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We held a Twitter chat to discuss who is really in charge of the new commissioning system - CCGs, the centre or patients? In case you were too busy to take part, here is what people said

Who is in charge of the new commissioning system?

An HSJ Twitter chat, hosted by @dwilliamsHSJ and @HSJnews

Storified by HealthServiceJournal· Mon, Apr 08 2013 07:12:52

Join us for a Twitter chat at 12.30 today, where we will be discussing who is really in charge of the new commissioning system #HSJnewsystemHealthServiceJournal

Are CCGs really in charge, or is the centre still pulling the strings; and have clinicians stepped up to lead commissioning? #HSJnewsystemHealthServiceJournal

We’re debating (among other things) who’s in charge of the new NHS. Join us for a twitter chat at 12:30 #hsjnewsystemAlastair McLellan

Only 10 minutes until our new commissioning system chat #HSJnewsystemHealthServiceJournal

Thinking caps on: who is in charge in the new NHS? CCGs? CSUs? providers? NHS England? #hsjnewsystemDavid Williams

And, is the new NHS system basically just being run by the same old managers or are new ppl making a difference? #hsjnewsystemDavid Williams

@dwilliamsHSJ telling that your list didn’t include patients #hsjnewsystemMihir Magudia

#hsjnewsystem twitter chat starting….. NOWDavid Williams

@MMagudia ha! my oversight…. are patients in charge? #hsjnewsystemDavid Williams

#HSJnewsystem Who’s in charge? Whoever controls the money. So that will be providers and government.Bill Russell

You could argue the same people are in charge now as were prior to April 1. @NHSEngland top table seems very familiar. #hsjnewsystemShaun Lintern

@dwilliamsHSJ we talk about patients as one group, the control they have varies - is the q whether now is any different? #hsjnewsystemKaren Lynas

how will we know when/if patients are in charge of the new NHS system? #hsjnewsystemDavid Williams

Doesn’t it depend on ’ in charge of what ? ’ #Hsjnewsystemmaxine craig

never mind IF patients are in charge - SHOULD they be? #hsjnewsystemDavid Williams

‘In charge’ difficult to define. CCGs important but just part of the system.Vital we are clear about roles for us & patients #hsjnewsystemSteve Kell

@KarenLynas2012 @dwilliamshsj need stakeholder matrix of all relevant patient groups & patient leaders &involve all relevant #hsjnewsystemKaren Maskell

@SteveKellGP I agree and I have to say if feels a bit chaotic at the moment #Hsjnewsystemmaxine craig

@maxine_craig of course. what should they be in charge of and not? #HsjnewsystemDavid Williams

@dwilliamsHSJ patients ought to be the primary of 3 deciders the others being commissioner and provider #hsjnewsystemMihir Magudia

@dwilliamsHSJ #hsjnewsystem As a member of public & patient I am not sure I want to be in charge. Involved in decision making; Yes.Bill Russell

@dwilliamsHSJ @maxine_craig amazing that this long after “no decision about me without me” that this has yet to be resolved #hsjnewsystemMihir Magudia

@dwilliamsHSJ that’s a hard ? I think we all need clarity before such big ? Can be considered further #Hsjnewsystemmaxine craig

authority but subject to some statutory restrictions.The Secretary of State will set the NHSCB an annual mandate, based on a#hsjnewsystem>Dee Speers

@bill_russell3 bill that’s what patients keep telling me when I ask #Hsjnewsystemmaxine craig

multi-year planning cycle, which will set out what the Government expects from the NHSCB. #hsjnewsystemDee Speers

is failing to discharge its functions properly.#hsjnewsystemIs word “consider” a get out of jail card?Dee Speers

@maxine_craig well, yes. but we’ll be waiting forever till we have all the info we need. best not to worry too much? #hsjnewsystemDavid Williams

The Secretary of State will be able to intervene if he considers that the NHSCB#hsjnewsystemDee Speers

#Hsjnewsystem it’s a partnership b/t patients-CCG. But if it goes wrong the real postcode lottery will begin and the lawyers will join!Jacqui Francis

@dwilliamsHSJ easy to say but we have a system to run day by day for public we serve and who pay our salaries , needs sorting #Hsjnewsystemmaxine craig

@dwilliamsHSJ @maxine_craig no! lack of detailed public worry and engagement is a major barrier to improving the #nhs #hsjnewsystemMihir Magudia

@dwilliamsHSJ Retain the value of expertise! Patients in charge = decision makers but no doctors/nurses. #hsjnewsystem balance requiredVeronika Thiel

Remember we have a new _commissioning_ system. Is the commissioner-dog strong enough to wag the provider-tail? #hsjnewsystemDavid Williams

@MMagudia agreed we need public to fully understand and work with us on issues we all face #Hsjnewsystemmaxine craig

If patients are in charge under #hsjnewsystem…then why do Complaints Review team need to go to Seattle when could be talking to us?Dee Speers

@dwilliamsHSJ see private pensions: pple said 2b in charge- complex intransparent products => bamboozled, often no/bad pension #hsjnewsystemVeronika Thiel

pts are (rightly) driven by self interest? i want to be in charge of my care but not for for broader public health #hsjnewsystemKaren Lynas

@dwilliamsHSJ we need to be carefully we are all one system creating sides doesn’t help in my view #Hsjnewsystemmaxine craig

@dwilliamshsj #hsjnewsystem We’re hoping to find some answers with @AndyburnhamMP and @NormanLamb at #healthpluscare hope you can make itKaty Lithgow

@CECOPS @ShaunLintern And bottles are screw top too! #hsjnewsystemDee Speers

@KarenLynas2012 that seems to be a really important point Karen when we start to decide what can and can’t be afforded #Hsjnewsystemmaxine craig

#hsjnewsystem Who does the government think is in charge? Do the CCGs feel in charge? I am sure the pts & public don’t feel in charge.Bill Russell

@MMagudia is that going to change now we have NHS England and CCGs? #hsjnewsystemDavid Williams

Are we ready to accept that whoever is in charge of the NHS, it isn’t the secretary of state for health any more? #hsjnewsystemDavid Williams

@npgdavies thanks! what’s the answer? #hsjnewsystemDavid Williams

@dwilliamsHSJ @dwilliamsHSJ wait till the next “never again” moment and we’ll see how suddenly involved the SoS becomes #hsjnewsystemMihir Magudia

After major losses of staff and cash, is the new commissioning system resourced well enough to exercise control? #hsjnewsystemDavid Williams

@dwilliamsHSJ these orgs only have one role in charge of the NHS and that is to hand it back to the patients and public #hsjnewsystemAntony Sumara

@NHSCCPress @SteveKellGP so… everyone’s in charge? #hsjnewsystemHealthServiceJournal

@dwilliamsHSJ control over budgets & access? it has to be. control over quality? complaints led systems have major risks #hsjnewsystemMihir Magudia

@HSJnews @NHSCCPress @SteveKellGP or no one is. #hsjnewsystemMihir Magudia

@zemba if we handed it back to patients, would they run it in the best interests of the taxpayer, who after all pays fo it? #hsjnewsystemDavid Williams

One if the skills of 1ry care is bringing systems/people together, and working with others.will be important in new system. #hsjnewsystemSteve Kell

@dwilliamsHSJ @zemba Pleasing to see a FT CEO championing giving up control, is it a customer style service in Bolton? #hsjnewsystemMihir Magudia

@dwilliamsHSJ @zemba #hsjnewsystem Which patients to run NHS? existing pts with LTCs, A&E attenders, potential pts like me? Unlikely!Bill Russell

@MMagudia @zemba tho telling that it’s not an ordinary FT CEO, but one who tends to clean up the mess after things go wrong? #hsjnewsystemDavid Williams

@zemba @dwilliamsHSJ how are you working with your patients so that they know about the shift #hsjnewsystemMihir Magudia

@bill_russell3 @dwilliamsHSJ @zemba dont think anyone thinks #longtermconditions have enough control, be a good place to start #hsjnewsystemMihir Magudia

Thank you all for taking part in our #HSJnewsystem chat. We’ll Storify the whole discussion so you can catch up on it laterHealthServiceJournal