Commissioning board makes its move

Last month, the NHS Commissioning Board made the surprise announcement that it would not be using the complex new formula proposed for the allocation of around £65bn funding among England’s clinical commissioning groups next year.

‘You can certainly make a case for this being an early example of the board asserting its independence’

Instead, each CCG would get a uniform 2.3 per cent increase in 2013-14, and the board would lead an “urgent fundamental review” of the whole approach to NHS allocations.

The new formula, it explained, would mainly have resulted in the highest funding increases going to areas which “already have the best health outcomes” − an outcome the board said seemed inconsistent with its responsibility to reduce health inequalities.

One interesting real world question is this: what does the commissioning board’s move tell us about the way it is going to operate in the post-reform NHS?

Preserving stability

Some have taken it as evidence that the board will be genuinely independent from government. It appears the new formula would have moved allocations in a direction supported by parts of the current administration − a direction that, for example, then health secretary Andrew Lansley advocated last April when he argued that age, not deprivation, was the main determinant of health need.

If you assume that the current health secretary shares his predecessor’s views, you can certainly make a case for this being an early example of the board asserting its independence.

However, you can equally interpret it as primarily an attempt to preserve as much stability in the system as possible, at a time of major upheaval. There is some precedent for this − primary care trusts’ allocations were also increased at a uniform rate between 2011-12 and 2012-13.

You might also argue that, in this case, the government itself has more interest in stability than in reform. With the overall settlement for CCGs as tight as it is, the uniform funding increase they will receive next year is only marginally higher than the forecast rate of inflation. This leaves little headroom for above average funding increases in any part of the country, unless other parts were to get real terms cuts − and that would surely be an open goal for the coalition’s political opponents.