How to get NHS proposals funded - or confessions of an ex-commissioner

Monday, 6 October 2008

This is based on a presentation I recently gave on how to get services commissioned by the NHS.

Firstly a number of observations:

1) Most NHS funding streams are still process-based rather than outcomes-based so it is much easier to get funding to improve a process than improve an outcome
2) Most NHS funding sources are oversubscribed by a factor of at least 10
3) Most pilot projects are not given mainstream funding at the end of the pilot

Health initiatives tend to impact in one of the following 2 areas:

a) Quality improvements - Improving the quality of the patient experience or outcome (e.g. improved symptom management, more information, greater convenience, improved morbidity, improved mortality, etc)
b) Process improvements - Changing the process of healthcare delivery (e.g. reducing the need for outpatient or inpatient activity, increasing the number of patients a healthcare professional can support, remote monitoring of conditions, etc).

In my 7 years' experience in NHS commissioning, they are likely to get funded according to the following priorities:

1. Process improvements with a proven reduction in expenditure
2. Process improvements with a possible reduction in expenditure or a proven improvement in key performance targets
3. Process improvements with a possible improvement in key performance targets
4. Quality improvements with a proven impact on mortality or morbidity
5. Quality improvements with a possible impact on mortality or morbidity
6. Quality improvements or Process improvements with increased user satisfaction

Where this talks about proven, this needs to be based on evidence collected during the pilot stage and ideally:

• Using a commonly accepted measurement technique (e.g. health economic evaluation such as QALYs, marginal or full cost pricing, etc)
• Performed by an independent 3rd party, ideally a University department
• Using measures which have a historic record of success with the target commissioner (i.e. look at what they have funded in the past and why)


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