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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“We will radically delayer and simplify the number of NHS bodies” (Health White Paper 2010)

Filed Under (Clinical Commissioning Groups, GP Commissioning, Health and Social Care Bill, Health and Well-being Boards, National Commissioning Board, Reform of the NHS, White Paper) by Paul on 31-01-2012

So how does this simplification look in respect of commissioning?

If you are a Tory MP you will look back to July 2010 and remember a White Paper which rang out loudly with some important truths about getting rid of bureaucracy in the NHS. At the time the Government was announcing its revolutionary plans to reform the NHS. Whilst no-one, including Tory MPs was too clear about what health care problem the reforms were meant to solve, they were at least clear that they wanted to remove layers of bureaucracy form the NHS.

As in the quote above – from the executive summary of the White Paper – there was much talk of decluttering the bureaucratic maze of the NHS.

The Bill enacting this White Paper has now been going through Parliament for a year. So if I were that same Tory MP looking at the architecture of NHS Commissioning from 2013 what would I see?

Let’s pretend that I am that MP, having a cup of coffee with Dr Smith the GP who is chairing his pathfinder Clinical Commissioning Group, and that I ask him what this simplified commissioning will look like.

Dr Smith is assisted in answering this because just last Wednesday David Nicholson met all 50 CEOs of the PCT Clusters to discuss the formation of the NCB and Dr Smith has just been updated.

As an MP I have a real interest in this reform not only because I’m interested in health care for my constituents, but just as importantly from the point of view of  democratic representation I want to know where they will go with a constituency problem in the new dispensation.

This is what Dr Smith says,

“It’s a bit complicated. My colleagues and I plan to form a Clinical Commissioning Group that will commission a lot of the NHS care for your entire constituency. I will come back to how we will do that in a minute.

We will however not be commissioning all the NHS care for your constituents. Specialist care for those of them with rare diseases will be commissioned nationally by the National Commissioning Board. The NCB is a new national quango set up under the Bill going through Parliament.  The NCB will also be commissioning GP services in your constituency. So if you have a problem with either specialist care or the standard of GP service the body you need to complain to will be the NCB – run from Leeds.

The NCB will have a field force at our local level. Your old local PCT which had a local chair and non-executives has been abolished and formed into a cluster of PCTs. This PCT cluster will now become a part of the National Commissioning Board in our region.

Some NHS Public Health Services will be commissioned by the NCB and some by your local authority. Public Health England – a quango that has been set up under the Bill – will have a further role. Therefore if you have a complaint about the public health services commissioned for your constituent you can go to your local authority, the NCB or Public Health England.

I and my GP colleagues are forming a clinical commissioning group. But before we are allowed to commission any services we will have to be authorised by the National Commissioning Board. We don’t know yet what this authorisation will entail but are starting to plan for it. So if we gain authorisation you will be coming to us with any complaints about the NHS services that we have commissioned for your constituents.

It is however possible that we won’t be authorised by the NCB – in which case a manager from the NCB will be appointed to run commissioning services and you will probably have to take any complaints to the NCB.

As CCGs we will employ some staff ourselves. We are also being told that we have to employ ex-PCT staff that are being formed into Clinical Support Organisations.

If we are authorised we will be working with both our own staff and those from the CSO to develop our commissioning intentions. Before we will be allowed to publish these they will be agreed by another new body – the Health and Well-being Board formed by the local authority.

But before we take it to the Health and Well-being Board we will have to consult the clinical senates that will have been set up by the National Commissioning Board.

So if you don’t like the CCGs commissioning intentions you can complain to the Health and Well-being Board and the Clinical Senate as well as the NCB.”

Whatever else the Bill achieves – no one can see this as simplified.


12 Responses to ““We will radically delayer and simplify the number of NHS bodies” (Health White Paper 2010)”

  1. […] second is a blog from Paul Corrigan  (previously health policy advisor to Tony Blair 2005-7) published today, in which a GP explains to […]

  2. Paul,Do you know if the NHS commissioning board meetings in Leeds will be open to members of the public/community to attend?and how will they be published?One of the best avenues our local community has is the current system where our local PCT allows questions from members of the public at their board meetings both before and after the meeting, showing openness and transparency at all times.

  3. […] second is a blog from Paul Corrigan  (previously health policy advisor to Tony Blair 2005-7) published today, in which a GP explains to […]

  4. Its worse than this – ‘we might be authorised for some commissioning so your consituent who has had a problem with their GP, local hospital and another more specialist service might have to raise it with 3 different bodies and possibly more’.

  5. Not only is this scary in terms of the complexity of the ‘new simpler’ NHS, it is so well written I actually understand it more than I did. Thank you!

  6. The authors of the preceeding white paper and the bill appear to believe that commissioning is the most important activity going on in the NHS. In fact according to the House of Commons health committee on commissioning, commissioning is mostly done badly and it consumed, in 2009, 20% of all NHS expenditure – yes, 20%. We don’t need to have commissioning separate from the provider units. Because of the market ideology (now thoroughly discredited by the financial crash of 2008, private scandals, fraud etc)it was believed necessary to have an arms length relationship with the provider units i.e. a market with buyers and sellers. This sacrifices the knowledge, expertise and dedication of those in secondary care. Because commissioners don’t have the expertise to determine the future of 54 medical specialities, they buy in at exorbitant cost the services of the huge city management firms. In addition, separate commissioners will commission because they are there and there will be a permanent state of re-disorganisation of the clinical services. Those in secondary care can actually be trusted to do their best for their patients and participate importantly in strategic planning and, when it is occasionally required, change. Separate commissionming bodies should be scrapped and the 20% of NHS expenditure (now after 2009 more in fact) ploughed back into the clinical services, related research and teaching.

  7. […] I mentioned earlier this week, CCGs are being set up in every locality. The NCB is set up to bring power to the centre.  More […]

  8. Sorry Morris Bernadt. Don’t know where you get your 20% from but it’s totally wrong. There was a much-circulated myth at the time of the Health Select Committee report on commissioning that the cost of NHS Commissioning was 14% of NHS expenditure, and that was wrong too. If you read the Select Committee Report, you’ll see that the Committee couldn’t identify the cost of commissioning, but that the total admin/clerical/management costs in the NHS (including med records, med secretaries etc as well as CEOs) was around 14%. Check it. I’ve no problem at all with us debating the value of commissioning (or otherwise), but lets get our figures straight.

  9. The County Councils / Unitary Authorities are involved in the Health and Well-Being boards or scrutiny committees that will be working alongside the CCGs.

    H&W-B boards bring together the CCGs and local health partnerships.

    H&W-B boards will be at the hub of all commissioning activity for their area.

    H&W-B boards are preparing the strategy that the CCGs will be commissioning against.

    It is not yet known whether the CCGs will need the approval of the H&W-B board or whether the boards are only consultative.

    Commissioning boards will look at private providers.

    Why is something being implemented that has not even been thought through. You would not build a nuclear submarine like this. They are making it up as they go along.

  10. […]–Companys-role-Andrew-Lansleys-proposals.html […]

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  12. […] leading health blogger Paul Corrigan explains in a recent post: ‘Whatever else the Bill achieves – no one can see this as […]

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