NHS England could allow clinical commissioning groups to take ownership of their support service providers, rather than let the units be moved into the private sector, HSJ has learned.
The proposal is one of several options for the long term future of commissioning support units currently under discussion. Others include setting CSUs up as social enterprises, or allowing existing private firms to take majority stakes, with minor shareholdings reserved for staff and management.
CSUs: the first three years
Although the prospect of CCG ownership has been welcomed by commissioning groups, some CSU leaders are understood to be uneasy at the development. It would amount to a radical reinterpretation of the long term vision for CSUs, which were intended to become “freestanding enterprises” under Department of Health guidance set out two years ago.
CSUs are currently hosted by NHS England – an arrangement that comes to an end in March 2016. It had been assumed that when hosting ended CSUs could be transferred to the private or voluntary sector.
The process had been referred to as “externalisation” since 2011. However, HSJ has discovered the term has now been dropped, in favour of “autonomisation”. NHS England is expected to publish details of its plans in November or December.
Bob Ricketts, NHS England’s director for commissioning support strategy and market development, said: “We’re saying we’re creating autonomous CSUs. That means no longer directly owned or controlled by NHS England. ‘Externalisation’ doesn’t really convey that… to say they are independent of NHS England is a better description.”
Mr Ricketts confirmed CCG ownership was one of a range of options for the long term future of CSUs being looked at by NHS England.
While some senior CSU figures were sanguine at the prospect of CCGs owning their organisations, others were more sceptical. One said a mutual model would be a better way of ensuring the continued engagement of staff, and pointed out that it was unclear how a CCG-owned CSU could raise capital.
Under EU rules, CCGs could avoid going to procurement if they took ownership of their CSU, as long as the support unit receives at least 80 per cent of its income from the acquiring CCG. However, many CSUs are already earning more than 20 per cent of their revenue from other sources, such as GPs, NHS England, local government and the private sector.
“CCG ownership is a safe option, but it is not what I wanted to run a CSU to do,” the CSU source added. “Managing directors were recruited because they had some sort of commercial background.”
NHS Clinical Commissioners co-chair Steve Kell said: “I would welcome any change in CSU policy that enables CCGs to ensure value for money and quality for their populations. It’s important CCGs have all options available, and in some areas that may mean CCGs accommodating CSU functions.”
CCG ownership is being discussed as a possibility for Anglia CSU, whose managing director and finance chief were replaced by NHS England in April. Anglia is understood in recent weeks to have been the main area of focus for NHS England’s business development unit, which supports and assures CSUs.
Beyond Anglia, it is understood the CCG ownership model has attracted interest among CCGs wishing to more actively shape the direction of their support service providers.
HSJ understands NHS England leaders are asking why, if CSUs prove valuable to the NHS, they would want to lose their value to the private sector.
But Derek Felton, executive director for health at Ernst and Young, said CCG ownership of CSUs was a “flawed” concept.
“Great enterprises do not let customers control their mission or their business plan,” he said.