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CCGs blast Whitehall for spend ambiguity and micro-managing

Commissioners have blasted the government for publishing a consultation on the 2016-17 NHS England mandate before the Spending Review, making providing a response “quite difficult and largely to be reviewed once we have clarity on the finances”.

NHS Clinical Commissioners (NHSCC) added in their consultation response that the objectives and priorities outlined in the consultation are an extensive mix of government manifesto pledges and longer term NHS development plans.

While these appear to be equally prioritised in the consultation document, they warned that this may need to change depending on the outcome of today’s Spending Review. As a result, the organisation’s members have stated that they will soon request national clarity on which priorities they need to address in the short, medium and longer term.

“The Spending Review outcome is critical. There is some complexity when working on outcomes across populations, as they are dependent on the relative national investment afforded to securing their improvement,” it said, proceeding to question the Department of Health on its prioritisation of different parts of NHS spend.

The body also claimed that over the last three years, it has become “increasingly clear” that, while Whitehall has set out an overall ambition to NHS England and local commissioning to focus on outcomes and prevention, it has not translated this “into the environment that CCGs work in”.

“Sadly, the day to day financial and operational performance of hospitals has dominated both national rhetoric, national to local relationships, and the CCG assurance process. This has all too often translated into an increasing burden on CCGs to report at short notice to various national bodies, or to be told how to manage their local health economies,” it continued.

“This only serves to take vital clinical focus away from local population healthcare and only short term national priorities. CCGs are strategic organisations – in order to deliver better outcomes for their populations, they must be freed up to focus on local priorities.”

‘Micro-managing is counterintuitive’

Drawing heavily on a report recently written with its members, ‘Solutions to National Challenges’, NHSCC also claimed that commissioners must not be “subject to the burden of short-term reporting to fulfil central need” given that they are local statutory bodies.

“We have previously said that the risk of micro-managing local organisations is that they focus their scarce resources on report filling as opposed to what they are there to do – improve the health outcomes of populations,” respondents said.

Citing previous discussions with The King’s Fund and NHS England, the organisation noted that CCG outcomes must be meaningfully compared with the right metrics, comparisons drawn and alignments to the existing CCG assurance framework.

It continued: “We have flagged that there are some risks in giving the public an inaccurate view on performance on a CCG footprint – for example, while you can enforce choice-based on provider performance ratings, the same is not true of CCGs, as they are geographically established.

“The key is to ensure we give the public the right level of information to ensure it is a fair assessment and that it’s clear why we are making this information public in the first place.”

NHSCC also welcomed the idea of creating a multi-year mandate complemented with multi-year CCG allocations, tariff and contracts, subject to the Spending Review.

But they warned against overlaying that with single year financial balancing for local commissioners, since CCGs must have the freedoms and flexibilities to plan and invest upfront in order to reap improved outcomes further down the line. Annual budget balancing, they said, would work against this ambition.

Furthermore, they recommended that the Department of Health align the mandate of other national bodies, given that many of the objectives and priorities being proposed are things the NHS cannot deliver on its own.

According to them, the commissioning sector would greatly benefit from knowing how the mandate lines up with other parts of the public sector – such as local government, public health, NICE and wider regulators, including NHS Improvement and the CQC.

They also cautioned the department against using an ‘annual refresh’ of the mandate as a way to hold NHS England and CCGs to account on new and extra priorities based on short-term initiatives.

“This will disrupt longer-term planning, add burden and take focus away from local priorities. CCGs require stability in the years ahead and a stable mandate will provide that,” their response said.

The consultation, launched on 29 October and which closed just this week, seemed to have gone largely unreported by the government, despite its paramount importance to how NHS England is run and financed.

The new mandate will be subject to the outcome of today’s Spending Review and will take effect from April 2016.