Strategic commissioning is making a comeback. The secretary of state for health and social care has tasked ICBs with being ‘pioneers of reform' and strategic commissioning is set to be a core function going forward. But what does this mean? And how do we get there? 

As stewards of £164bn of public money, 19% of all public sector spending in England and roughly equivalent to the gross domestic product of Slovakia, ICBs have a significant role to play in the guardianship of the public purse. With demand for healthcare growing at an increasing pace and outstripping the rate of economic growth, there is enormous pressure on the NHS services ICBs are responsible for commissioning and the wider public sector. 

Changing the way ICBs determine what healthcare services deliver, where, why and by whom, is key to unlocking better care for patients, improving population health and delivering on the Government's three healthcare shifts: towards prevention, care closer to home and harnessing the power of digital. Fundamentally, strategic commissioning should start with understanding people's needs and collaboratively designing and commissioning services to meet them; the service should be built around the patient rather than the patient having to navigate a service designed around professional interests or organisational convenience.

Setting a clear vision for strategic commissioning will help ICBs and their partners focus on delivering on the public's priorities. The NHS Confederation has worked closely with system leaders to identify what, in their view, this future role should look like. 

Those leaders tell us the NHS must address population need, based on a deep understanding of the communities we serve, underpinned by harnessing high-quality data. Many ICBs are already segmenting their population into cohorts to whom they can target the most effective early interventions and around whom they develop new models of care. 

This strategic approach can help drive a greater share of resources upstream to anticipatory interventions in the community and provide better support for longer-term and complex conditions. It should also strengthen the goal of achieving a return on investment for the longer term, not just managing costs. ICBs have power in the deployment of their resources, and with the right infrastructure and culture in place, can ensure this creates best value for taxpayers, both for the short and longer term, including contributing to economic growth. 

In recent years, commissioning has mostly taken a transactional approach. There are now big opportunities, particularly when ICBs are commissioning whole pathways. Patients too often get lost in the complexity of health services. Strategic commissioning can provide a more joined up approach to their experience. 

Day in and day out, staff deliver a huge number of services for patients and communities, but does their work always improve outcomes in the ways that matter most to people? Reimagining commissioning means an ever-greater focus on developing, tracking and measuring outcomes and making sure we're delivering the right care, in the right place, at the right time. 

This transition will succeed through a streamlined centre, which sets out a small number of national priorities and devolves power to systems. Alongside this we need aligning financial incentives and tariffs and to take a robust and approach to oversight and performance management. 

The Government recently announced cuts to ICBs' running and programme costs by 50% within the next six months. The fear is that this will distract from a focus on improving commissioning. ICSs cannot deliver the Government's reform if they are not given the headspace, resource and training and support to undertake it. We should focus attention particularly on strengthening data analysis, diplomatic, contract and estate management skills. At the NHS Confederation, we will be enabling systems to learn from each other, challenging and supporting each other and drawing on successful practice. 

Delivering the transformation needed through strategic commissioning will not happen overnight, but the rewards will be great if, with a clear mandate from government, ICBs are given the autonomy and tools they need.