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The Government's vision for social care highlights choice and control by individuals. This paper draws on findings from a King's Fund study and considers how far collaborative commissioning is ready to meet the challenges of ensuring a diverse menu of flexible, integrated services for people using either direct payments or individual budgets. It concludes that more needs to be done to build commissioning skills, and other investment in developing the care market will be needed to deliver the Green Paper's aspirations.

This paper is the sequel to the authors' earlier paper in this journal and aims to present the “future research” outlined in that paper.

The approaches being employed by Welsh local authorities in commissioning home care from the independent sector are surveyed to see how a mixed economy of care is being implemented. The observed differences are analysed to see what can be learnt for the benefit of public sector managers concerned with the development of commissioning practices. Semi‐structured interviews have been performed with home care managers and commissioning officers in 13 (60 per cent) of the local, unitary authorities in Wales. Managers at independent home care providers have been interviewed also. The study has been ongoing since September 2004. For comparison, Barnet in England has been included because, unlike any Welsh authority, it has implemented 100 per cent outsourcing of home care. Croydon has been included as it has a good practice brokerage that has helped it to expand its provision from the independent sector.

Great diversity is seen in the approaches adopted by the Welsh local authorities when commissioning home care from the independent sector. They differ in the proportion of home care that is commissioned from the independent sector, what is commissioned, the number of independent providers and the contractual arrangements. These features are used to develop a taxonomy of home care strategies that reveals high levels of diversity. It is seen that in Wales there has been less political drive and compulsion to outsource home care than in England, but the natural desire to reduce costs in the face of a growing need for home care is now driving outsourcing in Wales.

This paper provides guidance to public sector managers in local authorities seeking best practice in the commissioning of home care from the independent sector.

The existing literature contains little research into good practice in the commissioning of home care by local authorities from the independent sector. This paper is a timely contribution to addressing this shortfall.

The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care.

Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken.

Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident.

This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity.

Current English health policy is focused on strengthening the ‘demand-side’ of the health care system. Recent reforms are designed to significantly enhance the capability and status of the organisations responsible for commissioning health care services and, in so doing, to address some of the perceived problems of a historically provider/supplierled health system. In this context, commissioning organisations are being encouraged to draw on concepts and processes derived from commercial procurement and supply chain management (SCM) as they develop their expertise. While the application of such principles in the health sector is not new, existing work in the UK has not often considered the role of health care purchasers in the management of health service supply-chains. This paper describes the status of commissioning in the NHS, briefly reviews the procurement and SCM literature and begins to explore the links between them. It lays the foundations for further work which will test the extent to which lessons can be extracted in principle from the procurement literature and applied in practice by health care commissioners.

Joint commissioning is an important part of the current health and social care context and will continue to be crucial in the future. An essential component of any commissioning process is priority setting, and this paper begins to explore the idea of integrated priority setting as a key element of health and social care commissioning. After setting out the key terminology in this area and the main priority‐setting processes for health and social care, the paper describes a number of barriers that might be encountered in integrated priority setting. We argue that there are significant barriers in financing, accessibility, evidence and politics, and it is important that such barriers are acknowledged if priority setting is to become a component of joint commissioning. While these barriers are not insurmountable, the solution lies in engagement with a range of stakeholders, rather than simply a technical process.

Securing better health and better care outcomes for people by effective use of public resources is at the heart of the commissioning agenda. Commissioning should ensure that the needs and wishes of people are well understood, and the market managed, so there are a range of local supports and provision available at a reasonable price. This is particularly important for people with intellectual disability whose behaviour is challenging, where effective clinically informed leadership is essential. Although models of good practice have been demonstrated for more than 20 years, making this happen on a wider scale remains the real challenge. Common wisdom about positive practice is not common practice in meeting identified needs. This paper aims to demystify the ‘commissioning’ role, and highlights the case for change in current practice, exploring some of the key barriers that must be addressed and suggesting ways to achieve better outcomes.

The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.

The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.

The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.

Addressing the implementation of OBC in adult social care in England in the context of extra care housing.

The purpose of this paper is to present the perspectives of English adult social care sector partners on the qualifications and standards required for leaders as they prepare to meet the demands of commissioning personalised care. Continuing an action research cycle guided by Coghlan and Brannicks (2010, p. 4) organisational centred model (McCray and Palmer, 2009) it benefits from the previous experience and reflection in action of the partners and researchers. Set in a general social care context, lessons learned from the study outcomes will be of interest to both commissioners of services and service users with acquired brain injury.

A model of action research informed by Coghlan and Brannicks’ (2010, p. 4) organisational centred model focused on context, quality of relationships, quality of the research process and its’ outcomes was used. The role of the authors was to facilitate diagnosis of the leadership issues arising from the implementation of personalised care in the English adult social care sector and in collaboration with sector partners seek resolutions. Six focus groups comprising two commissioners, service providers, user group and care manager/social work leads were facilitated at two separate events in the south of England.

Findings presented are derived from focus group discussions with strategic and organisational leaders and service user partners from the English adult social care sectors. Analysis of focus group data identified a number of themes. The overarching themes of human resource management, gaps in industry standards and leadership are discussed here. Whilst industry sector standard qualifications and frameworks may be at the centre of strategic planning for transformation, findings here have identified that additional support will be required to create leaders who can commission successfully to create cultural change. New approaches to leadership development may be needed to facilitate this process.

The study offers a single method qualitative research approach based on two local authorities in the south of England. It presents a localised and particular view of leadership development needs.

The paper shows how action research can make a contribution to knowledge and practice.

The paper provides interesting new insights into the skills for commissioning in a changing public and third sector environment with reference to commissioning personalised support for people with brain injury.

The purpose of the paper is to investigate the inter‐ and intra‐organisational relationships in the commissioning of secondary care by primary care trusts in England, using a principal‐agent framework.

The methodology is a qualitative study of three case studies. A total of 13 commissioning‐related meetings were observed. In total, 21 managers and six consultant surgeons were interviewed.

There are a number of different levels at which contractual and managerial control take place. Different strengths of control at one level can affect willingness to comply with agreements at other levels. Agreements at one level do not necessarily result in appropriate or expected action at another.

The system for commissioning in the National Health Service (NHS) has changed with the introduction of payment by results and practice‐based commissioning. However, the dynamics of the inter‐ and intra‐organisational relationships studied remain.

Incentives within organisations are as important as those between organisations. Within a chain of principal‐agent relations, it is important that a strong link in the chain does not result in the exploitation of weaknesses in other links. If government targets and frameworks are to be met through commissioning, it may be advantageous to concentrate efforts on developing incentives that align clinician with NHS trust objectives as well as NHS trust with primary care trust (PCT) and government objectives.

This paper is based on original empirical work. It uses a principal‐agent framework to understand the relationships between PCTs and NHS trusts and highlights the importance of internal NHS trust governance systems in the fulfilment of commissioning agreements.

This article follows an earlier article in this journal (Goldman, 2010), examines the emerging government policy on integration and considers some of the implications for joint financing. Most primary care trusts (PCTs) and councils with adult social care responsibilities are engaged in joint financing and wider health and social care partnership arrangements. But, with the demise of PCTs and the growth in GP commissioning, there are issues and questions about the future of such arrangements. However, despite these organisational changes, partners must continue to be able to demonstrate the outcomes that integrated health and social care services are achieving.