Developing effective joint commissioning between health and social care: Prospects for the future based on lessons from the past

Abstract

This paper argues that effective joint commissioning between health and social care is a necessary component of the Government's plans for adult services manifest in the policies of its 2006 White Paper Our Health, Our Care, Our Say. The paper begins with an analysis of the key objectives of the White Paper which predicate a move towards new models of integrated care that emphasise community-based management of adults with chronic diseases and long-term conditions. It then provides an historical examination of policies to show how the mechanisms for promoting joint commissioning have never been fully mastered or made effective. Lessons from the evidence for developing effective joint commissioning are then examined. In particular, the multi-agency 'strategic commissioning' approach emphasised in the White Paper is contrasted with NHS policies that emphasise choice and contestability and a return to practice-based commissioning. The paper postulates that commissioning agencies are being entrusted with developing a care pathway model that aims for a substantial reinvestment into community-based care services to tackle long-term conditions. The paper concludes, however, that commissioners remain in a relatively weak position to achieve these goals and provides an evidence-based agenda for action if the strategic commissioning agenda is to become a reality.