News and Comment

Putting user-driven commissioning on the NHS agenda

Tuesday 25 June 2013


Bernd Sass is Strategic Partnership Manager at Disability Rights UK

Alongside our partners Shaping Our Lives and CHANGE – Disability Rights has been working with the Department of Health, NHS England and Public Health England to try and ensure that the ‘lived experience’ of disabled people is prioritised in all future health and social care policies.

As part of this, Disability Rights and our partners were invited to respond to the latest draft for guidance on the involvement duties – i.e. the duty for the health service to involve patients in decisions relating to their care – set out in the Health and Social Care Act 2012. We have always believed that the answers to the many challenges in health and social care lie in the creation of strong partnerships with individual disabled people and wider communities. However, we feel that an opportunity to convince the newly established Clinical Commissioning Groups (CCGs) of the importance of engaging and investing in genuine co-production as an integral part of the commissioning cycle is in danger of being missed.

As such, we made two clear points when feeding back on the involvement guidance. Firstly, that the business case for greater involvement of users in commissioning services needs to be made much more strongly: without financial figures and clear guidance to capture evidence there will be no comprehensive improvement. And secondly; that there is a need to empower and increase people’s capacity to act as change agents in the process.

Taking these two issues in turn, current guidance to commissioners lacks a clearly illustrated public sector business case, i.e. a way of demonstrating that user-driven commissioning will save the NHS money. As the guidance in a previous guise pointed out, “people (can be) inclined to be more radical in their thinking about options than managers and professionals”. There remains a real need to build consensus around things like ‘minimum staffing levels’, quality standards and fair and viable transition arrangements in service re-configuration, while capitalising on the expertise of user-led and voluntary community social enterprise organisations.

The second point relates to the fact that evidence shows that empowering patients from simply having a voice to having a say, has been shown to improve outcomes. However, in order to realise this goal something of a cultural shift needs to take place, requiring investment in training for patients and the public to become co-change agents and thereby push for improvements. We feel that by adopting a commissioning support infrastructure model that is more akin to that in social care – where capacity building, individual support planning and representation are all or partly commissioned out to independent user-led organisations – would go some way to helping the NHS to achieve this.

Last December Disability Rights produced a report on user-driven commissioning, illustrating how the model can be achieved. These approaches have already been introduced in six facilitated local partnerships between commissioners and innovative user-led projects. From the outset in these partnerships people were seen and encouraged to pursue their own pathways. Thus, commissioners could not approach providers and come up with ready-made services, but instead had to co-produce those new pathways with people on the basis of their wants, needs, assets and insights.

We are planning to expand this programme from social care to the NHS and align our learning with approaches such as experience-led commissioning, in the hope that it encourages a greater shift from merely giving the users of services a voice, to bestowing them with real power.

If you are interested in discussing the issues raised in this blog further please email Bernd Sass, Strategic Partnership Manager at Disability Rights UK