A new report from the think tank Reform argues that the current system of central commissioning of public services, including healthcare, is not delivering value for money. 'Vive-la-Devolution' says that commissioning of over £100 billion of public services spend, including 95% of the NHS's budget, could be devolved to some 38 regions delivering better outcomes at a lower cost to the taxpayers.
The report calls for a radical new approach to healthcare commissioning, involving rapid acceleration of the devolution agenda across England. Since 2000, eight devolution deals have been agreed in England. However, this report finds that to-date, devolution of public services commissioning has been no more than delegation, with the focus on generating economic growth. True devolution involves a shift in control from central government to a more localised body, with the power to commission public services, which means the design, purchase and evaluation of services.
The Reform report states: "Commissioners need the power to design contracts for providers to meet local needs most effectively - in healthcare, employment services, skills and offender management. This requires commissioners to hold non-ring-fenced budgets, with maximum freedom to design contracts to offer to competitive public-service markets. This will only flourish if commissioning areas are designed to cover geographies requiring similar interventions and governed by single, integrated and accountable commissioning bodies."
The report sets out the strong theoretical case for commissioning services at a local level, saying that local commissioners are best placed to tailor services to the needs of their regions. Such a move would make NHS England, Clinical Commissioning Groups (CCGs) and Police and Crime Commissioners (PCCs) redundant, with single commissioning bodies integrating commissioning functions, allowing commissioners to design policies that improve outcomes across policy areas.
It also states that commissioners should be focused on outcomes, not processes. In healthcare this can be achieved through using capitated contracts (per person funding based on individual characteristics), with the potential for some small outcomes payments, of around 10% of contract value, attached for key areas identified for improvement.
Vive-la-Devolution lists 10 core recommendations, including scrapping NHS England.
Download the full report here:
http://www.reform.uk/publication/vive-la-devolution-devolved-public-services-commissioning
