It is worth noting however that even where the The benefits of devolution or distribution of procurement of services takes place at the most local commissioning responsibility should also be carefully level, there is still scope for the much wider range of balanced against the risk of fragmented skills and resources involved in commissioning to be commissioning. Reforms to the English health and shared across multiple organisations. Commissioning care system in 2012 which split responsibility for Support Units – which provide support functions to commissioning of health and care services amongst a GP commissioners in England – work across multiple number of bodies including NHS England, clinical commissioners. Some of this function may be commissioning groups and Local Authorities (see provided at a national level, but may also be locally Figure 8 below), have been criticised for producing a augmented by local alliance arrangements. As an fragmented system which makes the delivery of example of this, Victoria has a PHN alliance integrated services more challenging (Ham et al arrangement that aims to share evidence and 2015a). Distribution of commissioning responsibility guidance across the six PHNs in the state and also in this way also increases the need for stakeholder play a role in influencing important shared management across all organisations, making the stakeholders. Where commissioning is delegated to delivery and implementation of transformation plans a very local level, it is important to consider how more difficult. access to the full range of skills and resources required will be available, and whether there is a market available to support this. Figure 8 Commissioning responsibility in England following the 2012 Health and Social Care Act (adapted from Naylor et al 2013)
It is worth noting however that even where the procurement of services takes place at the most local level, there is still scope for the much wider range of skills and resources involved in commissioning to be shared across multiple organisations. Commissioning Support Units – which provide support functions to GP commissioners in England – work across multiple commissioners. Some of this function may be provided at a national level, but may also be locally augmented by local alliance arrangements. As an example of this, Victoria has a PHN alliance arrangement that aims to share evidence and guidance across the six PHNs in the state and also play a role in influencing important shared stakeholders. Where commissioning is delegated to a very local level, it is important to consider how access to the full range of skills and resources required will be available, and whether there is a market available to support this. The benefits of devolution or distribution of commissioning responsibility should also be carefully balanced against the risk of fragmented commissioning. Reforms to the English health and care system in 2012 which split responsibility for commissioning of health and care services amongst a number of bodies including NHS England, clinical commissioning groups and Local Authorities (see Figure 8 below), have been criticised for producing a fragmented system which makes the delivery of integrated services more challenging (Ham et al 2015a). Distribution of commissioning responsibility in this way also increases the need for stakeholder management across all organisations, making the delivery and implementation of transformation plans more difficult. Figure 8 Commissioning responsibility in England following the 2012 Health and Social Care Act (adapted from Naylor et al 2013)