Commissioning for equity in the NHS: rhetoric and practice

Area of Science:

• Health policy analysis
• Healthcare management
• Public health

Background:

• The English National Health Service (NHS) has a policy goal of resource allocation equity.
• Clinical Commissioning Groups (CCGs) have been purchasers of health services since 2013.
• This review examines CCGs' capacity to achieve equity in commissioning.

Purpose of the Study:

• To review evidence on equity as a policy goal in NHS resource allocation.
• To assess the role and capacity of CCGs in achieving equity through commissioning.
• To understand the impact of 2012 reforms on equity in healthcare access.

Main Methods:

• Systematic literature search (since 1990).
• Review of grey literature, including CCG policy documents.
• Analysis of healthcare system policy documents.

Main Results:

• NHS 2012 reforms created a structure allowing significant variation among care purchasers.
• CCGs, separated from public health, show limited capacity and incentives for equity commissioning.
• Definitions of equity of access and health inequalities lack consistency and implementation.

Conclusions:

• Equity has been secondary to cost containment and quality improvement goals in NHS reforms.
• CCGs' commissioning practices currently prioritize efficiency over equity.
• Achieving health equity requires wider social policies beyond the NHS.