Introduction

The aim of this book is to bring together in one volume the most important research which the Policy Research Unit in Commissioning and the Healthcare System (PRUComm) has undertaken during the period 2011 to 2018. PRUComm is a multicentre research unit based at the London School of Hygiene and Tropical Medicine (LSHTM), the University of Manchester and the University of Kent. It is led by Professors Stephen Peckham (LSHTM and Kent), Kath Checkland (Manchester) and Pauline Allen (LSHTM). PRUComm was funded (following an open competition) by the Policy Research Programme of the English Department of Health and Social Care (DHSC) (that is, the English Ministry of Health) from 2011 onwards to provide evidence to the DHSC to inform the development of policy on commissioning and the healthcare system. The analytical work supports understanding of how commissioning operates and how it can improve services and access, increase effectiveness and respond better to patient and population needs.

Commissioning

The term ‘commissioning’ is used in the context of the quasi-market structures in the English National Health Service (NHS), which will be explained in detail in the following chapter. Briefly, ‘commissioning’ can be understood as ‘the process of assessing needs, planning and prioritising, purchasing and monitoring health services, to get the best health outcomes’ (NHS England, 2018a). In other words, commissioning focuses on the demand side of the NHS quasi-market (where organs of the state make decisions on behalf of patients), as opposed to the providers of care, such as hospitals. The research extends to analysing the structure and operation of the NHS healthcare system as a whole, focusing on how commissioning can be used to influence providers’ behaviour. Clearly, the concept of commissioning is not confined to the English NHS. Quasi (or actual) markets were introduced into many English public services in the 1990s and the necessity for the state to undertake demand-side activities on behalf of (or in conjunction with) citizens became widespread (Le Grand and Bartlett, 1993). For example, social care has also been subject to marketisation (Forder et al, 2004). Although the term commissioning is not always used internationally, many countries have developed institutional structures for their public services in which commissioning functions are undertaken either by the state (for example, in the Italian healthcare system) (France et al, 2005) or social insurance funds (for example, in the Dutch healthcare system) (Rutten, 2004).