Looking beyond individual services

Reflecting on her career across provider, regional and national roles, Kathy explains that what drew her to commissioning was the opportunity to think beyond individual services and focus on the health of entire populations.

For Kathy, commissioning provides a unique opportunity to influence outcomes at scale, particularly for communities experiencing the greatest health inequalities. Rather than focusing solely on treating illness, commissioners have a responsibility to understand population need, direct resources effectively and create conditions that improve health outcomes over the long term.

This population perspective is increasingly important as health systems seek to balance growing demand with finite resources.

The opportunity presented by the NHS 10 Year Plan

The conversation explores how commissioning aligns with the three shifts outlined in the NHS 10 Year Plan: moving care from hospitals into communities, shifting from treatment to prevention, and making better use of digital technology.

While many of these ambitions have been discussed for decades, Kathy argues that conditions are beginning to align in a way that creates genuine opportunity for change.

Hospital demand continues to increase, placing pressure on both capacity and finances. At the same time, there is growing recognition that long-term sustainability depends on helping people stay healthier for longer and supporting them to manage their health more effectively outside traditional hospital settings.

Commissioning has an important role to play in enabling that shift by creating incentives, designing services and directing investment towards approaches that deliver value for populations rather than simply activity.

Strategic commissioning starts with understanding communities

A key theme throughout the discussion is the importance of strategic commissioning.

For Kathy, this begins with understanding local populations in far greater detail than has often been possible in the past. Better use of data, analytics and population insight can help systems identify different needs across neighbourhoods and tailor services accordingly.

This is particularly important because communities are not all the same. Rural populations, coastal communities and urban areas with high levels of deprivation face different challenges and require different approaches.

Strategic commissioning therefore involves more than allocating budgets. It requires understanding how people experience services, identifying gaps in provision and ensuring resources are targeted where they can have the greatest impact.

As healthcare becomes increasingly integrated, this also means working beyond traditional NHS boundaries, collaborating with local authorities, voluntary organisations and other partners whose work influences health outcomes.

Developing the next generation of commissioners

As responsibilities have evolved, so too have the skills required to commission effectively.

Kathy highlights the growing importance of areas such as data analysis, procurement, partnership working, contract management and service transformation. Bringing these disciplines together requires specialist expertise and strong leadership.

For that reason, she argues that developing commissioning capability should be a priority for the future. Delivering the ambitions of the NHS will depend not only on having a clear vision, but also on having people with the skills and experience needed to turn that vision into practical action.

Investment in current and future commissioners, she suggests, will be essential if systems are to make full use of the opportunities available to them.

A vision for the next 20 years

Looking ahead, Kathy shares an optimistic vision for the future.

She describes neighbourhood-based services that are fully embedded within communities and closely connected with local partners, making it easier for people to access support close to home. In this future, hospitals remain vital but are focused on delivering the specialist care that only they can provide, while more health and wellbeing support is available through local, integrated networks.

Digital tools, improved data sharing and stronger collaboration across organisations could make services easier to navigate and more responsive to individual needs.

Despite the scale of change required, Kathy concludes with a reminder that the purpose of commissioning remains simple; structures may evolve and organisations may change, but successful commissioning ultimately depends on people working together to improve outcomes for the populations they serve.

The Next 20 is a celebration of 20 years of The PSC making public services brilliant. We're looking at lessons from the past, while also considering the biggest challenges in the next 20 months, and the biggest opportunities in the next 20 years. Explore our other episodes on your preferred podcast platform.