About market shaping and development
Person-centred care requires a different approach to arranging health, care and support that puts the person at the centre of the process of planning how their needs are met with more control over how services enable them to improve their health and wellbeing.
Through IPC, this will include access to a wider choice of service and support options from non-traditional providers, from the voluntary sector and by enabling people to draw on universal services available in the community.
Experience from the introduction of personal budgets in social care and more recently in health demonstrates that people can and do make different decisions about how to meet their needs when afforded the opportunity.
This has implications for how services are planned and delivered that will shift the commissioning role over time towards “market shaping” in the areas where IPC is introduced.
This requires a different and more facilitative sort of commissioning so that commissioners support the adaptation of existing services and the development of new options to meet changes in demand and aspiration.
Market shaping should be understood as a cycle of coordinated action that extends beyond commissioning and procurement to include working collaboratively across organisational boundaries to understand what people want and need, reshape services and develop community resources accordingly.
Meeting this challenge will require action at all stages of the commissioning cycle and strong engagement with patients and communities throughout. An approach to market shaping might include:
- Understanding what is available – where the scope of services under consideration is far wider than those currently dealt with, reflecting the focus on supporting self-management, prevention and community capacity building.
- Planning what needs to change – where the mechanisms for influencing supply reflect the shift in power towards patients, connecting individuals and communities to services, mapping assets and resources and sharing information about what people want and need.
- Intervening where needed – where the approaches to securing supply and encouraging innovation may differ from block contracts, where providers are supported through a transition to different contractual models and where individuals increasingly purchase care and support for themselves, with the support they need to navigate their options.
Key messages for NHS commissioners on market shaping and IPC:
- A significant increase in personalised care and support planning and personal budgets will require commissioners to develop a more rounded understanding of the local system and different relationships with the provider market – the development of Market Position Statements has been one tangible example of this in social care.
- This will mean focusing on what people want and an ability to think beyond conventional services and tariffs.
- This requires a different approach to engagement to ensure that commissioning decisions are coproduced with people and communities.
- Commissioners will need to address the current use of NHS resources proactively, to free up money for personal health budgets and avoid double funding.
- Commissioners will need to work with providers to ensure a safe and sustainable transition to new funding models, supporting and nurturing the development of a diverse range of personalised services.
- There will need to be changes in contracting practice to enable more flexible arrangements (including independent user trusts and individual service funds, lead provider models and outcomes based approaches) that free providers up to respond directly to customers.
- This will enable the growth of new types of provider, including micro-providers and social enterprise, who can be well placed to focus on meeting individual needs and preferences.
- An increase in direct payments will mean more personal assistants and a need to develop local direct payment support services.