The problem
Commissioning arrangements for intermediate care services are often fragmented, with separate funding streams and contractual models that do not align. Multiple providers and overlapping services, particularly within home-based intermediate care, create duplication, additional handoffs, and delays.
While outcomes-focused and alliance-based commissioning models have shown benefits, their adoption is not widespread. Where commissioning is uncoordinated, partners may make unilateral decisions that impact the wider system.
Voices from stakeholders
“We had all the classic issues: separate thinking, separate commissioning, separate funding. We have worked hard to develop a joint approach now, which is leading to better commissioning decisions”.
“We have a system ambition to have all intermediate care sitting within our integrated commissioning unit. Even though it hasn’t actually transferred yet, the joined-up conversations are already helping strategically”.
Actions
C1. Create a joint commissioning and design plan
| Step | Action |
| Step 1 | Audit existing contracts and services to identify overlaps, gaps, and opportunities for redesign. |
| Step 2 | Agree shared design principles: outcomes-led approaches, use of technology, therapy-led recovery, and streamlined pathways inclusive of both step-up and step-down. |
| Step 3 | As part of neighbourhood health and BCF planning, ICBs and local authorities must develop joint plans, agreed by health and wellbeing boards, with timescales for key decisions. |
| Step 4 | Test alliance-based and outcomes-led commissioning models that foster transparency, trust, and continuous improvement, develop contracts that enable innovation and flexibility in delivery. |
| Step 5 | Agree in advance regular points of review of joint plans. Consider a joint annual review of service capacity to inform future JSNA/BCF plans. |
C2. Develop a joint funding plan and business case
Colleagues engaged with described that this is a challenging area. The following steps provide a realistic starting sequence:
| Step | Action |
| Step 1 | Understand your current service demand and workforce capacity. Map current funding flows across all partners to understand who is spending what, where, and the arrangements for making payments. |
| Step 2 | Agree the principle that intermediate care should be funded on a shared risk and reward mechanism and identify high level principles to enable more detailed work on this. |
| Step 3 | Explore opportunities to direct existing pooled resources to support agreed priorities. |
| Step 4 | Work towards a fully pooled funding arrangement with equitable cost and benefit sharing, building on existing BCF arrangements. |
Productivity impact
Joint commissioning reduces duplication, aligns incentives, and creates the conditions for outcomes-focused service delivery.