Resolving a complex national commissioning question for children and young people in secure settings
| Outcomes at a glance |
|---|
| • Enabled NHS England’s national Health and Justice team to make a clear, evidence-based decision on the future commissioning model for CYPSE healthcare |
| • Identified clear opportunities to strengthen collaborative commissioning between NHS England and Integrated Care Boards across regions |
| • Established a replicable approach to commissioning model evaluation, now available to other complex and specialised services facing similar questions |
The challenge
The Health and Care Act 2022 introduced significant reform to the NHS, including the formalisation of Integrated Care Systems (ICSs) and a shift towards more collaborative and delegated commissioning approaches.
For the Children and Young People Secure Estate (CYPSE), this created a critical strategic challenge. NHS England needed to determine the optimal commissioning model and level, whether national, regional or local, to ensure consistent, high‑quality healthcare for children and young people in secure settings while aligning with wider system reform.
CYPSE represents a highly complex and specialised cohort, requiring:
- Consistent standards of care across multiple secure settings
- Strong coordination between national bodies, local systems and providers
- Clear accountability across health and justice interfaces
Without a clear, evidence‑based approach, there was a real risk that commissioning responsibility could fragment, leading to variation in care, weakened accountability and poorer outcomes for a highly vulnerable group.
Our approach
NHS England’s Health and Justice Children’s Team commissioned Transformation Partners in Health and Care (TPHC) to deliver a comprehensive strategic options appraisal, supporting national decision‑making on future commissioning arrangements for CYPSE healthcare.
Our team led a structured, evidence‑led approach, combining detailed analysis, stakeholder engagement and options modelling to support system‑wide consensus and informed decision‑making. This included:
- Establishing and facilitating multi‑agency working groups, bringing together clinical, commissioning and operational stakeholders
- Identifying and developing seven commissioning models, spanning national, regional and local approaches
- Designing a structured evaluation and scoring framework, enabling consistent, transparent and objective comparison of options
- Undertaking qualitative and quantitative analysis, alongside desktop research and stakeholder insight, to assess feasibility, risk, accountability and alignment with policy reform
- Applying a theory of change model to articulate how each commissioning option would deliver desired outcomes for children and young people
- Validating findings through iterative engagement, challenge and refinement with system partners
We translated the outputs into a clear, structured recommendation, presented to the Health and Justice Delivery Oversight Group (HJDOG) to support national decision‑making.
The impact
The programme provided NHS England with a robust evidence base and a clear decision‑making framework to determine the future of CYPSE healthcare commissioning.
Following the appraisal, NHS England confirmed the decision to retain national commissioning responsibility for CYPSE healthcare while strengthening collaborative working with Integrated Care Boards across regions. This was the central question the programme was commissioned to answer, and it now has a clear, evidenced response.
The work also delivered:
- A structured scoring framework that enabled consistent, transparent comparison across seven commissioning models
- Clear alignment with ICS reforms while maintaining accountability and oversight for a highly vulnerable cohort
- Strengthened foundations for partnership working between NHS England and Integrated Care Boards
- An approach to commissioning model evaluation now available to other complex and specialised services facing similar questions of delegation and accountability
What our clients say
“TPHC’s ability to navigate evolving healthcare landscapes and provide clear, actionable recommendations demonstrates their capability to drive strategic initiatives in complex environments.”
Caroline Twitchett, Children’s Quality Lead, Health and Justice, NHS England
Ready to start a conversation? If you’re working through a complex commissioning question in Health and Justice, we’d be glad to talk through how we can help. Get in touch with one of our specialists to discuss your challenges.
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