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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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