After two decades of wandering, commissioning has a destination
The report on commissioning from the Commons health select committee is both insightful and flawed.
Its analysis is excoriating, caricaturing commissioning as 20 years of costly failure. Many of the accusations would not be contested by players on either side of the purchaser/provider split; primary care trusts are too passive, lack the clinical knowledge and management firepower to take on the hospitals, and struggle to show the return on their costs.
The direct and indirect costs from abolition would haemorrhage cash precisely when the NHS needs to slash waste
But the committee is mistaken in claiming the commissioning system may need to be scrapped. While their frustration at the slow pace and high cost of progress is understandable, tearing up commissioning would be wrong in principle and expensive and harmful in practice.
There could be no worse time to leave the hospitals supremely powerful, when clinical standards are still too poor too often, money is tight and there is an increasingly desperate need to move care into the community, for the sake of the budget and the patients.
The direct and indirect costs from abolition would haemorrhage cash at precisely the time the NHS needs to be slashing waste, while the disruption to service provision would be severe and long lasting.
Done well commissioning can, and increasingly does, improve healthcare. While there is a long way to go, PCTs are heading in the right direction. “Clustering” - an appealing euphemism for merging PCTs’ operations - is becoming common. This is avoiding the pain and distraction of yet another national reorganisation, while recognising that the current total of 152 PCTs is too many. Talent and expertise is gradually being pulled together across cities and counties to provide the critical mass to make a difference.
It is becoming fashionable to rubbish world class commissioning, and the select committee has jumped on that bandwagon. Of course it hasn’t delivered adequate commissioning in two years, and its competency framework is better at exposing weaknesses than developing excellence. But after two decades of aimless wandering it has given commissioning a destination and a direction - as well as expose the impossibility of creating a first class commissioning organisation 152 times over.
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Readers' comments (2)
Anonymous | 1-Apr-2010 5:01 pm
Richard, good on you. The providers need strong commissioners to keep them honest. The relationship we should be aiming for is where we have strong, knowledgeable buyers and responsive, innovative suppliers. I believe that Monitor has done some analysis looking at strong FT / PCT relationships and weak FT / PCT relationships. The symbiotic dependencies I understand are quite striking.
WCC may not be the silver bullitt, but I think we are heading in the right direction. By the way, I am a GP that doesnt want to fund hold, but wants to work with PCTs to get the right contracts in place to meet our community needs
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Anonymous | 7-Apr-2010 4:55 pm
I read the HSC report in a slightly different light. I didn't think it was particularly critical of World Class Commissioning. Infact, it was rather measured in its analysis but, sadly, rather less measured in its view of the past 20 years. WCC has given some vision and purpose to commissioning and it was always designed to show that creating 152 world class PCTs was - frankly - impossible. The baby shouldn't be thrown out with the bathwater but sensible consolidation should now take place. People also have to be brave enough to let PCTs commission without so much central control and direction. WCC was always going to be a 5 year venture - its a pity that the HSC wishes to make more changes at a time when we are just starting to professionalise commissioning. The NHS is very poor at sticking with a programme - the irony being too much political meddling! Perhaps the HSC should have thought more deeply about that.
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