My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Turning the tables. How might CCGs use the Secretary of State’s mandate to hold the National Commissioning Board to account?

Filed Under (Clinical Commissioning Groups, Health Policy, National Commissioning Board, Secretary of State) by Paul on 26-11-2012

This is my third post about the mandate because I think this is such an important part of the new NHS architecture. This one is looks at it from a different point of view – in a way that could turn the whole politics of the mandate on its head.

The main aim of the mandate is for the Secretary of State to hold the NCB to account for the £85 billion that it is handing over from the Treasury. The public pay that money in taxation and they have a right to some Parliamentary accountability for its disposal.

The secondary political purpose of the mandate is that it should provide a framework for the way in which the NCB holds local CCGs to account. So the latter should look closely at the mandate to better understand what the former will be expecting of them.

However whilst I was running a session with some CCGs the other day one of them was interested in a way they could use the mandate to operate in a very different way.

It was suggested to me that since this was the document that the Secretary of State was using to hold the NCB to account, CCGs could help him do just that. This turns the mandate around – from something that helps the NCB hold CCGs to account – into something allowing CCGs to help the Secretary of State hold the NCB to account.

How might this work?

As I mentioned twice last week, a lot of the mandate concerns the necessity to quicken the pace of development of integrated care for NHS patients. This quite rightly lays a lot of expectation on how CCGs will work in developing that care.

But the mandate goes further than simply laying this duty on CCGs. It recognises that there are structures within the NHS that will stand in the way as strong barriers to the creation of localised integrated care pathways. It lays objectives not only on CCGs but on the NCB itself.

“2.7 As a leader of the health system, the NHS Commissioning Board is uniquely placed to co ordinate a major drive for better integration of care across different services, to enable local implementation at scale and with pave from April 2013

2.9 In taking forward this objective we are asking the Board to drive and coordinate engagement with local councils, CCGs and providers; and at a national level, to work with the DH, Monitor, Health Education England, Public Health England and the Local Government Association, as well as other organisations that want to contribute. The challenge is to tackle practical barriers that stop services working together effectively, and for national organisations to provide help and expertise, rather than to design a blueprint. Local commissioners have the vital role of stimulating the development of innovative provision- for example across primary, secondary and social care, or for frail elderly patients. In responding to the barriers revealed by their work, further national action will be needed in a number of areas, including

  • Better measurement of user experience and seamless care
  • Better use of technology to share information
  • Open and fair procurement practice
  • And new models of contracting and pricing which reward value based integrated care that keeps people healthy and independent as possible.”

 So this objective lays a duty on the NCB to help CCGs by tackling these national barriers. It also recognises that national action will need to be taken.

Let’s take some examples.

Everyone I know believes that payments for episodic care are a disincentive to the full integration of care. This part of the mandate agrees and tells the NCB, insofar as it is a barrier to integrated care, to do something about the nature of pricing.

Similarly the incompatibilities between primary and secondary care information systems make it difficult to construct the flow of information that would make integrated care much easier.

What the mandate is saying is that CCGs should identify these issues with the NCB and expect national action.

What was being suggested to me last week was that if the NCB fails to take this national action CCGs that have asked for this to happen should shop the NCB to the Secretary of State for failing to carry out the mandate.

This could be an interesting development. In the New Year the NHS Alliance and the NAPC will be forming the ‘Commissioning Coalition’. It would be interesting if every three months or so if they wrote to the NCB with examples of the national changes that their members – the GPs in the CCGs – needed to carry out if they were going to be successful in commissioning integrated care. In order to assist the Secretary of State in carrying out the mandate, they could copy that information to the Secretary of State.

And in order to help Parliament hold the Secretary of State to account for his mandate they could also copy this to the Chair of the Health Select Committee. The Select Committee could then have an annual hearing with the representatives of the CCGs and the Secretary of State to discuss and write a report on how the Secretary of State felt the mandate was going?

In this way the mandate could become a part of ‘bottom up’ accountability.

Comments:

2 Responses to “Turning the tables. How might CCGs use the Secretary of State’s mandate to hold the National Commissioning Board to account?”


  1. NHS Clinical Commissioners (the independent collective voice of CCGs) announced that it will be delivering a locally led appraisal of the NHS Commissioning Board. This approach we welcomed by the Board.

    More information can be found at the NHSCC website


  2. […] on from my post on Monday about the way in which local CCGs might use the Secretary of State’s mandate to hold the NCB to […]

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