CCGs face old fears with desire for change
Three things strike you immediately about the results of HSJ’s Barometer survey of clinical commissioning group leaders - the first to drill down into the hopes, fears and aspirations of this new cohort of NHS chiefs.
The first is their confidence that they can deliver change in short order. The second is how many of their priorities and concerns echo those of commissioning teams from past structures. The third striking finding is CCGs’ overwhelming enthusiasm for health and social care integration.
‘One message roars out of the survey: the belief that greater integration of health and social care services is the future’
CCGs are fired up by undergoing the authorisation process, specially designed to ignite ambition within the new leaders, and fresh from brainstorming their joint health and wellbeing strategies. There appears little doubt CCGs believe they can make “significant” improvements and changes in service patterns by this time next year.
Privately some CCG leaders admit to a level of naivety in their colleagues which only experience can cure. It is instructive that while 75 per cent of the CCG leaders surveyed claim to have a “good” or “very good” relationship with local hospital trusts, HSJ’s latest survey of hospital chief executives rated their relationships with CCGs at an average six out of 10.
Burning with energy to drive change
However, the key finding is that CCG leaders are still burning with energy and enthusiasm to drive change. This is welcome for there is much work to be done. But if CCG leaders are bringing a freshness to a somewhat jaded sector, they are also ironically singing the same laments that have echoed from commissioners for over a decade.
They are worried about: too much central control; the inappropriateness of payment by results; political opposition to service redesign; and having enough money to deliver quality care. As HSJ readers could have predicted, the reorganisation has not changed the fundamental problems facing the service.
This fact is also reflected in the similarity in priorities, noticeably controlling secondary demand. It will bring an ironic smile to the faces of primary care trust managers to see the great majority of CCG leaders back “bans or limits” on “treatments which are not clinically justified”.
Clinical “justification” is, of course, in the eye of the beholder and it will be interesting to see if the Daily Mail (and the health secretary) sees any difference when the argument is made by a CCG chair rather than a PCT medical director.
Swimming in a straitjacket
It is also clear how dissatisfied CCGs are with deep government cuts to management funding and support - singling it out as the number one barrier to their effectiveness and with one respondent likening it to “swimming in a straitjacket.”
But one message roars out of the survey: the belief that greater integration of health and social care services is the future. The professional role of GPs as an aid to good commissioning decisions is overplayed, but it seems likely the day-to-day experience of hearing patients’ frustrations with the health and social care divide has convinced many to take a whole system approach.
CCGs also do not appear to have the suspicion of local authorities that existed in many PCTs. Movement on this front now seems to have real momentum.
The determination to deliver joined-up care shines through in the support for greater use of the third sector and, of course, a wider range of GP provision.
Yet there is little interest in embracing the private sector. It would be wrong to suggest thatCCGs have rejected this approach outright - some still believe it has a tactical role and government advisers, during Andrew Lansley’s time at least, used to argue CCGs would soon learn the value and power of competition.
However, with one in three CCG leaders saying increased competition is a “significant barrier” to improvement, that moment of “enlightenment” seems some way off.
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Readers' comments (8)
Jeremy Taylor | 8-Nov-2012 11:02 am
The role of the Third Sector, cited here, will be crucial and needs development. Not just 'competing providers' but able to marshall patient needs and opinions, co-design strategies and services, and bring to the integration picture a real focus on person-centredness and support for recovery and for wellbeing. E.g. see Nesta's work on 'co-production' approaches or Diabetes Year of Care report on the contribution of 'non-traditional' provision. Competitive tendering model will fail on this -- needs good commissioning instead!
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Kosta Manis | 8-Nov-2012 11:35 am
I heard Dame Barbara Hakin summarising better than anyone else the essence of the reforms: "The CCGs belong to the practices."
Is it not time HSJ abandons its fixation with "leaders" and explores what grass roots GPs and their staff think? It may discover that in some areas there is indeed a fissure between governing bodies and practices, rapidly turning into a chasm.
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Anonymous | 8-Nov-2012 2:03 pm
The descent into McDonald's style healthcare continues: warm, mushy, soft, soothing and comforting. Bland and homogenous with little variation, choice or excellence. Nothing exotic or different tolerated. 'One size fits all', mass-market product: a triumph of marketing over substance. Branded [like using NHS kitemark] and superficially attractive. Cheap for an occasional 'quick-fix' and to satisfy a transient craving, but deadly as a regular diet. Staff that are trained to be subservient and expendable, whilst a fat cat many thousands of miles away gorges on the profits. A better experience as a drive-through, not so good inside, especially if simultaneously occupied by the local benefit dependant crowd on a Saturday night....
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Patrick Newman | 9-Nov-2012 2:53 pm
Integration is motherhood and apple pie but who is going to do it. GP/CCG statements of enthusiasm for this goal demonstrates acute naivety. Competition and its processes will militate against integration. The internal supervised and regulated health market will create many sub optimum islands of private, independent and NHS organisation self interest. GP's are use to being the good guys on closures but when they propose it they wont know what has hit them. Who now will be the patient advocate?
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Ruth Carnall | 9-Nov-2012 9:34 pm
I have spent the last couple of months visiting most ccg's in London. It has been so encouraging to see their enthusiasm and commitment to make improvements for their patients and communities .the challenge will be to find effective ways to help them work together to deliver complex changes across boundaries. The long winded processes we have at the moment will be unmanageable for them.
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Andrew Craig | 11-Nov-2012 6:11 pm
It's great to learn that CCG leaders are enthusiastic for integration. But who is meant to benefit from integration? Nut just commissioners and providers. What service users want is coordination and continuity of services. Whether they are “integrated” or not is less important than how they are received and their responsiveness. So the question is “integration for whose benefit?” If done for the "wrong" reasons and without user and carer engagement from the outsest, Integration could be anti-competitive and anti-user and carer choice.
Integration makes good sense for people with complex needs and for those using health and social care (old people, long term conditions, kids) – so vertical and horizontal across services is needed. The biggest problem is that we don’t have enough practitioners who think and work like that. So just changing structures will not do much good, even if it is possible and affordable. Of course, doing nothing is also not affordable.
Changing professional attitudes and practice to commission and deliver coordination from a user perspective requires leadership and persuasion, not just initial enthusiasm.
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Anonymous | 12-Nov-2012 7:06 pm
An astonishingly naive survey, followed by an equally astonishingly naive analysis, with a bewildering array of comments disconnected from reality.
There will be no revolution. CCGs are already hamstrung by inadequate management cost expectations, conflicted leadership, rapidly disengaging practices, demoralised staff, a mass of governance expectations that they do not understand, huge stresses on budgets, gaps in expertise, chief officers who are treating their roles as a chance to make a name rather than show leadership, predatory private sector suppliers, and local authorities intent on takeovers. No, the headline elsewhere in the HSJ is much more informative: These reforms are a car crash, and it really is a shame...
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Anonymous | 13-Nov-2012 2:17 pm
7.06, I really do think it's time you retired.
I remember the horrors of working with people with your attitude, who just complained and sneered and moaned at everything all the time. You never actually DID anything - after all, it's so much easier playing the world weary "I'm very wise but I can't possibly share my wisdom with you because you're too stupid". And incidentally, the car crash piece was written by the Red Tory, who's just been "disowned" by the party, there was an article in the Sunday Times.
Yes, the reforms are a mess. No, HSJ's barometer survey hasn't the robustness of a double blind randomised controlled trial. So what? I have at least another 15 years left to keep working, so the rest of us thickos making an array of bewildering comments disconnected from reality based on numptie surveys will just get on with our day jobs as best we can. I'm rather enjoying the blitz spirit.
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