McMahon, Jamie
(2019)
The development of a fully integrated, outcomes based, whole system framework of public sector commissioning for the health and wellbeing of the population.
[Dissertation (University of Nottingham only)]
Abstract
Integration of public services is a key policy objective for every government and policy maker, ever increasingly so. However, the history of successful public sector integration is one of failed ambition. At a time when public services face increased demand and significant budget pressures the desire for integration of public services has grown, especially health and social care integration.
This report provides an analysis on whether a new model of whole system integrated commissioning across the full range of public services is required in order to effectively improve the health and wellbeing of the population.
The research draws together a wide range of academic material and grey literature in order to consider the potential of a new model. The report considers the context of a number of public policy areas in order to articulate the art of the possible, namely focusing on the NHS, adult social care and public health but also considering the potential in areas such as children’s social care, housing and police and fire services. The report also outlines a proposition for the future model of integrated commissioning, in order to develop a framework against which the benefits and challenges can be considered.
Finally, the report makes the case for the integration of public service commissioning and then outlines key salient issues for consideration during the potential implementation of a new model.
In conclusion, this paper argues that current attempts to integrate health and social care are restricted by the structure in which public services in England are commissioned: a disparate range of organisations managing budgets, placing organisational priorities above achievement of health and wellbeing outcomes. It argues that if policy makers are to make the required step change needed to deliver a 21st century model of public services that is centred on the health and wellbeing of the population, prioritising the wider determinants of health, a significant redesign of the structure of public service commissioning is required. Furthermore, any new model of public sector commissioning should be centered on the principles of: single budget holder, population based, outcomes focused and localised.
The report recognises that the proposal under consideration requires significant change and investment, and any proposal is only as good as its implementation. The analysis also highlights weaknesses in evidence base for integration generally, meaning a case for change is based logical implications for the benefit to society as a whole.
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