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Farrar: Commissioning board manager cuts 'pose a danger to patient care'

NHS Confederation chief executive Mike Farrar has warned the health service’s capacity could be reduced to “dangerously low levels” by proposals to halve the number of managers in key areas of NHS commissioning and planning.

The NHS Commissioning Board yesterday published detailed proposals for the design of its structure. The organisation will take on direct commissioning of specialist and family health services - worth tens of billions of pounds - as well as much of the running of the NHS from April 2013.

Design of the NHS Commissioning Board admits one of the main risks to its “resilience” will be trying to run its functions with “50 per cent less resource [than is currently spent on them] by 2014-15”. It will include a similar reduction in staff.

It says the board will employ around 3,560 people - 2,500 in around 50 local board offices; 200 in four regional “sectors”; and the rest in national teams, mainly based in Leeds.

Mr Farrar said in a statement to HSJ: “The NHS is facing its biggest ever challenge, with the £20bn productivity requirement alongside the huge pressures facing the social care system and the need to continue to drive up quality of care. To meet this challenge we will need strong leadership and management.

“International comparisons show us that the NHS has a low spend on management relative to other systems. We need to be confident that the proposals for the NHS Commissioning Board and clinical commissioning groups will deliver a health system with the necessary capacity.”

Referring to the risks identified by the board, Mr Farrar said: “The board itself recognises there are significant risks in reducing the level of management in the new system.”

He added: “As the trade organisation for the health service, we have consistently backed the delivery of efficiencies to ensure the maximum resource is available for commissioners to put into patient care for their populations. But, the levels of management set out here could pose a real danger to effective patient care.

“It doesn’t matter whether the people filling these positions have an administrative or a clinical background, the fact remains that if insufficient money is spent on the organisation of care then patient outcomes will suffer.

“I am really worried that we are reducing this capacity to dangerously low levels. I fear that this level of reduction will undermine the ability of the NHS to achieve the tasks it will be set. We urge them to reconsider the level of resource they dedicate to the organisation of patient care.”

The commissioning board design says its total running cost budget - including management staff - will be £492m. Meanwhile, CCGs running costs, which will cover their commissioning support services, are to be fixed at £25 per head - or around £1.25bn nationally.

Based on the DH’s expectation that the total health system running costs will be £3bn in 2014-15, the figures appear to leave a massive £1.3bn for management of public health services, and the DH itself.

Commissioning board managing director Bill McCarthy, speaking to HSJ earlier in the week, said it had to make the proposed reduction in management cost to help meet the need for huge efficiency savings in the service.

Readers' comments (10)

  • Total running cost budget is £429 million not billion surely?

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  • If not we've found our QIPP!

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  • welcome to our world !! Singnificantly more risk of patient outcomes suffering from the equal reductions in clinical staff wouldn't you say !!

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  • Dave West

    Yes. Million not billion. Apologies.

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  • the 50% reduction is a great step in the right direction but does not go anywhere near far enough. in our area there will be 50 people in the sector office and another 300 across the 6 local board offices. more of the resource should be going into the ccg running cost pot. jobs for the boys again!

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  • Anon 4.13 you're right. And given that over half of the people in the local board offices are responsible for commissioning primary care services or FHS functions actually paying the GPs let's start with them. Idiot.

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  • It is good to see once more the HSJ blog has been reduced to ill informed comments rather than intellectual debates about the appropriate design.

    If the geography 4.13 is describe is one of the 4 hubs, the 350 people will be responsible for ensuring the public expenditure of £20bn! The safety of services for 15M people, and the probity of 60 CCGs. Really you think 350 people is too many. Get real.

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  • Sad to see Mike speaking out when SHA staffing gets threatened, but much less clear throated challenge about the running costs for the people who actually DO the job of commissioning.

    SHA staff are clearly split between those who genuinely add value and those who add compliance and reporting costs to frontline commisisoners. It looks in the makeup of the local offices that we may have considerably more of the second group in the new 54 office 'middle tier'.

    How will La la claim he has eliminated an entire tier of bureaucracy now?

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  • The people going into NCB include the PCT staff who are not going into CCGs. The question that is coming into focus is whether you can manage a £90bn industry with 2.2% running costs (£1.5bn for CCGs and £492m for NCB). So how many staff is that per organisation?

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  • Anon 29 Jan 5.22pm is equating NCB and CCGs staff costs as "running costs." However, these would also need to include all the provider Trust management costs to get an accurate figure, which would then far exceed the 2.2% quoted.

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