Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning upon clinical activity in the English NHS: A mixed methods study of cervical screeningCitation formats

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@article{159f9413113f48b5891a7d9db4e62d25,
title = "Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning upon clinical activity in the English NHS: A mixed methods study of cervical screening",
abstract = "Objectives: Explore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms. Methods: Qualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities, service providers), observations of commissioning meetings in two metropolitan areas of England. Quantitative: triple-difference analysis of national administrative data. Variability in the expected effects of HSCA on commissioning was measured by comparing CCGs working with one local authority with CCGs working with multiple local authorities. To control for unmeasured confounders, differential changes over time in cervical screening rates (amongst women, 25-64 years) between CCGs more and less likely to have been affected by HSCA commissioning organisational change were compared with another outcome – unassisted birth rates – largely unaffected by HSCA changes. Results: Interviewees identified that cervical screening commissioning and provision was more complex and ‘fragmented’, with responsibilities less certain, following the HSCA. Interviewees predicted this would reduce cervical screening rates in some areas more than others. Quantitative findings supported these predictions. Areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4 percent) than those dealing with one local authority (1.0 percent). Over the same period, unassisted deliveries decreased by 1.6 percent and 2.0 percent, respectively, in the two groups. Conclusions: Arrangements for commissioning and delivering cervical screening were disrupted and made more complex by the HSCA. Areas most affected saw a greater decline in screening rates than others. The fact that this was identified qualitatively and then confirmed quantitatively using strengthens this finding. The study suggests large scale health system reforms may have unintended consequences, and that complex commissioning arrangements may be problematic.",
keywords = "Screening, Health policy, Mixed methods, Commissioning, NHS, Health system reform",
author = "Jonathan Hammond and Thomas Mason and Matt Sutton and Alex Hall and Nicholas Mays and Anna Coleman and Pauline Allen and Lynsey Warwick-Giles and Katherine Checkland",
year = "2019",
doi = "10.1136/bmjopen-2018-024156",
language = "English",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ",

}

RIS

TY - JOUR

T1 - Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning upon clinical activity in the English NHS: A mixed methods study of cervical screening

AU - Hammond, Jonathan

AU - Mason, Thomas

AU - Sutton, Matt

AU - Hall, Alex

AU - Mays, Nicholas

AU - Coleman, Anna

AU - Allen, Pauline

AU - Warwick-Giles, Lynsey

AU - Checkland, Katherine

PY - 2019

Y1 - 2019

N2 - Objectives: Explore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms. Methods: Qualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities, service providers), observations of commissioning meetings in two metropolitan areas of England. Quantitative: triple-difference analysis of national administrative data. Variability in the expected effects of HSCA on commissioning was measured by comparing CCGs working with one local authority with CCGs working with multiple local authorities. To control for unmeasured confounders, differential changes over time in cervical screening rates (amongst women, 25-64 years) between CCGs more and less likely to have been affected by HSCA commissioning organisational change were compared with another outcome – unassisted birth rates – largely unaffected by HSCA changes. Results: Interviewees identified that cervical screening commissioning and provision was more complex and ‘fragmented’, with responsibilities less certain, following the HSCA. Interviewees predicted this would reduce cervical screening rates in some areas more than others. Quantitative findings supported these predictions. Areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4 percent) than those dealing with one local authority (1.0 percent). Over the same period, unassisted deliveries decreased by 1.6 percent and 2.0 percent, respectively, in the two groups. Conclusions: Arrangements for commissioning and delivering cervical screening were disrupted and made more complex by the HSCA. Areas most affected saw a greater decline in screening rates than others. The fact that this was identified qualitatively and then confirmed quantitatively using strengthens this finding. The study suggests large scale health system reforms may have unintended consequences, and that complex commissioning arrangements may be problematic.

AB - Objectives: Explore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms. Methods: Qualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities, service providers), observations of commissioning meetings in two metropolitan areas of England. Quantitative: triple-difference analysis of national administrative data. Variability in the expected effects of HSCA on commissioning was measured by comparing CCGs working with one local authority with CCGs working with multiple local authorities. To control for unmeasured confounders, differential changes over time in cervical screening rates (amongst women, 25-64 years) between CCGs more and less likely to have been affected by HSCA commissioning organisational change were compared with another outcome – unassisted birth rates – largely unaffected by HSCA changes. Results: Interviewees identified that cervical screening commissioning and provision was more complex and ‘fragmented’, with responsibilities less certain, following the HSCA. Interviewees predicted this would reduce cervical screening rates in some areas more than others. Quantitative findings supported these predictions. Areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4 percent) than those dealing with one local authority (1.0 percent). Over the same period, unassisted deliveries decreased by 1.6 percent and 2.0 percent, respectively, in the two groups. Conclusions: Arrangements for commissioning and delivering cervical screening were disrupted and made more complex by the HSCA. Areas most affected saw a greater decline in screening rates than others. The fact that this was identified qualitatively and then confirmed quantitatively using strengthens this finding. The study suggests large scale health system reforms may have unintended consequences, and that complex commissioning arrangements may be problematic.

KW - Screening

KW - Health policy

KW - Mixed methods

KW - Commissioning

KW - NHS

KW - Health system reform

U2 - 10.1136/bmjopen-2018-024156

DO - 10.1136/bmjopen-2018-024156

M3 - Article

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

ER -