Critical Appraisal of Healthcare Commissioning in the UK and Abroad

This report offers a critical appraisal of healthcare commissioning, examining its significance within the UK and international public health contexts. The introduction defines commissioning as a crucial process involving the prioritization, purchasing, planning, and monitoring of health services to achieve optimal health outcomes. It highlights various commissioning models and the role of the Healthcare Commission, emphasizing its functions in promoting quality, measuring healthcare system levels, and providing valuable information resources. The background section traces the evolution of commissioning in England, from its early involvement with local authorities to the emergence of Clinical Commissioning Groups. Critical appraisal 1 demonstrates a comprehensive understanding of healthcare commissioning and its importance to UK and international public health. Critical appraisal 2 builds on this understanding by focusing on the assessment of strengths and weaknesses. The report explores the distinctions between public health and healthcare, the factors influencing well-being, and the roles of public health specialists and clinicians. The report delves into the historical context of public health in England and the legal frameworks in place to protect public health. The report emphasizes the importance of health education and its impact on health promotion. The document concludes by summarizing the key findings and the implications of healthcare commissioning for public health, providing a comprehensive analysis of the topic.

HEALTHCARE
COMMISSIONING

Contents
INTRODUCTION...........................................................................................................................3
BACKGROUND.............................................................................................................................3
Critical appraisal 1...........................................................................................................................5
Demonstrate comprehensive knowledge and understanding of healthcare commissioning and
its importance to UK and international public health..................................................................5
STRENGTH....................................................................................................................................9
WEAKNESS..................................................................................................................................10
CRITICAL APPRAISAL 2...........................................................................................................10
STRENGTH..................................................................................................................................11
WEAKNESS..................................................................................................................................11
CONCLUSION..............................................................................................................................12
REFERENCES..............................................................................................................................12

INTRODUCTION
Commissioning is demonstrated as the process which access prioritising, purchasing and
planning, along with monitoring various health services in order to accomplish finest and better outcome
in the terms of health. Commissioning this process is defined as which acquires health services. This
process it is known as complex process which understand the health needs of the population and it also
involve the process of assessment. In addition this also involves planning services in order to meet the
needs as well as to secure the various services in a limited budget further which services have been
o0btained they are monitored in a proper manner thus in this way healthcare commissioning is required.
There are many models which have been used in the terms of commissioning . The healthcare
commission this is well known for non- departmental public which is probably sponsored by the health
department of UK. This commission of health it is mainly set for the purpose of promoting quality of
health or for the improvement of public health in Wales and England. Their main aim was to accomplish
this and alo0ng with this becoming an information source as well as authoritative source and further
making endure that these information can be used as the drive improvement. Healthcare commission their
main aim is to measure the levels of the health care system. They explains the role of limitations and
strength and outcome of indicators. They provides bundled for the use of indicators. Healthcare
commission they commonly provides many tip regarding indicators as well as data along with effective
information resources. The important purpose of healthcare commission is to accomplish better health
outcomes, all the accountabilities must focus on outcomes, not on the processes by which they have been
accomplished. The commissioning outcomes are known as framework indicators which are developed by
the NHS commissioning, and they also include measuring of inequalities. Their main aims are to bring
improvement in the outcomes and health care quality. Providing information for the population regarding
quality of health by the healthcare commissioned. They reduce inequalities and promote quality these all
are the primary aims of the healthcare commission (Campion, and et. al., 2019).
BACKGROUND
In England commissioning had several personification. In 1991 health care commissioning was
nearly followed by the local authorities. During the 1990 the community care act and the NHS their
government generated providers and purchasers, in this process purchasing was followed by the family
health services and health authorities further they focused on the general practices. Furthermore groups
of primary care they were established in 1999, which brought health authorities and family health
services together. The groups of primary care they were barely short lived which further combined with
the larger organisational and existed in the form of PCTs. PCTs they distributed approximately 80% of
the NHS regarding community and public health services, they were accountable for the wide range of the

clinical governance in the terms of general practices and there were several contracts along with the
general practices and in addition the Gps was personally responsible under the rules and regulations
regarding the clinical practice. Clinical commissioning they had become the latest attempt in the terms of
clinicians commissioning. In the 1990 the conservative government they bring the GP fund holding. The
commission was terminated in 2009 on march 31. Furthermost their responsibilities were subsumed by
the quality care commission. The healthcare commission they do have legal name which is known as
commission for healthcare inspection as well as healthcare audit. This commission was produced by the
social care and the health care community and standards, and it was act of 2003. The healthcare service
they took the effective role in the field of commission regarding improvement in the healthy in 2004 on 1
april and in addition the healthcare they also assumed various responsibilities which are associated with
the national care standards commission and along with numerous additional functions. The chairman of
commission was professor sir lan kennedy and further chief executive was Anna walker and peter hioma
was known as chief executive of improvement in the terms of health commission. The social care and
health act of 2008 this act was barely replaced by the replaced by the health commission. However
mental health act commission and the social care inspection they are combined with the regulator of adult
social care and in the terms of health and this process is called care quality commission. The commission
of care quality they started in 2009 on April 1st and it was called non- departmental public body
(Fernandez, and et. al., 2019). There are many functions healthcare commission they have been
mentioned below;
 Maintaining the independent sectors of healthcare through the process of monitoring,
registration, inspections as well as enforcement activities and monitoring complaint.
 Assessing the quality NHS and the provision period management in the sector of public and
healthcare services.
 Examining important failures in the field of healthcare services.
 Reviewing the performance and award of NHS trusts.
 Reviewing the patients complaints regarding the NHS services and further they been alleviated
by the trusts.
 Assessments are usually promoted which is carried out by the regulatory organisation and
commission.
 Publishing effective information regarding healthcare in England.
The healthcare commission they commonly have very limited roles which go with healthcare inspectorate
Wales. They have capability to provide proper guidance and along with this inspect all the particular
sectors and if guidance is not implemented according to the possibilities this is because healthcare
commission they are independent government. In the beginning of 1 or 2 year existence of healthcare

commission they usually constantly was reporting annually of NHS providers bu using star ratings, by
following this process NHS trusts were awarded many times such as they got award one , two and three
stars, this award is mainly based on the performance which is measured against the clinical targets. In
2006 the system of annual health check was replaced by the star rating system and further looking
towards various issues compared to the targets which are probably used before. They were seeking for
the effective data as well as judgements which could measure and focuses what is significant for the
people who often utilise as well as supply healthcare services.
Critical appraisal 1
Demonstrate comprehensive knowledge and understanding of healthcare commissioning and its
importance to UK and international public health.
Health is demonstrated as a state of complete mental, physical and social well – being and this not only
the absence of infirmity and disease. Health is refers to which measures various group of peoples in order
to protect, preserve and promote the health.
Public health it can be conceptualized as mentioned below;
Most fundamentally analysing the health of the population across the world along with inspecting the
threats which have been faced by the population, this is known as basic step for public health. In other
words it can be explained as a science which enhance the community of health and this also protect the
safety through research regarding diseases inhibition of injury and making policy. The art of inhibiting
disease and promoting health they effort for;
 Controlling of communicable disease
 Cleanliness of the environment
 Providing education of personal sanitation.

There are many factors which have been influenced by the well being as well as health, they are
mentioned below.
 Health behaviours
 Economic and social factors
 Biology and genes
 Physical environment
The larger number of deaths they could be premature.
The significant number of deaths should be avoided( Jelen, and et. al.,2018).
Public health this could define inhibiting of avoidable deaths and premature deaths.
Difference between public health and healthcare
Public Health Healthcare
They mainly focus on population.
Inhibition and public health emphasis.
They are basis of public sector.
They are known as public health ethic.
They mainly focus on individual patient.
Treatment emphasis
Joint laboratry and have the patient involvement.

The process of healthcare commissioning they had drag the attention of public and professional because
of the partnership government reforming excellence and equity of white paper. The NHS publication was
done in 2010 and their proposals were examined and then further formalised as the social care and health
act, this process lead to the generating clinician commissioning system and which has been found quite
sensitive for the requirements of the patients. The term commissioning it is defined as creation of NHS
market they are known as part of conservative reforms of 1990.
Health improvement – which involves health services and health promotion which changes the lifestyle of
peoples along with inequalities in the terms of health such as healthy public policy and in wide range
they impact on health.
Health services public health – This process include clinical audit, service planning, and efficiency along
with estimating health as well as monitoring inequalities and social care fields and social care provision.
Public health they have they have greater history in England as compared to the health care system and
this is combined in both local government system and health care system at different times. There are
many laws which are for the protection of public health in England. A healthcare system it is defined as a
system which is designed to control and manage the data of healthcare data. This system mainly involves
manage, store, and collect as and in addition transmit a patient’s electronic medical record along with
this supporting policy of healthcare system and hospital operational management. The system of health
information this includes those systems which handle or mange the data which is associated with the
activities of health organisation. This efforts enhance the patients’s outcomes and impacts decision
making and policy – making and inform research. However all the information systems they usually
maintain larger volumes and access process of sensitive data, and in this process security is major concern
in the terms of health information.
Public health specialist and clinician
In the medical sector clinicians they usually diagnosis and treat diseases along with injuries of single
patients at a time. However on the other hand in the sector public health disease and injury both are
prevented. The practitioners of public health, and researchers and educators they all works with
population and community. It is identified the causes of disability and disease and large scale of solutions
are implemented. Instead of devoting or prescribing medicaments for hypertension high blood pressure,
this statement means there is need of performing anaylysis between heart disease, diabetes, and obesity
and further then data is used to impact the policy which usually have aim of reducing there conditions.
Which includes in the terms of public health, the microbiologists they often works to discover a vaccine
for the prevention of malaria, whilst additionally behavioural scientists they found ways to discourage

the population from smoking. Scientist of environment health they finds out foods which could prevent
cancer, on the other hand analysts of health policy they mainly estimates insurance programmms. The
term epidemiologists they recognize different trends in the terms of illness and health, which further
looking for certain links, interventions and causes in the area of AIDS and HIV whether infant mortality
and tuberculosis. Public health they have collective responsibility for the proper health, this is known as
disease prevention and protection. The public health they emphasises partnership with the activities which
devotes their contribution for the health of the population .Health education it is demonstrated as which
motivate, informs and helps group of peoples to maintain as well as adopt healthy practices along with
healthy life styles and environmental changes they probably assist the goals which could conduct
research and professional training to the similar way and same end. There are many stages of health
education such as awareness, evaluation, interest and adoption and trial. Health promotion it is defined as
a process which enables group of peoples to enhance or increase control over and improve their health.
This process commonly focuses on the person behaviour towards the larger range of environmental and
social interventions.
Health promotion = healthy public policy into health education.
Health protection this is defined as branch of public health which commonly concern with practice and
policies which could enhance the control and prevention of various disease along with threats of
environment in the terms of population health. Disease prevention they not only measures the prevention
of appearing of various disease, which include risk factor reduction but this also reduces all the outcomes
which have been established once. Rehabilitation this process it is a integrated with social, medical, and
educational they are measured for the training as well as retraining of the group of individuals which have
greater possibility of functional ability. Salutogenesis it is defined as medical approach which generally
focuses on the certain factors which usually supports well – being and health of the patients or human
instead of those factors which causes disease and this process is known as pathogenesis.
Activities of public health
 They monitors the status of health of the population.
 Inhibit epidemics
 They usually protects, housing, environment and workplace, water and food.
 They respond to the disaster.
 They also organise community actions.
Great deal of confusion
The great deal of confusion this statement gives the meaning of the public health such as social medicine,
community medicines and additionally preventive medicines. This type of term are used in the practice
which commonly adds various confusions (Finlay, and et. al., 2020). There are two fundamentally

concepts which are at issue they are public health and on the other hand preventive, social, and
community medicine. The social, community and preventive medicines they are taken into consideration
to the subdivision of discipline. In this process the common denominator of these mentioned terms is
called medicine. They represent subdivision of medicine. The process of public health is major social
activity, multidisciplinary and governmental , they probably spread in all the aspects of society, in this
process they keyword is not medicine it is health. Preventive medicine this term is defined when public
health is concerned with the prevention of various infectious disease. Social medicine this is well known
for product of France, Belgium and Germany as well as European countries. Their firm mainly rely in the
profession of medical, and this process concern about the social factors in the terms of etiology of disease.
Social justice it refers to the concept of relations and fair relations among the society and individuals. The
term social justice they commonly assigns numerous duties and rights in the society institution, which
helps group of individuals to accomplish basic cooperation and benefits. Truth telling it is described as
misrepresentation, deception, and avoidance of lying while having interaction with the patient acre or
patients.
Disease control phase
 They have least technical knowledge
 Sanitary reforms
 Sanitary legislation
 Their aim is to control physical environment of human’s which include sewage disposal, water
supply not exclusively control any particular disease.
 Enhancement in the terms of health of population due to the reason of disease control and disease.
 Additionally to the activities of disease control there was one important goal which was added in
the terms of public health that is called health promotion of the population or individuals.
However it was initiated as services of personal health which include, industrial health services
and school health services and in addition child health services.
STRENGTH
 Health commissioning they elaborate network of healthcare facilities.
 They also takes locational advantages in the terms of healthcare buildings in the
government sector.
WEAKNESS
 Inadequate buildings as chcs, scs and PHCs and their poor functioning.

 Absence of faith while manufacturing local equipment.
CRITICAL APPRAISAL 2
Demonstrate skills and abilities to critically evaluate/ reflect on and apply the key theoretical and
practical concepts in a healthcare commissioning scenario.
Many nurses they do have critical skills which have been mentioned below;
Compassion
Most fundamentally the profession of nursing is a calling, they have desires to help group of
peoples those who have experience of life changing medical situations which entailing nurse to
deal with compassion and sensitivity for other peoples.
Critical thinking
As a nurse they should surely determine the course of action which is entailed for the purpose of
supplying best healthcare which could be possible. A nurse should always know when they
should refer while any issues during suitable member in the medical staff.
Communication
Nurse they commonly have good communication with the patients they do interact with the
patient in a proper way, Communicating with the number of patients is known as important key
components of nursing.
Organization
When nursing they enters in the BSN degree, thus the professors they require that nurse should
become organized in the doings or work. Because they probably moves to the responsible
position therefore they must have the capability to mange or handle the issues that occurs with
many different patients. All the healthcare they primarily deliver patient- centred care as a
interdisciplinary team member and they emphasizing practices which are known as evidence
based practice, they also approaches for enhancement of quality as well as informatics.
Provide patient – centred care – Respect, identity and providing care to the patients values,
differences, and expressed needs and reliving pain, clearly inform, coordinate continuous care
and with patients decision making and they usually perform continuation advocating disease
such as wellness, prevention, and promotion regarding healthy lifestyle which include focusing
on the population health.

Employee evidence based practice – They combined with the clinical expertise nad best
researchers, and the patient values increases for the optimum care, and further they take
participate in research and learning activities (Coffey, and et. al.,2020).
Work in interdisciplinary team – Communicate, cooperate, and collaborate the combined form of
care they may ensure that care should be provided continuously and it should be reliable.
Apply quality improvement
This process means recognizing errors and hazards in the terms of care, in this phase
implemented and understanding safety principles have been applied which include
simplification, standardization, constantly measuring the quality of care is known as apply
quality improvement, the quality is measured in terms of process, structure and outcomes which
are associated with the community needs and the patients, test interventions and design
interventions these are used to change the system of care along improving in quality and
objectives.
Developing communication skills is very essential to become better health provider. In present
years the communication between patient and doctors, nurse this has been found as patient
satisfaction and better patient care. Healthcare professional they need capability to elict
information from the variety of patients. The interpersonal skills also adopted in order to respond
the patient feeling. Communication skills are very necessary thus to diagnose the patient or for
the treatment of the disease. It is also very important to maintain a therapeutic relationship in
order to offer educate as well as for the information too.
STRENGTH
Strength which are primarily based on the nursing leadership this is not a new concept. Most
fundamentally nursing they are connected with strength based thinking.. Accountability,
dependability and flexibility they are the strength t in the terms nursing healthcare commission.
WEAKNESS
PCT commissioning this is regard as wide range of weakness. The positive perception regarding
commissioning it was odd when extensive evidence were received and it was pointed as
weakness.

CONCLUSION
As per discussed above that healthcare commission plays an essential role in the sector of
healthcare. They are quite useful in performing various functions which include doing inspection of value
and quality of money in the terms of public health and healthcare. The healthcare commission is
accounted as very significant because they usually promotes enhancement in the sector of public health
and healthcare. Equipping patients with finest and best information regarding healthcare. Healthcare
commissions they performs three main function such as improve, inspect and inform. Commission they
are responsible for reporting as well as assessing NHS performance along with unconventional
organisations of healthcare in order to make assure that hight standard of care have been provided. Social
and healthcare commissioning they explore the outcomes as well as services. Commissioning this process
is defined as the activity which mainly decides what kind of services should be supplied to the wide range
of population, and how these services should be paid and who should supply them. The public health
work mostly divided into various services that are provided wsuch as health enhacement and health
promotion which include smoking cessation, healthy eating and along with this community services for
the group of old peoples and health services commission includes screening programms, immunisation,
and school nursing service. As concluded that different understanding between patients, providers,
commissioners they are seen as specific importance. They commonly analyse relationship between
patient and the public and further identifying influence on the commissioning process. Identifying the
changes in the terms of commissioning reshape all the local services. Exploring various process that any
change would not impact on the patient experience. Recognising how group of patients and people they
all together represent their voice to be heard and which process and mechanisms use make their voice to
be heard. The outcome of research is to provide guidance for the healthcare commissioning.