NHS Reset: Beyond commissioning - MHCC leading, facilitating, helping out during COVID-19

The impact of COVID-19 on the health and care system cannot be overestimated. Within a national command and control environment, local organisations have torn down organisational boundaries and worked together, under unprecedented circumstances, to make sure the people they care for are as safe and well as possible.

Old relationships have been strengthened, new relationships have been forged. National policy and guidance have, to a great degree, replaced local bodies’ freedom to make decisions. Local financial freedoms have been paused in favour of national direction. It’s a very different world from when we first started noticing a faraway threat towards the end of 2019.

So, in these times of national emergency, what have commissioning organisations such as Manchester Health and Care Commissioning (MHCC) actually done? What value have we added to the city’s response to COVID-19?

What is the point of us?

In normal times, I would respond by talking about our focus on population health and tackling health inequalities. How we use data, and insight from local people, to identify need and response. How we take a long-term view, working collaboratively with our partners and blurring the boundaries between health and social care, and between commissioners and providers. How we allocate resources to ensure we have excellent hospital care in the city when people need it. How, through our Local Care Organisation, we commission high quality health and care services in people’s neighbourhoods, bringing together community services, social care, primary care, and the vibrant voluntary and community sector, to keep people as well as possible, at home. How we monitor quality and safety across all sectors, and work with providers to improve it when we can.

But these aren’t normal times and, over the last six months, our aim has been to be as flexible and proactive as possible – leading programmes of work, facilitating system working, and helping out our provider colleagues. We haven’t focussed on what a ‘commissioner’ does; we have concentrated on what the city, its residents, and our partners need us to do.

For example, we have:

• implemented a policy of testing patients for COVID-19 prior to discharge to care homes from the outset
• led the creation of NHS Nightingale North West and provided a range of staff to work within it
• established and led system-wide governance to oversee and coordinate the work of individual organisations’ COVID-19 response
• created a £500,000 COVID-19 Recovery Fund for the voluntary and community sector in the city
• led work to respond to the emerging picture of disproportionate impact of COVID-19 on different communities in the city
• worked with Manchester City FC to create a Rest and Relaxation Centre for NHS staff at their stadium
• delivered our ambition for a digital-first primary care in three months, sourcing and distributing hardware to support practices
• encouraged requests for extra capacity from all providers and deployed staff to fill gaps
• commissioned a care home to only provide care to those with COVID-19proactively liaised with community groups to find out what they needed, supported when we could, and linked to other assistance when more appropriate
• continued with our plans to increase non-COVID-19-specific mental health spending in the city daily monitored all care homes and GP practices in the city to see if they required support or assistance
• sourced, packed and distributed toiletries, hand sanitiser and other ‘goodies’ to community groups and charities across the city on a weekly basis.

So a wide range of activity, some of it in line with our ‘usual’ role, some of it not. All of it, though, contributing positively to Manchester’s response to, and recovery from, the COVID-19 pandemic. None of it would have been possible without the skills, knowledge, experience and flexibility of all our staff who have been amazing throughout this time.

The future

As we move forward from this phase, we need to capture and build on what we’ve learnt. Things are likely to be tough in the medium term. While the budgetary reins have been loosened during the last six months to cope with an immediate threat, they are likely to be tightened over the coming months and years. This will happen locally, regionally and nationally and will no doubt be accompanied by talk of impending NHS reorganisations. Those of us who have been round a while are all too familiar with the upheaval these can cause and the need to keep a focus on what’s important – improving health and addressing health inequalities.

Whatever happens in the future, what we’ve seen in Manchester during the last six months, and indeed over the preceding five years, is that both commissioners and providers bring something unique to the table. It may be their skills, their knowledge, or their expertise. It may be how they work, who they work with, or their perspective.

Whatever it is, the impact is so much greater when we plan together, decide together, and work together. That’s what the public expect of us and COVID-19 has reminded us all of the value of it.

Ian Williamson is chief accountable officer of Manchester Health and Care Commissioning. Follow them on twitter @ManchesterHCC

Get involved in the NHS Reset campaign 

• Be part of our comment piece series by writing a blog -- please contact Joy.okunnu@nhsconfed.org 
• Read our NHS Reset briefing to learn more about the campaign.
• Share your views to shape the debate.
• Sign up for our NHS Reset webinars.
• Shine a light on your COVID-19 innovations and ingenuity.
• Join the conversation online #NHSReset