interviews

Commissioning support units – a new culture?

NHE got some insight into the work being done by CSUs from Mike Savage, newly-appointed chief finance officer for NHS West and South Yorkshire and Bassetlaw Commissioning Support Unit (NHS WSYB CSU), formed in March by the merger of two predecessor CSUs.

It's been clear since the original white paper outlining the NHS reforms that clinical commissioners could not do their jobs alone – they would need organisational support and administration. That has come in the form of the Commissioning Support Units (CSUs), of which there are currently 19 across England – though one of these, Surrey & Sussex CSU, has been deemed by its own interim MD to be ‘unviable’ and seems set to be closed or restructured.

The full strategy for CSUs was set out in the Towards Service Excellence strategy early last year. As it puts it: “‘Commissioning support’ will bring the specialist skills and knowledge to the nonclinical elements of commissioning so that clinicians can use their strengths to focus on leading change and improvement locally.”

CCGs are technically free to decide themselves how to carry out their commissioning functions, through appointing their own staff, working with other CCGs, or buying in support from CSUs or other private or voluntary bodies. In the long-term, the Government envisions a fully competitive market, but during the transition and these early days since the April switch-over, many CSUs and CCGs are simply picking up where the PCTs left off, albeit with some changes in exactly who commissions what, with the formation of NHS England and Public Health England, and some duties going over to local authorities.

The CSUs are currently being hosted by NHS England and the Business Services Authority, but are eventually meant to become selfsustaining.

West and South Yorkshire and Bassetlaw

In March, two CSUs in Yorkshire merged to form NHS West and South Yorkshire and Bassetlaw Commissioning Support Unit (NHS WSYB CSU). The organisation, based out of Sheffield and Bradford, has about 600 different staff, predominately from the predecessor PCTs.

Its new chief finance officer, Mike Savage, told NHE: “One of the challenges and opportunities for us is to establish a new culture.

“We have to recognise that all of our staff have been through a long period of change and people react differently to change.

“The new landscape has been talked about for quite awhile, and now it’s reality. What we have to do is be sure that we take our staff with us on this journey to create a different culture within our organisation, which will be more entrepreneurial and innovative with a passion for doing things better for our customers.”

The CSU is working with 15 CCGs across West and South Yorkshire, and will have some of its staff co-located with those customers.

Savage said: “The CCGs across West and South Yorkshire basically cover about 500 GP practices serving a population of around 3.9 million. We also host NHS communications for NHS England, which provides communications and freedom of information requests and complaint services to NHS England. We also have some non-commissioning activity with NHS clients.

“Our focus is very much on delivering to those existing customers but obviously we do receive requests from time to time to look at other opportunities within the west and south Yorkshire region: we’ll look at those on a case-by- case basis.”

Freedom to operate

NHE asked Savage how free and liberated the CSUs feel to deliver for the CCGs in a new way – or whether command and control from the centre remains the order of the day.

He said: “We have to work within the spine or the framework that comes down from NHS England and our own internal corporate governance and the scheme of delegation, the standing orders, and the financial limits.”

“We have certain central guidance that we have to follow, but we can tailor it locally and develop our own internal operating framework.

“My responsibility here covers core fi nance for the CSU, corporate performance and reporting, CSU corporate governance, as well as contractual and procurement matters.

“Effectively we have financial services and procurement services that we offer to our customers.

“I’ll probably be a lead director for some CCGs – that’s the scope of my role. It’s a totally new role in a new organisation. It’s exciting from day one to help shape that role and shape the strategy and direction of the CSU. We are very much able to shape the commercial strategy, the marketing strategy, the brand strategy as well as the culture of our organisation.”

Managing director Alison Hughes said: “This is a hugely exciting time for us and for our clients. We’re navigating our way through the most radical reforms since the NHS began in 1948. Now clinicians are at the centre of commissioning and working together we can make the best use of our financial resources to improve outcomes for patients.

“We’re operating an entirely new type of organisation; one with NHS ethics and values, but one that is commercially focused and client-driven. Mike will be a great asset to us as we launch and help shape the financial landscape going forward.”

Learning from other CSUs

Asked about collaboration and partnership working, Savage said: “We’re looking to work very closely with the CCGs. We’re also looking to work both locally and nationally to develop a dynamic supply chain so we can access the best talent and ideally provide a world class service to our customers.

“Obviously we can bring on board best practice that we can see across the CSU landscape. We’re already talking to some of the CSUs and working collaboratively with them.

“We recognise that we would perhaps be competing, but where we can, we will work together with them.

“The unique selling point for the CSU is the NHS knowledge and expertise we’ve got.

“The message is that we are going to be commercially focused and that will enable the CCGs and our customers to be freed up in a different way that they can focus on quality and perhaps transform their service.”

The CSU has contracts in place for 12 months with the CCGs. “We obviously have to deliver a good level of service this year to enable us to renegotiate and sign contracts for years two and three,” Savage said.

“Some services are bought-in, but most we deliver in-house.”

He concluded: “Innovation is going to be part of our DNA and that will enable us, hopefully, to successfully challenge the old ways of working and transform services.”

The services offered by NHS WSYB CSU

• Transformation
• Business intelligence
• Information technology
• Communications, engagement, equality and diversity
• Continuing healthcare
• Individual funding requests
• Primary care development
• Procurement
• Provider management
• Governance
• Financial services
• Medicines management
• Workforce and organisational development

Biography

Mike Savage has 16 years experience as a chartered accountant with companies like JP Morgan Chase and PricewaterhouseCoopers, and joined the CSU from McCann Worldgroup.

He was also a non-executive director at Calderdale and Huddersfield NHS Foundation Trust.

He said: “Obviously it was a great benefit to be able to have that five to six months of experience at Calderdale and Huddersfield. I attended the monthly board meetings as well as finance meetings, and the audit and risk committee.

“That gave me an insight into what’s important – for example, we had presentations at board level on the four hour A&E target and 18 week referrals, and so on.”