Towards strategic commissioning of VCSEs in mental health services: a context analysis in England

Thesis

Since the introduction of Integrated Care Systems (ICSs) in England under the Health and Care Act 2022, responsibility for local healthcare commissioning has shifted to forty-two Integrated Care Boards (ICBs). These statutory bodies are tasked with aligning national directives such as the NHS Long Term Plan and NICE guidance with locally assessed health needs, in a system that increasingly emphasises prevention, integration, and equity. Yet, despite this structural reform, the practical realities of commissioning – particularly for mental health services – remain marked by complexity, variation, and persistent systemic constraints. In the mental health space, Voluntary, Community and Social Enterprise (VCSE) organisations play an increasingly prominent role in service delivery, specifically in providing community-based and preventative interventions. However, commissioning arrangements involving these actors remain fragmented and underdeveloped, often lacking clear frameworks for accountability, long-term funding, and integration with statutory services. Recent literature and policy reviews have highlighted a lack of methodological consistency in how commissioning decisions are made, with concerns over transparency, resource allocation, and the alignment between strategic planning and service delivery.

This thesis investigates the current commissioning landscape within two Integrated Care Boards located in Southeast ICB and East ICB with a focus on mental health. The study adopts a mixed-methods approach comprising three methodologies: (1) document analysis of board meeting minutes, annual reports and strategy presentations to assess institutional priorities, governance structures, and procurement frameworks; (2) semi-structured interviews with commissioners, VCSE representatives, ICB and Council executives to explore decision-making practices and implementation challenges; and (3) demonstration of assessing value for money of mental health services commissioned from VCSEs. Together, these methods provide a multi-dimensional understanding of how population needs are assessed and prioritised, how strategic intent is translated into service procurement, and how commissioning outcomes are measured across provider sectors.

By integrating strategic, operational, and economic perspectives, this thesis offers critical insights for commissioners, policymakers, and provider organisations. It supports the development of more consistent, transparent, and accountable commissioning processes particularly around investment in the VCSE sector and contributes to future frameworks for embedding value-based commissioning across Integrated Care Systems. The findings will inform both immediate practice and long-term strategic thinking, offering practical implications for policy, planning, and research in mental health commissioning.

Authors: Sever, N

• DOI: 10.5287/ora-mpkw97gyx
• Type of award: MSc by Research
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: psychiatry; health economics; commissioning; mental health economics
• Subjects: Medical economics