint Commissioning ? ..102. Case Study A ..103. Case Study B ..107. Case Study C ..109. Case Study D ..111. Case Study E ..114. Bringing these perspectives What organisational processes are in place to facilitate Joint Commissioning ? ..117. Formalised structures ..118. Pooled budgets ..119. Lead Commissioning .