There will not be a single commissioning model across England over the next five years, with local authorities and accountable care organisations increasingly taking on these functions, Simon Stevens has said.

The NHS England chief executive also said he expected more areas to follow the “devo Manc” model of devolved health and social care budgets being trialled in Greater Manchester but it is “[unlikely] to be universally adoptable across England any time soon”.

He said there will probably be “at least five energy forces” in commissioning “not just the two that we are used to most used to: clinical commissioning groups and NHS England”, speaking an event in London yesterday held by the think tank Reform

Simon Stevens

Simon Stevens said some regions should be allowed to ‘move further faster and do things differently’

He named the three others as “partnerships with local authorities”, new provider organisations set up as part of NHS England’s new models of care programme, and patients themselves through integrated personal budgets for health and care.

Mr Stevens said: “If our working proposition is that this country is too large for ‘one size fits all’, then we don’t actually have to put all our eggs in the basket of a single commissioner model.

“We can have five different flavours as long as we are clear about the equity of the offer that exists across the [NHS], and we use these different energy pools to drive improvement in a way that tackles some longstanding inequalities in access to the outcomes from NHS funded care.”

He stressed that the move towards local authority delegation included in the Manchester deal would not mark the end of the national service. “There will still be minimum standards and entitlements for patients in Greater Manchester,” he said.  

“The choice facing us is just because some places can move further faster and do things differently, should we hold them back until everyone could theoretically do the same?

“In my opinion that is one of the great fallacies of the approach to managing improvement. We kid ourselves that we get uniformity of effort and results.

“Instead we’ll end up having… conversations about rearranging deckchairs rather than a much more focused, practical means-end conversation about how to drive change.”

Mr Stevens also said that NHS England would “selectively delegate… responsibility for funding for their populations” to extended provider organisations developed under the new care models, which would bear “obvious” parallels to accountable care organisation type models.

“What that in effect means is that the commissioning responsibility there is being led by groups of providers, subject to certain safeguards and standards,” he said.