14.11.14
Breaking down barriers
Source: National Health Executive Nov/Dec 2014
The commissioning landscape continues to change, with the latest announcements showing that NHS England got some of its initial decisions on organisational structure wrong – or, more charitably, that it has more confidence now in the ability of CCGs (most of them, at least) to take on new responsibilities and to handle conflicts of interest.
The current fragmented picture never made much long-term sense, and most welcome the coming changes. Primary care co-commissioning and changes to specialised commissioning are well on their way – what is less clear is the future relationship with health and wellbeing boards. Both the Lib Dems and Labour – as well as many in local government – want those boards beefed up and to take more strategic decisions and have more sign-off powers. CCGs, who perhaps rightly see a zero-sum game in which stronger HWBs equals less influence for clinical commissioners, are sceptical. They fear that ‘unequal partnerships’ with over-powered HWBs would hinder the mutual trust, respect and communication vital to improve health and care services in the long term. Dr Amanda Doyle of NHS Clinical Commissioners sets out this view.
But have a read too of our interviews with Dr Marc Rowland and Dr Simon Bowers, senior GPs and commissioners from London and Liverpool respectively. Both have some fascinating things to say about the rapidly-evolving role of CCGs and their own place within that landscape as doctors.
Elsewhere in this edition is a look at new work between the NHS Alliance and the Foundation Trust Network (which should be known as NHS Providers by the time you read this), seeking to break down some of the cultural and practical barriers between primary and secondary care. It’s an admittedly big task, but we would never wish anything but good luck to credible and respected organisations like these taking on the challenge.
On the theme of barriers, what are the practical challenges when clinical staff and social care practitioners have to start working together? Mary Twomey, programme director for health and social care at the Open University, argues on page 54 that one often-ignored issue is a clash of values. Good care is often seen as the prime value for healthcare staff, but for social care practitioners, the prime value is respect and promoting self-determination. When these values align, it’s all to the good, but they don’t always. “It’s an issue because there is a risk that those actually delivering care to individuals may be talking different languages, or at least may be uncomfortable with or unable to hear a different perspective,” Twomey writes.
Procurement is another theme in this edition, a few months on from the Department of Health’s eProcurement Strategy launch. We investigate the progress that trusts are making on achieving compliance, and what help they’ve got from the centre and their peers (the verdict is decidedly mixed, based on the sample of procurement directors we spoke to). Lord Carter of Coles gave us a few minutes of his time and expertise to answer our questions, too.
Adam Hewitt
Editor