Title: Commissioning, Co-commissioning and Being Commissioned; the NHS and Third Sector Organisations
Funder: Department of Health and Social Care

Abstract: The government’s Civil Society Strategy aims to involve third sector organisations, i.e. volunteers, charities and social enterprises, more in the NHS. From them the NHS will buy (commission) services for NHS patients. These bodies can also help the NHS decide what services the NHS should pay for (co-commissioning). Research now exists about the NHS buying services from (say) private hospitals but we know much less about how the NHS could work better with third sector organisations. This study aims to increase that knowledge. Partly this means NHS bodies knowing better how third sector organisations work, and about how they react when outside bodies buy services from them. We also wish to pin-point what third sector organisations themselves need to learn about how to work with the NHS. One reason for wanting to know these things is that third sector organisations often focus on the needs of groups for whom (as they see it) NHS services are not well designed. This research will therefore focus on three such areas: _x000D_ 1. Older people wanting activities (e.g. exercise or social contact) that will help keep them healthy_x000D_ 2. Hospice care _x000D_ 3. People with learning disabilities and complex behavioural problems. _x000D_ _x000D_ This three year study, by researchers with much experience of this kind of work, will focus on these three groups of people. We will make case studies of how the NHS buys services for them from third sector organisations. We will look, too, at how these bodies can help the NHS design better services for these groups. As the other side of the coin we will also look into how the NHS can help third sector organisations provide the evidence and other material that the NHS needs in order to buy services from them. We also wish to find out what happens to third sector organisations that sign contracts with the NHS to care for these groups. For example, does it make them behave more like NHS or other public bodies? We will analyse NHS accounts to find out where third sector organisations are providing NHS-funded services, what kind of services and for whom (for example, what services they provide for deprived or ethnic minority groups). By using these findings and surveys of staff and volunteers, we will find out what further skills, knowledge, training and perhaps other support both the NHS bodies and the third sector organisations working with the NHS need, in order to co-operate more fully. _x000D_ _x000D_ We are keen to involve patients and the public in this work, above all members of charities and not-for-profit bodies. The project Advisory Committee will include many such people to advise and guide us about our research questions and working methods, and in making sense of the findings. It will include service users, since they may have a different view from volunteers and paid staff. From the third sector organisations where we make case studies, we will recruit members to join the research team, so that they can learn-by-doing about how to deal with NHS bodies, and how to do their own research, in future, to help their own organisation win NHS funding and support. The project’s two research fellows will each be out-posted for short periods to the case study third sector organisations, both to collect data and help mentor VCSE colleagues. In these ways, and through the training and other support activities noted above, members of the public and patients will play a major role in this project.

Lay abstract: Research Questions_x000D_ _x000D_ RQ1. How do healthcare commissioners address the task of commissioning voluntary, community and social enterprises (VCSE) as service providers, and what barriers do they face? _x000D_ _x000D_ RQ2. What are the consequences for VCSEs, of the public bodies commissioning services from them? _x000D_ _x000D_ RQ3. How are VCSEs involved in CCG, local authority and other (e.g. ACS, NHS England) commissioning decisions? _x000D_ _x000D_ RQ4. What absorptive capacities do healthcare commissioners and VCSEs respectively need for enabling VSCEs to be commissioned, and for co-commissioning? _x000D_ _x000D_ Background_x000D_ _x000D_ National policies towards third sector organisations and the NHS Long Term Plan encourage the NHS to commission VCSE providers, and ‘co-commissioning’ (VCSE participation in NHS commissioning of providers of all kinds). Alongside potentially positive consequences of the NHS commissioning VCSEs as service providers and co-commissioning with them, previous studies also describe how, in certain circumstances, being commissioned by public bodies may compromise the characteristics of VCSEs which made them potentially valuable to the NHS commissioners in the first place. What ‘modes of commissioning’ help NHS commissioners productively commission different kinds of providers (NHS-owned, corporate, VCSE etc.) is partly understood, but not how the effective mode(s) of commissioning might differ for different kinds of VCSE. Increasing the absorptive capacity of both NHS commissioners and VCSEs to exploit the relevant research is also required. _x000D_ _x000D_ Aims and Objectives_x000D_ _x000D_ Besides answering the above research questions, this study aims at making a practical contribution to strengthening NHS and VCSE capacity to exploit evidence relevant to commissioning._x000D_ _x000D_ _x000D_ Methods_x000D_ _x000D_ Mixed methods realist evaluation:_x000D_ 1. Systematic comparison of case studies of the commissioning relationships between commissioners and VCSE providers._x000D_ _x000D_ 2. Cross-sectional and longitudinal analysis of post-2014 CCG accounts and other routine administrative data to show the extent and profile of CCG commissioning of VCSEs._x000D_ _x000D_ 3. Systematic comparison of case studies of NHS and VCSE co-commissioning._x000D_ _x000D_ 4. VCSE and commissioner self-assessment of their current capacity for participating in NHS commissioning, leading to design and implementation of development activities for strengthening their capacities, including involving VCSE members as co-researchers in the research project itself._x000D_ _x000D_ Purposive maximum-variety sample of sites in terms of commissioning relationships with VSCEs: one in each quartile for proportion of services provided by VCSEs; plus at least two and up to four 'positive deviance' sites have comparatively well-developed commissioning relationships with VCSEs.Three ‘tracer’ care groups: social prescribing for older people; hospices; and people with slearning disability and complex behavioural needs. _x000D_ _x000D_ _x000D_ Timelines for delivery_x000D_ _x000D_ Three years from October 2019. Milestones: _x000D_ 3 months: Elaborated criteria for study site selection._x000D_ _x000D_ 1 year: Initial profile of CCG commissioning of VCSEs._x000D_ _x000D_ 1 year: Profile of study organisations’ capacity for participating in commissioning._x000D_ _x000D_ _x000D_ Anticipated impact and dissemination _x000D_ _x000D_ Capacity building in participating (co-researching) VCSEs, as prototype for dissemination via networks of VCSEs and NHS commissioners. Evidence based guidelines for commissioning of, and co-commissioning with, VCSEs.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE