Commissioning in health, education and social care : Models, research bibliography and in-depth review of joint commissioning between health and social care agencies. Technical report

摘要

What do we want to know? The way that public services are organised and work has changed considerably over the last 25 years. One of the main changes has been to divide the function of public agencies into service purchasers which ‘commission’ or ‘purchase’ services on behalf of the public and service providers which provide the services. This change has been introduced across all public sectors in many different countries. The broad aims of this research were to: identify research evidence on ‘commissioning’ or ‘public service purchasing’ in education, health and/or social welfare in the UK and other countries investigate the impact of ‘joint commissioning’ of health, education and/or social welfare services identify the factors which influence the impact of joint commissioning of health, education and/or social welfare services Who wants to know and why? This research project was funded by The National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme. This evidence may be helpful in improving the practice of commissioning and/or undertaking better quality research on commissioning in the future. What did we find? This project identified a far larger evidence base for service commissioning in health, education and social care than was previously known. A searchable database of research studies of commissioning in health, education and social welfare can be found at: http://eppi.ioe.ac.uk/webdatabases/Intro.aspx?ID=22 The proposed loose typology of commissioning will, if adopted, make it easier for future primary and secondary research to identify which type or types of commissioning are being investigated. The in-depth review on the impacts of joint commissioning between agencies in sectors identified a comparatively small number of low quality studies. The evidence about the impacts of joint commissioning cannot therefore be regarded as compelling. The evidence about the factors that affect commissioning was judged to be of better quality. Synthesis of the results of these studies highlight the importance to successful joint commissioning of: • trusting relationships between commissioners, and how these are built up over time by continuity of staff; • Clarity over responsibilities and legal frameworks, particularly in the context of any shared or pooled financial arrangements; • The importance of coterminosity between organisational geographical boundaries; • The development of clear structures, information systems and communications between stakeholders. Given the importance of joint working it is clear that these findings have resonance for the development of structures and relations and practices in the new NHS commissioning landscape. Furthermore, and perhaps most importantly, the new reforms provide the opportunity for the conduct of much-needed rigorous evaluative research on the impacts of different forms of commissioning. However, in order to realise this, it is imperative that any proposed changes are introduced in such a way as to create the conditions for rigorous comparative evaluative research on a sufficient scale to begin to address questions about the impact of different types of commissioning. How did we get these results? The project was completed in three stages consistent with the research questions addressed. A scoping literature review and an online stakeholder questionnaire on models and theories of commissioning provided information on practices, and models and theories of commissioning. The systematic review questions were addressed using systematic review methods: • Comprehensive and systematic searching for empirical research evidence on the impact of commissioning using multiple sources. • The selection of studies for the review based on pre-specified criteria. • Selection of a subset of studies for inclusion in the in-depth review that address the question of the impact of joint commissioning between health and social care agencies and factors that affect impact. • Detailed data extraction and quality assessment of the selected subset of studies. • Narrative synthesis of impacts and factors affecting the impact of joint commissioning between health and social care agencies.