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Out of CSS failure will come a ready-made market

How important is it that commissioning support services are set up along commercial lines? According to NHS Commissioning Board plans exclusively obtained by HSJ, it appears to be very important indeed. 

One of the documents declares: “This is about building new businesses, not new organisational forms”. The word “businesses” is underlined.

This is a stiff test for many emergent CSSs – mostly staffed by former primary care trust staff who had no desire to work in a commercial organisation. The unforgiving nature of the assessment process contrasts sharply with the “developmental journey” approach to authorising commissioning groups.

Failure for CSSs in some regions seems certain, creating a ready-made market for those passing muster.

Plunging into a fully competitive market – if that happens – seems hasty given some CCGs would prefer to source support services from NHS organisations, and the uncertainty still surrounding the reforms.

It must also be asked whether a support services market would be set up in this way unless the main objective was to minimise redundancy costs.

Readers' comments (15)

  • Pse could you explain how redundancy costs are minimised as a result of CSS failure...?

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  • Because people are taken down the performance route, i.e. dismissed on grounds of capability. Rose Gibb judgement means Boards are more cautious with compromise agreements. Nasty but not entirely unlikely.......

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  • Am I right in assuming that you suggest redundancy costs would be minimised by a proportion of PCT staff transferring to a CSS which subsequently fails, folds, and takes their redundancy entitlements (and perhaps pensions) down with it?

    That's been my fear, ever since I saw the report of the King's Fund simulation exercise of a post-Bill NHS, which I think is almost a year old now.

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  • But staff will be on NHSCB contracts for at least the first couple of years of CSS as they won't become non-NHS organisations until 2015 (?16) so redundancy entitlements will still apply. I can't see how taking people down the performance route answers the question either as individuals could be performing perfectly well but CSS still fails. It would be v helpful if HSJ Editor could be a little less cryptic in making a statement which, if true, has such potentially signficant implications for many of his readers - Mr Mcllelan could you provide a little clarity regarding your point here please?

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  • Hello Cassander, previous poster here. Yes, that's exactly what I think. I know it's cynical, but it seems to be what's happening with so many other things (people who transfer across to services run by e.g. Serco) - although I know there're proposals out re preservation of superannuation and other T&Cs, but there's nothing substantive in law to protect them. Given the hysteria over privatisation, I think it'd be a brave company and/ or Minister who subs out CSSs but then it could all be part of the manager bashing drive....... And may even be a political tactic to suggest "we're giving GPs support from X to make sure they succeed".... Perhaps being so prescriptive about management costs is also a driver (which begs the question what firm will eye commissioning and think "profit" rather than "headache"). Barbara Hakin and others have been quiet on the subject of FESC2 but perhaps this could be back on the agenda again?!

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  • additionally you've got Andy Burnham saying he'll repeal the Bill if Labour is elected in 2015 - presumably this would involve bringing commissioning back into the NHS, so it'll be a pretty big risk for any private sector organisation to invest time / money in setting up themselves up to provide significant commissioning support when the whole landscape could change again in a couple of years

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  • Anon 10.03, I'm not an HR expert, far from it, but I'm getting external independent advice on my NHSCB contract if and when I get one, because I think the key word is "hosted". I don't know if this is like e.g. cancer networks being hosted by a particular PCT that gives me the same "rights" as PCT staff or not. I'm also concerned (paranoid?!) about length of service getting carried over. We assume we take this with us as that's been the case with all the other reorganisations but what if this time the rules are different? I don't want to sound like a conspiracy theorist but there have been so many changes I've lost track and feel very risk averse, so am spending my own money on getting answers from someone who knows (or will tell me more) than I'm hearing at the moment......

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  • We've been commissioning in the NHS in earnest for well over 20 years and the reality is it is still perceived as bureaucracy rather than a legitimate activity and a legitimate overhead on the total cost of getting effective care to patients. The contrast with the private sector is stunning. Any activity that is worth doing within an overall value chain to achieve an objective should be properly resourced. Good commissioning enhances quality and efficiency. Do you remember the Alan MIlburn buzz? "We've invested in providers and now we need to invest in commissioning". Plus ca change. The NHS will always fail unless someone puts some investment (financial, human and ethical) into the planning, buying, performance managing and improving of healthcare - whether you call it commissioning or something else.

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  • still no clarity from Alastair Mclellan as to rationale for his final paragraph i.e what does it actually mean...? despite it being quite clear from comments above that readers don't understand it. I wonder if he does? I keep getting emails from HSJ asking for my comments and saying my views matter - well here goes - please seek to explain clearly and unequivocally what on earth your point is in your editorials rather than posing vague, ambiguous questions, the true meaning of which is clear to no-one.

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  • Hello all

    Apologies for my tardiness in clarifying my last point about redundancy (a lot going on this week).

    The point I was making was not about failure being related to minimising redundancy costs.

    Rather I am suggesting that simply transferring PCT staff to new organisations to form support 'businesses' is not the most logical way to proceed - UNLESS you main aim is to mitigate redundancy payments.

    My apologies for appearing to mix up the two points.

    Alastair McLellan
    Editor. HSJ

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  • Alastair - thanks for clarification, however I'm none the wiser - PCT staff transferred to support businesses will be contracted to the NHSCB in the first instance and therefore will retain NHS T&Cs until being "floated off" in 2016 - therefore they would presumably still have existing redundancy entitlements in the meantime if their CSS failed unless I'm missing something...? any light you can shed on what you're getting at would be helpful...

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  • There is talk of AQP staff getting access to the NHS pension.

    I wonder if the same will apply to staff that are TUPE'd over to the private sector?

    If a CSS folds then the staff should be entitled to jobs in the new organisation. In effect, the NHS CB would probably take over the failed CSS and then it would be recommissioned.

    In essence, the only thing that a folded CSS would achieve is a re-franchising of the management. The staff would simply TUPE over.

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  • Hi Anon 4:13

    My redundancy point is not connected to the potential failure of CSSs to pass the authorisatrion process.

    Rather, I'm commenting on the fact that the method chosen to create CSSs is largely driven by a desire to keep redundancy costs down.

    As you say, the failure of CSSs would NOT affect the redundancy situation.

    Alastair

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  • The failure of CSS will create a gaping hole in control of the system that will lead to providers doing what they like, CCGs unable to contract with them properly and unable to shift signifiicant amounts of activity away from them. Budgets will run out of control, CCGs across the country will run up massive debts within a few years and Lansley's daft idea will be exposed in all its glory. Just such a shame that the NHS is going to be thrown into such chaos before enough MPs grow a spine and stand up against the whipping.

    Those CSS that pass the first test will be wary of rushing to expand into "failed areas" and there are no private sector alternatives that are affordable to CCGs. No one in the NHSCB seems willing to clarify what will really happen in an area where competent NHS commissioners fail to develop an all singing all dancing economically viable customer focused organsation running on a fraction of the cost they've done in the past.They just get blamed for not instantly developing commercial acumen and told to "stop" their CSS development. Then what? The reality is CCGs have to be authorised to make the reforms happen, and to be authorised they have to demonstrate access to credible commissioning support. What that means is that in reality all this talkfrom the NHSCB on the essential need for customer focus and commercial acumen will actualy be a lot of hot air and the bulk of CSS will be passed on the back of some wooly words and dodgy numbers in business plans, plus an expensive dose of consultancy supported assessment prep work.

    it's one giant mess

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  • I'm surprised it has taken so long for people to realise that this was part of the overall 'vision' of the Bill.

    The first time I read the White Paper it was apparent what the sub plot was about.
    Privatisation by stealth using levers that were in the hands of government. That way you avoid having to do the same thing as they did with British Rail, British Gas, Water Companies, etc etc.

    It's not so much selling the family silver as opening the door and letting in the corporate burglars.

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