Health Services Management Centre Health Care Commissioning in the International Context: Lessons from Experience and Evidence

If you are reading this document, it is likely to be because you have an interest in how we can improve health care commissioning in the NHS and an appetite to use international comparisons to help us to do so. Our rationale for asking Chris Ham to produce this high level paper was based on a conviction that management decision making should be as much as is practicable evidence based (acknowledging the evidence is drawn largely from empirical observation) and that it is imperative to learn from the experience of others. We need always of course to take into account when making international comparisons the different historical, social, economic and political context which shapes the provision of health care. Nonetheless, there are some very powerful observations in this paper relating to the fundamental challenges of commissioning for health care; the need to recognise the probable limitations of commissioning as the sole tool to deliver a world class health care system; and that the best performing systems are characterised by integration of commissioning and provision with alignment of incentives for clinicians. I will endeavour to keep these messages in my mind as we move forward in the West Midlands on the implementation of World Class Commissioning.