CommiSSIONING Definition

The role of commissioning has evolved over the last twenty years.  Long passed are the days when commissioning meant little more than purchaser of health services.  Now it is more “a complex process with responsibilities ranging from assessing population needs, prioritising health outcomes, procuring products and services and managing service providers."  The process of commissioning itself, however,  has never been easy to define especially as a number of health policies such as wider patient choice have used the commissioning vehicle to deliver their objectives and then subsequently been inexorably linked to it.  As a result of this and the confusion that presides generally about the concept, there have been numerous attempts at defining commissioning, each of a slightly different nature.  Probably the best, although not perfect definition is that which was published recently in the consultation report “Liberating the NHS: Commissioning for Patients.”  This states that the central theme of commissioning as:

“to decide what services will best meet the needs of patients and local communities and to commission these services in ways that ensure high quality outcomes, maximise patient choice and secure efficient use of NHS resources” (Department of Health, 2010).

As can be observed, this does entangle a policy objective of patient choice within it which I would argue is not an essential consideration.  Notwithstanding this, it does highlight the main aspects that should be examined when involved in the role of commissioning: the needs of the local population, quality, outcomes and that NHS resources are used efficiently.  One aspect that is not explicitly stated as to do so has been said to "make voters - politically speaking - sick," but is of fundamental importance is that of rationing health resources.  In an environment where demand for services outstrips the capacity of local health authorities to pay for them, the commissioner must allocate funding in the best way possible and to do so is to ration health resources.  Rationing and other aspects dealt above will be discussed in more detail in subsequent sections.

Paul Towey 22/1/2012