Best start in life: cost-effective commissioning

Public Health England  |  March 2018   | Best start in life: cost-effective commissioning  

Public Health England has produced guidance for local commissioners to provide cost-effective interventions for children aged up to 5 and pregnant women.  It is designed to support local authorities and clinical commissioning groups  when making commissioning decisions.


The interventions included in the tool have been selected because they demonstrate cost-effectiveness and good economic return aimed at the target population(s).  In total, there are eleven interventions; two of these are focused on breastfeeding uptake and the other nine look at preventing or treating postnatal depression (PND).

Best start in life: cost-effectiveness and ROI of interventions,  a report which provides further details on how the tool was constructed can be read at PHE 

Best start in life: return on investment tool can be  downoaded from PHE  

Further details are available at Public Health England 



Falls prevention: cost-effective commissioning

Guidance from Public Health England (PHE) for commissioners and communities to provide cost effective falls prevention activities.  Local authorities and Clinical Commissioning Groups (CCGs) can use results from the tool to protect and improve the health of their local populations when making commissioning decisions.

The flexible Excel sheet allows for results to be tailored to the local situation based on the knowledge of the user. All interventions are aimed at those aged 65 and over. It can be accessed here 

The accompanying report, A Return on Investment Tool for the Assessment of Falls Prevention Programmes for Older People Living in the Community,  which explains how the tool was constructed and outlines the main findings, can be read here 

PHE have also produced a structured literature review which identifies which interventions are cost-effective in preventing falls in older people living in the community can be downloaded from their website.

Alchol and drugs prevention, treatment and recovery: why invest?

A new resource by Public Health England (PHE) poses this question, to support local commissioners, providers and healthcare professionals to make the case for investing in drug and alcohol treatment and interventions. 

PHE spend
Image source: Public Health England

Estimates show that the social and economic costs of alcohol related harm amount to £21.5bn, while harm from illicit drug use costs £10.7bn. These include costs associated with deaths, the NHS, crime and, in the case of alcohol, lost productivity.

Providing well funded drug and alcohol services is good value for money because it cuts crime, improves health, and can support individuals and families on the road to recovery.

PHE partnership
Image source: Public Health England

PHE have produced a set of 32 slides, outlining the impact on families and communities, the costs, the benefits and challenges and approaches,  all of  which can  be downloaded.

Full  guidance from PHE’s website

All the Why invest? slides are available from PHE to download here 


Reducing prescriptions for over-the counter medicines

NHS England is launching a public consultation on reducing prescribing of over-the-counter medicines for 33 minor, short-term health concerns.


These prescriptions include items for a condition:

  • That is considered to be self-limiting and so does not need treatment as it will heal of its own accord;
  • Which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care but may decide to seek help with symptom relief from a local pharmacy and use an over the counter medicine.

Vitamins/minerals and probiotics have also been included in the consultation proposals as items of low clinical effectiveness which are of high cost to the NHS.

NHS England has partnered with NHS Clinical Commissioners to carry out the consultation after CCGs asked for a nationally co-ordinated approach to the development of commissioning guidance in this area to ensure consistency and address unwarranted variation.  The intention is to produce a consistent, national framework for CCGs to use. The consultation closes on the 14 March 2018.

View the full consultation document here

Musculoskeletal conditions: return on investment tool

Return on Investment of Interventions for the Prevention and Treatment of Musculoskeletal Conditions | Public Health England

This tool has been designed to aid healthcare commissioners and providers in England who wish to assess the cost-effectiveness of interventions for the prevention musculoskeletal (MSK) conditions.

It is hoped that the tool will aid decision-making and increase the uptake of cost-effective interventions aimed at the prevention of MSK conditions. Conditions within the scope of this tool are: Lower back pain; chronic knee pain and osteoarthritis (hip and knee).

Full detail at Public Health England

Mental health services: cost-effective commissioning

Return on investment resources to support local commissioners in designing and implementing mental health and wellbeing support services. | Public Health England

Public Health England has produced a series of resources around mental health services.

The commissioning report summarizes the evidence on promoting good mental health and reducing the impact of poor mental health, generated through a rapid evidence review.

The return on investment (ROI) tool and user guide:

  • builds on the evidence in the commissioning report
  • can be adapted to local conditions
  • presents results showing the economic benefits of each intervention
  • show you how to use the ROI tool

The barriers and facilitator report identifies issues that can make the commissioning of mental health and wellbeing interventions easier or more difficult in a local area.

Local authorities, clinical commissioning groups, Health and Wellbeing Boards and their local partners (for example schools, employers, police) can use these set of resources to improve the provision of mental health services.

The documnets can be accessedd via Public Health England

Where next for commissioning?

Councillor Izzi Seccombe, chairman of the Local Government Association Wellbeing Board, shares her view on where next for commissioning as part of Provider Voices – a new publication series from NHS Providers.

Local government has been actively commissioning services for decades and sees commissioning as a continuous ongoing process, which starts with an assessment of needs, followed by an identification of priorities, market and demand management, contract development and procurement. The NHS sometimes focuses narrowly on procurement, and would benefit from adopting a whole-cycle approach.

Commissioning is far wider than contracting and procurement. Assessing the quality and outcomes of commissioned services is vital to ensure value for public money and to inform future commissioning decisions.

Local government is moving away from commissioning activities or input towards commissioning for outcomes. This approach is person-centred and doesn’t just treat individual health conditions. Its focus is on what matters to the individual: what makes their life worthwhile, and what they want to get out of their life.

Read the full post here