Commissioning: further issues - Health Committee Contents

Written evidence from the Evidence Adoption Centre (CFI 02)

The Evidence Adoption Centre (EAC) is the East of England's coordinating centre for the Adoption of Evidence-Based Practice and Innovation.


1.  Introduction

The Evidence Adoption Centre provides a rapid on demand reviewing and evidence analyses service for commissioners of health care. We help them to make informed commissioning decisions by providing evidence based answers to focused questions. We aim to complete the reviews within a short space of time, usually 8-10 weeks.

2.  What is the process?

We provide a short, realistic analyses of the most up to date and relevant literature available in response to a specific and focused commissioning question. Together with the submitter of the question we focus the question to ensure that the answers will prove of real value to support commissioning decisions. The critical analyses of the evidence is conducted by our research officers, health economists and a network of high caliber critical appraisers based across the East of England.

This provides a pool of expert senior health care professionals conducting evidence appraisal reviews and peer reviewing their colleagues work. We are currently working with NICE to ensure that our methodology and processes are robust and vigorous. We aim to have NICE accreditation in place so that we can give all our reviews a kite mark to help commissioners be confident in the decisions that they make.

3.  The Critical Appraiser Network (CAN)

The Critical Appraiser Network is made up of high caliber critical appraisers form across the East of England working in health care. We currently have academics from the University of East Anglia, input from the Eastern Region Public Health Observatory (ERPHO), appraisers from the Institute of Public Health, Research Officers and Public Health Consultants. The CAN members are often the policy makers in their own organisations. As part of the EACCAN the members review the work plan, and share the work around reviews and peer reviews requested. The can ensures that the best expertise across the East of England is pooled and available for difficult commissioning questions.

4.  The Priorities Advisory Committee

The EAC hosts the East of England Priorities Advisory Committee (PAC). The PAC addresses the need for medicines and technologies where NICE guidance does not exist, needs updating with current evidence, or needs local interpretation. The objective of the PAC is to achieve prioritisation and make recommendations across the East of England which are high quality, consistent, efficient, transparent and evidence based. The PAC has resulted in a significant reductions in variations and duplications across the East of England and makes efficient use of resources and expertise.


4.1  We intend to examine further the assurance regime which it is proposed to establish around commissioning consortia in order to satisfy itself that the NHS Commissioning Board has sufficient authority to deliver its objectives defined in its Commissioning Outcomes Framework. (Paragraph 89)

5.1  The EAC welcomes the Committee's view that a robust assurance regime is required. Commissioning consortia should be encouraged to seek expert local input into all commissioning decisions. The EAC can help achieve this. Use of the EAC services will help commissioning consortia make intelligent commissioning decisions. No service redesign should be instigated without an expert review of the evidence for it, neither should any adoption of technology take place without supporting evidence. The EAC supports commissioners in this function.

6.    The Committee believes it is essential for clinical engagement in commissioning to draw from as wide a pool of practitioners as is possible in order to ensure that it delivers maximum benefits to patients. GPs have an essential role to play as the catalyst of this process, and under the terms of the Government's changes they, through the commissioning consortia, will have the statutory responsibility for commissioning. They should, however, be seen as generalists who draw on specialist knowledge when required, not as the ultimate arbiters of all commissioning decisions. The Committee therefore intends to review the arrangements proposed for integrating the full range of clinical expertise into the commissioning process. (Paragraph 96)

6.1  The Reviews and Peer Reviews of the EAC are made via the Critical Appraisal Network, described in point 3 above. The CAN is made up of Public Health Consultants, Commissioners, Health Economists and Academics etc, across the East of England who have an interest in Health Care Commissioning and are experts in their field. The EAC has a high personal specification for CAN members. The EAC welcomes the Committee's view that high calibre expertise from a wide pool of practitioners should be available to Commissioning Consortia and that these views should be sought for commissioning decisions.

7.    Although the Committee understands the value of the separation of the commissioner and provider functions it believes it is important that this function separation is not allowed to obstruct the development of high quality and cost effective service solutions. We therefore intend to review the arrangements proposed in the Bill for reconciling these conflicts. (Paragraph 102)

7.1  The EAC welcomes this approach. Advice, recommendations and opinions in response to commissioning questions are independently made by the EAC and PAC and will follow robust, NICE accredited processes.

8.    The Committee agrees that local engagement with the commissioning of primary care services is important and therefore welcomes this development. The potential conflict of interest between consortia and local primary care providers does however remain. We therefore intend to review the arrangements proposed in the Bill for the commissioning of primary care services. (Paragraph 104)

8.1  As per 7.1 above.

9.    The commissioning of services that either work across [health and social care] boundaries, or are intimately linked is therefore an issue to which the Committee attaches great importance, and we intend to review the effectiveness of the structures proposed in the Bill which are designed to safeguard co-operative arrangements which already exist and promote the development of new ones. (Paragraph 107)

9.1  The EAC regards the use of evidence when commissioning across boundaries services as essential. The EAC is actively seeking across professional boundaries input to the CAN. This will encourage cross sectional input in commissioning decisions. The EAC is a model that could be adopted nationally to support cross boundary commissioning decisions.

10.  We intend to review the arrangements proposed in the Bill to enable commissioning consortia to address these issues [cross-area collaboration by consortia in reconfiguring services] effectively; this will include a review of the ability of the new system to encourage commissioning consortia to cooperate in achieving the benefits to patients which may be available from major service reconfiguration. (Paragraph 110)

10.1  As 9.1 above.

11.  The Committee intends to review the arrangements proposed in the Bill for enabling consortia to reconcile this potential conflict [between patient choice and commissioning] by enhancing patient choice at the same time as delivering the consortium's clinical and financial priorities. (Paragraph 115)

11.1  The EAC welcomes this stance. Patient choice and input into commissioning is a difficult task. Traditional assessments based on effectiveness and cost effectiveness need to assess individual value as well. The EAC and PAC have incorporated PPI into the development and discharge of its processes. PPI is encouraged via workshops, presentations, web forums and feedback. The evidence reviewed is assessed for patient participation and input. Emphasis is laid on showing how evidence has been used to inform commissioning decisions.

12.  The Committee does not find the current stance on patient and public engagement in commissioning persuasive. The National Health Service uses taxpayers' resources to deliver a service in which a high proportion of citizens take a close interest both as taxpayers and actual or potential patients. While the Department may be right to point out that there is no special virtue in uniformity of structure, the Committee regards the principle that there should be greater accountability by commissioners for their commissioning decisions as important. We therefore intend to review the arrangements for local accountability proposed in the Bill. (Paragraph 118)

12.1  As above in 11.1.

13.  The Government must support consortia and existing commissioning organisations to form clear and credible plans for debt eradication and for tackling structural deficits within their local health economy. The Committee intends to further review this issue in its further work. (Paragraph 123)

13.1  The EAC welcomes the proposal that the government insists on credible deficit plans. The EAC in the East of England has been specifically designed to support the current SHAs QIPP plans which are designed to address the need for efficiency savings and innovation. This model is appropriate for adoption nationally.

14.  Further information about the EAC can be obtained from

January 2011

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