Area of Research: Health and Social Care Systems and Commissioning
Section 1: Summary of main strands/themes for research
The aim of this unit is to provide evidence to support understanding of how health and care organisations function together as a system, including planning, commissioning and delivering services, as well as examining incentives for behaviours. This includes understanding system processes and impacts on the system, and on outcomes for patients and service users.
The recent Health and Care Act 2022 and the Integration White Paper puts integration and collaboration at the forefront of commissioning decisions. This is particularly pertinent given the establishment of statutory Integrated Care Boards and Integrated Care Partnerships, and the expectation that leaders will collaborate in care commissioning and deliver at both ‘Place’ and ‘Neighbourhood’ levels. Themes covered by the unit are expected to include, but are not limited to:
System management and oversight
The Department of Health and Social Care (DHSC) works with Arm’s Length Bodies (ALBs) (such as NHS England) to improve health outcomes by maximising effective use of available health and care resources. Research is required on the high-level organisation, resourcing and management of systems for planning, commissioning and delivering health and social care services, including interactions and integration between elements of the health and social care system (linking up with other Policy Research Units (PRUs) where beneficial).
Research may also be required on the relationship between DHSC, its ALBs and the wider system following changes in the Health and Care Act 2022. Furthermore, proposals in the Integration White Paper will ensure that accompanying oversight arrangements and regulatory structures have a clear focus on the planning and delivery of shared outcomes. DHSC will work with the Care Quality Commission (CQC) and others to ensure there is effective regulation and oversight and that these new [accountability] models achieve their purposes. Evidence from the PRU should inform this work.
Commissioning of services at Integrated Care System (ICS), Place and Neighbourhood levels (focused on processes and collaboration)
Research is needed to:
- assess how planners and commissioners of both health and social care develop their understanding of the needs of local populations and plan strategically to meet these needs, such as how addressing health inequalities is prioritised;
- identify effective practice in planning - focusing in particular on activity that enables everyone to live more independent, healthier lives, for longer. This could include approaches to focusing on prevention through tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health, and improving mental health, and to improve the health outcomes of people with multiple unhealthy behaviours;
- examine what kind of strategic partnerships are developed locally and how these may be associated with delivering improved health outcomes, in particular relationships between the NHS and local authorities and the VCSE sector;
- identify how to ensure commissioning of social care promotes a good quality and sustainable systems, such as ensuring value for money;
- understand current commissioning practices, and determine what policy action can best support the development of sustainable care markets; and
- understand how shared outcomes are agreed and used to prioritise [shared] planning, commissioning and delivery, and their potential impact.
Delivery of health and care services
Research is required to provide a better understanding of the people, communities and organisations responsible for local delivery of health and care services. Looking at how different organisational, management and staffing configurations impact on services delivered, and output and outcomes for patients, service users and carers. In particular, whether the structures introduced by the Health and Care Act 2022 have facilitated a change in the culture and relationships within systems and the impact this has on delivery of services. This includes how mechanisms such as the Provider Selection Regime are used to procure services.
Efficiency and cost effectiveness
The unit should help inform the evidence base on how to maximise allocative efficiency. This should support understanding of how resources can produce the right care, for the right people, at the right time to maximise benefits. This should include methods and indicators to measure and monitor health gains achieved through provision of configurations of health and social care services.
Projects may identify the cost implications of initiatives in particular services, such as community health services, and their impact on health outcomes. The particular focus will be on cost-effectiveness and value for money.
Section 2: Policy context and background
The Health and Care Act 2022 has put in place a new structure for how health and care is delivered. The Act ensures that every part of England is covered by an Integrated Care System, which brings together NHS, Local Government and wider system partners to empower them to put collaboration and partnership at the heart of planning. Each Integrated Care System has an Integrated Care Board, an NHS statutory body and the successor body to Clinical Commissioning Groups (CCGs), and an Integrated Care Partnership, a statutory committee bringing together health, social care, public health (and potentially representatives from the wider public space where appropriate). It is intended to facilitate integration and greater collaboration. While direct responsibility for commissioning and providing NHS services is delegated to NHS England and Integrated Care Boards, and social care and public health is commissioned through Local Authorities, the DHSC sets the standards and rules for securing the integrity of the health and care system.
Section 3: Justification for research topics
The DHSC, through its system management responsibilities, sets the ‘system rules’ for the NHS. It is important that the Department has an evidence-based understanding of how the system is evolving and how well the key elements are working together.
Furthermore, the Health and Care Act grants significant flexibilities for local areas to arrange services in the ways that are best for their local contexts. The Act also places responsibilities on system leaders to make the best use of evidence to inform decision making. The evidence the PRU delivers will be integral in supporting local areas to make the best possible decisions.
Section 4: Other related research activity of which the unit will need to be aware
Applicants will need to be familiar with relevant policy research on integration policy, such as the Health and Care Act 2022 Post-Implementation Review.
Applicants will be expected to work closely with other PRUs, including the units on Economics of Health and Care Systems, Economic Methods of Evaluation in Health and Social Care Interventions, Public Health, Health and Social Care Workforce and Adult Social Care.