A large majority of commissioning leaders believe clinical priorities would lose out to political priorities if lead responsibility for NHS services was handed to health and wellbeing boards, an exclusive HSJ survey has found.

  • More than half of CCG leaders surveyed fear quality of health services would be damaged by new HWB role
  • Respondents cite ‘risk of local political interference’
  • Concerns raised that GPs would leave CCGs in large numbers
  • CCG barometer survey: interactive graphics

HSJ’s latest CCG barometer, carried out with law firm Capsticks, asked commissioners what they believed would be the effect of the policy, which has been floated by the Labour Party. More than half of the 80 senior CCG leaders who responded said it was likely or very likely the quality of health services would be damaged.

More than four in five thought it would result in NHS health budgets being transferred to fund social care services, and more than half thought they would be used for other council funded services.

More than 90 per cent of respondents were chairs or accountable officers; the remainder held other governing body positions.

Their responses suggest there would be substantial instability in commissioning leadership if Labour pursued the policy. Nearly two-thirds said they would personally give up their CCG roles, while 84 per cent said some of their CCGs’ GP leaders would leave.

Labour has described its policy in different ways over the last year. Its health manifesto, released earlier this month, said that: “[HWBs] will be supported to become a vehicle for system leadership.”

Ballot box

One CCG leader said giving more power to HWBs could lead to “commissioning for votes, not health”

However, shadow health secretary Andy Burnham told HSJ in October that he envisaged HWBs “signing off proposals” on health, while CCGs could act “as an executive” for them.

Responding to the survey, one CCG leader warned that the “risk of local political interference” could lead to “commissioning for votes, not health”.

Others expressed concern about possible “clinical disengagement” and the “loss of capacity and capability from the commissioning system”.

One said: “It is possible and would be very beneficial that CCGs and HWBs would become more closely aligned in our area… Our experience is that GPs and politicians can work very well together. Labour’s suggestion of a merely advisory role for CCGs, however, is ill judged and could be very damaging.”


Helen Hirst, chief officer for Bradford City and Bradford Districts CCGs, said she would be “really concerned” if GPs left CCGs in large numbers, “having invested so much over the last three years into clinical capability and capacity”.

“The job to be done won’t change… The need for that clinical leadership won’t go away, even if CCGs become advisory,” she added.

“The need for clinical leadership is just as important, if not more so,  in delivery. You don’t just need clinical leadership to make the decision; you need clinical leadership to transact the decision [and] for change management.”

A Labour spokesman said: “We would bring together budgets, commissioners and providers to integrate care at a local level. This also means accountable HWBs acting as a vehicle for system leadership.”