HSCFRU Future Research Activities
Future research activities might include the following:
Devolved commissioning in a time of financial austerity
Traditionally the bulk of both health care and social care has been commissioned by PCTs, local authorities, partnerships). However some aspects of care are subject to what might be referred to as devolved commissioning. The two most obvious examples of this are Practice Based Commissioning for health care and personal budgets for social care of individuals. Both of these initiatives were developed prior to the recent UK recession and fiscal crisis. Thus there might be some concerns about their applicability during a time of very limited or even negative growth in financial resources. The project would review the approaches to devolved commissioning and assess how well they will operate in a time of significant financial austerity.
The structure and role of the health and social care commissioning function in the future
There has been a considerable amount of criticism from various quarters about the role and operation of PCTs and it is not obvious that this criticism has abated following the merger process a few years ago. Much of the criticism seems to concentrate on PCTs focussing too much on operational contracting issues and too little on strategic issues and the re-shaping of local health services. Furthermore, it is not clear whether the implementation of World Class Commissioning has improved the situation. Similar criticism might also be made about the commissioning of social care in local government. The future of commissioning must be in doubt given the imminent general election at least in terms of structures and processes if not aims and objectives. A project in this area could aim to go back to basics and clarify a number of issues including: what commissioning organisations should be trying to achieve and what managerial functions they need to undertake to pursue their objectives.
The potential implications of Total Place for health and social care
The Total Place initiative is clearly one of the "hot topics" in the public sector at the moment. While the Total Place pilot sites have identified some very interesting findings around use of resources, variations, overlap etc it is important that Total Place should not be seen as a panacea for the financing problems of public services. Very interesting resource information has been generated but the key issue is how that information should be used, and by who, to effect change in public services. This project would consider how Total Place might develop in relation to the provision of health and social care and would consider what might be the financial management implications.
Quality and cost in health and social care delivery
Clearly both quality and cost are important issues in the delivery of health and social care. However, there is often an assumption among health professionals (and other public service professionals and the general public) that there is a direct linear relationship between quality and cost. In other words, more cost = more quality and vice-versa. Moreover, statements by organisations such as the Audit Commission sometimes reinforce this view. Experience from other sectors such as manufacturing clearly show that it is incorrect to assume that such a direct relationship exists in that cost can be reduced and quality raised. Moreover, it is also sometimes the case in health care that more cost equates to unwarranted interventions leading to reduced quality (in terms of clinical outcomes). Research in this area would involve reviewing a sample of quality improvement programmes to assess a number of factors including: definitions, frameworks, approaches outcomes etc.
Cost information and decision making in health and social care
Twenty three years ago, Professor Malcolm Prowle published a paper entitled "Cost information and decision making in the NHS" Obviously the world has moved on and both the range of availability of cost information and the types of decisions it might inform have changed enormously. A recent paper by a Dutch academic studied the use of cost information in various parts of the Dutch public sector. Briefly his conclusion was that not a lot of use was made by managers of cost information in making decisions and the situation had changed little in the last five years. This leads to the idea of research into how health and social care managers actually use (or don't use) cost information in making decisions and if they don't use it, why don't they. Such a review would need to cover decision making at all levels: strategic, managerial and operational and would be particularly relevant given the future cost pressures on services.
