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This article describes a process undertaken to develop a set of commissioning principles to support the commissioning of secure learning disability services across England. The principles, shaped around the 11 competencies laid down in the World Class Commissioning competencies framework (Department of Health, 2008a), were produced following a scoping exercise that looked at provision and commissioning of secure learning disability services within each strategic health authority (SHA) area in England. Specific details were collected about types of services provided, including detailed service specification, quality indicators, how these (specialist) services link with local services (secure and non secure) and cost of services. Information collected about commissioning concentrated on strategic vision, practical commissioning arrangements, how the quality of services was monitored, how access to services was controlled and how ‘secure’ service users are reintegrated back into local (non secure) services and communities. This scoping exercise was augmented by qualitative data obtained from interview with a group of former service users. Themes generated through the interviews were integrated within the general guidance. A quality assurance framework based on the World Class Commissioning Competencies is proposed, against which specialist and local commissioners can benchmark their current commissioning arrangements.

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.

Specialist CAMHS provide skilled assessment and interventions for children, young people and their families who have mental health disorders. The training needs of the staff who work in specialist CAMHS are not always clear or prioritised, due to the complexities and differing contexts in which specialist CAMHS are provided. The aim of this paper was to establish stakeholders' experiences of service complexities and challenges that affect training within specialist CAMHS. The project employed interviews to gain wide‐ranging consultation with key stakeholder groups. The sample consisted of 45 participants recruited from policy departments, professional bodies, higher education providers, commissioners, service managers, and practitioners. The participants identified a number of themes that limit training, and put forward solutions on how these could be facilitated in the future. Emerging themes related to leadership and the role of service managers, strategic management of training, commissioning, levels of staff training, resources, impact of training on service users, and availability of training programmes. The findings emphasise the need for the strategic workforce planning of training to meet service delivery goals. Policy, commissioning, workforce training strategies, service needs, and delivery of training should be integrated and closely linked.

This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.

The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.

The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.

This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.

This article aims to cover the experience of working with the new framework/criteria for specialist neuro‐rehabilitation services to meet the needs of patients with rare or complex conditions to achieve eligibility for a level 1 status.

Royal Leamington Spa Rehabilitation Hospital is currently collecting the full UK Rehabilitation Outcomes Collaborative (UKROC) dataset for all in‐patient episodes. A number of tools for measuring rehabilitation needs were gathered by the multi‐disciplinary team (i.e. costing of the service including staffing, building, equipments, etc.), and a range of clinical measures including needs: (the rehabilitation complexity scale); inputs: the Northwick Park nursing and therapy dependency scales (NPDS, NPTDA); and outcomes: the UK functional assessment measure (UK FIM+FAM) which are collated on the national UKROC database.

These measures have been used to assess the level of a patient's complex needs and to help formulate bandings, which are being used to inform national tariffs. A number of advantages and disadvantages have been acknowledged from the introduction of the new criteria and have been addressed in this viewpoint. As the current trend for services is to be paid (payment by results) depending on activity and outcome, it is essential to provide good outcome data to monitor performance and justify the units' effectiveness.

This paper outlines the authors' journey to achieve specialist commissioning and highlights the importance of monitoring and measuring the units' performance to reflect the continuous needs of the NHS and patients.

This paper provides an overview of the national child and adolescent mental health service (CAMHS) mapping exercise, the workforce data reported in the mapping between 2003 and 2006, and how this data relates to current policy. The paper will first outline key issues within current CAMHS workforce policy and provide an introduction to the mapping process itself in order to establish the context in which the findings from the mapping exercises are being presented. The mapping is carried out by Durham University on behalf of the Department of Health. Core trend data is provided on the growth and development of the specialist CAMHS.

Torbay Care Trust has been widely promoted as an effective model of integrated health and social care, and yet the impact of reforms introduced by the previous and current governments has been to destabilise its partnership coherence and its organisational form. This paper seeks to explain why this is the case, highlighting the potentially damaging consequences for the local, currently productive, system of care; and to indicate the local adaptations necessary to maintain progress, which are seen as under continuing threat in the current financial environment.

This is a personal reflection by the chief executive of Torbay Care Trust, reviewing the documented progress made since 2005.

The model of partnership, collaboration and risk sharing carefully nurtured over 15 years in Torbay has been proven to be beneficial not only for local people, but for NHS financial and clinical performance generally, and for social care performance. This is now paradoxically being undermined by the more commercially‐minded policy approaches of Labour's Transforming Community Services programme and by the current NHS reforms. New tensions have arisen across the “health and social care divide”.

The current government is unequivocally committed to integrated care, and specifically to integrated health and social care. The Torbay experience gives insight firstly into the care and attention which may be needed by government to secure this over forthcoming years; and secondly to the way in which integrated commissioning will have to be conceived and organised in the new system, and how integrated services will have, in turn, to be commissioned, and operated.

By bringing together the management of the local authority social services department and the new primary care trust, an alternative to the ‘care trust’ model has been tested in this London borough. A senior manager here describes the background, and outlines both the achievements and the difficult issues that remain.