CCG leaders: Reforms have not improved control of cost and activity

HSJ’s latest Barometer survey, carried out with PwC, asked CCGs’ most senior leaders to rate whether the NHS’s situation in various important areas was now better or worse than it was before the reforms.

The findings come a year after CCGs became statutory bodies on 1 April last year.

For several issues the majority said the situation was either better or significantly better. These included GP engagement, NHS relationships with local authorities and the ability to create better integrated services. CCG leaders also rated their confidence they could make significant improvements in the next year at a strong 7.3 out of 10.

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However, the findings suggest many CCG leaders feel they cannot control critical aspects of their health system.

A majority said the situation was either the same or worse in areas including commissioners’ ability to control costs, to stabilise hospital activity, and to support sustainable providers.

The greatest concern was about areas CCGs do not directly control such as specialised services, which is commissioned by NHS England, and public health, for which responsibility is divided between local authorities, Public Health England and NHS England.

However, a significant minority of 40 per cent said capacity to change acute and general hospital services – which are within CCGs’ responsibilities – was the same or worse.

Many survey respondents’ comments highlighted what one called a “fragmentation of commissioning” between CCGs, NHS England and local authorities. Several also complained of what were described as “dysfunctional relationships and arrangements” between national oversight bodies and regulators.

One respondent said: “The CCG movement has been largely successful and left to develop will continue to thrive. The co-commissioning system ([for] specialist and primary care) has got significantly worse.” Several complained that the activity-based tariff payment system meant they could not stop costs increasing.

The findings come as NHS England’s new chief executive Simon Stevens is understood to be reorganising its specialised commissioning functions. Some expect wider internal structure changes, for example to its regional and area team offices.

NHS Clinical Commissioners leadership group co-chair Steve Kell called for NHS England to pass more responsibilities and functions to CCGs. “It is a really positive survey,” he said. “The challenge of moving clinical commissioning into the next phase is to look at fragmentation across the commissioning system [and] see where we can shift more commissioning into CCGs.”

Dr Kell, who is also Bassetlaw CCG chair, declined to comment on NHS England’s structure but said moving functions to CCGs would have to come with “additional management resource”. This would mean cutting NHS England running costs and therefore potentially reorganisation.

Helen Hirst, chief officer of Bradford City and Bradford District CCGs, who is also NHS England’s director of CCG development, said CCGs had “taken quite a lot of effort over the last year to build relationships [with others in the system] back up again”. She said: “There’s a bit of impatience. We had probably underestimated how much you have to do in order to get to the point at which you can see change happening. [There was a] high burden of expectation, but we’ve achieved a lot and it’s a good foundation for this coming year.”

A Department of Health spokesman said: “Our reforms mean that local doctors and nurses now have the freedom to make sure that people in their communities get the care they need, with decisions made by clinical experts who can look at the whole health system in their area, not just primary or secondary care.”