PhD Study: Commissioning form and function in place-based health and care
This research is led by Melissa Surgey as part of her PhD Fellowship. For more information about Melissa, please check our PhD Fellowships pages
What are we trying to do?
This project is exploring how health and care commissioning is changing in the current reforms to health and social care in the English NHS, which reorganises health and care planning and delivery on differently sized geographical footprints. This includes the introduction of Integrated Care Systems (ICSs), place-based partnerships and neighbourhood working. There are three main research focuses:
- How place is defined and perceived by different partners in health and care
- What commissioning functions will be done where in the new system, and the rationale for this
- The accountability mechanisms that underpin the relationships between system, place and neighbourhood
The aim of the project is to review policy development and implementation to date, and provide recommendations for the future development of health and care commissioning.
Why is it important?
ICSs and place-based partnerships represent one of the biggest reorganisations of the health service in recent times. The Health and Care Act 2022 introduced significant legislative changes to how health services will be commissioned, abolishing Clinical Commissioning Groups on a place footprint, and transferring their budgets and statutory responsibilities to Integrated Care Boards, which operate on a bigger, sub-regional (system) level.
Although ICSs and places have emerged out of a long history of collaborative working in many local health and care systems, as these new organisational forms take on statutory responsibilities the practicalities of how they will work reality must be further developed. This project builds on existing research into spatial organisation of healthcare, commissioning, and devolved health and care powers to fill a gap in research into these new partnerships.
How will we do it?
This is a qualitative study consisting of ethnographic case studies of two ICSs and a sub-study of a place within each of these ICSs.
Over 6 months, key meetings in the ICS and place governance infrastructure will be observed, this will be supplemented by an analysis of key strategic documents and meeting papers.
Interviews with national policy-makers and influencers have already been completedm the next step is to interview approximately 50 senior leaders from different health and care partners at system, place and neighbourhood level; these will be analysed using thematic analysis.