Within the context of a complex health and care landscape, the route to becoming a commissioned service can be confusing, difficult, and frustrating. At our third Centre for Social Action Innovation Fund cohort event in early July, we explored these complexities (and frustrations!) and also discussed some successes and learnings.

So how do we find successes in health commissioning? Here are some top tips from the session:

1) Partnerships not competition

Ishrat Love-Chowdhury commissions mental health services in City and Hackney CCG. Her advice was to think about how you can deliver services or initiatives in partnership with others rather than as stand-alone interventions. An integrated and seamless service in partnership with other providers can result in a powerful business case to commissioners. This allows commissioners to focus on an end-to-end service rather than fighting through separate and siloed proposals from different service providers.

This advice was echoed by Nicky Runeckles. Nicky is currently the Managing Director of Monticola Consulting and previously, the Commercial Director of Big White Wall. She mentioned that establishing partnerships and collaborations with mental health trusts across the country was crucial to Big White Wall’s accomplishments and ability to scale nationally.

We have also seen these types of symbiotic partnerships within our portfolio of health innovations in Health Lab. For instance, the British Red Cross is currently working with Rutland’s Rural Community Council in order to embed their First Call Service into the council’s Community Agents Scheme. The Community Agents Scheme is a service that provides confidential information, advice and assistance about local services for people across Rutland who are in need of support. By partnering with a trusted service provider in the Rutland community, the British Red Cross has been able to scale their own service very successfully.   

2) Measurement as a process not a one-off activity

The process of learning about what is important to different commissioners takes commitment and time. Adrian Coggins commissions physical health services in Essex County Council. Adrian described how measures have changed as the commissioning landscape has shifted over the past 15 years of his career as a commissioner, from looking at particular clinical outcomes around physical health to social outcomes. Good Gym and The Conservation Volunteer’s Green Gym are both experiencing this particular shift and their programmes' evaluations (currently being supported by the Innovation Fund) is hoping to capture impact to both the social and physical dimensions of their service users. Rather than being disheartened about a potential moving target, Adrian’s advice to service providers was to understand the value you bring to a local health and care economy, and to have a lot persistence and flexibility.

3) Alignment not tangents

We also heard that services need to be aligned to local and national priorities. My Support Broker has been successful because of their clear alignment to the national and local focus on personalisation and personalised health care. The organisation has a model which clearly addresses personalisation by training and deploying support brokers who work directly with people (with any physical and mental health condition who need support and care) to ensure that they are living a life not dictated by their condition - on their own terms. The My Support Broker team have excelled at explaining how their model can help achieve personalised and cost-effective care and have subsequently been commissioned successfully by both local authorities and CCGs.

4) Hard slog not quick win

Perhaps the most important lesson that we heard was how much effort and time it takes to develop successful commissioner relationships. Whilst there may be some exceptional cases of ‘quick wins’, the usual story (even for exceptional services!) is that it all takes time. And unfortunately, there is no way to estimate the amount of time that's needed to foster these relationships – it will depend on the local commissioners and the local context.

5) Keep going - there’s a prize

Although health commissioning can be a complex, one of the main themes that we heard throughout the event was that amongst the complexity, there is a land of opportunity. At Nesta and within the Health Lab, we know first hand that commissioners are keen to look at new models of health and care and they appreciate the value that the VCSE sector as well as social action can bring. This openness and appreciation creates a field of opportunity and this was echoed strongly by Simon Morioka, the Joint Managing Director and Co-Founder of PPL Consulting, who works with commissioners across health and local government on a daily basis.

Capitalising on this opportunity is not necessarily easy - it takes smart partnerships, capturing measures that matter to commissioners, alignment with national and local priorities, and a whole lot of sweat. But with a complex combination of all of the above, developing successful commissioning stories becomes very possible.