NHS Confederation chief executive Mike Farrar has warned the health service’s capacity could be reduced to “dangerously low levels” by proposals to halve the number of managers in key areas of NHS commissioning and planning.

The NHS Commissioning Board yesterday published detailed proposals for the design of its structure. The organisation will take on direct commissioning of specialist and family health services - worth tens of billions of pounds - as well as much of the running of the NHS from April 2013.

Design of the NHS Commissioning Board admits one of the main risks to its “resilience” will be trying to run its functions with “50 per cent less resource [than is currently spent on them] by 2014-15”. It will include a similar reduction in staff.

It says the board will employ around 3,560 people - 2,500 in around 50 local board offices; 200 in four regional “sectors”; and the rest in national teams, mainly based in Leeds.

Mr Farrar said in a statement to HSJ: “The NHS is facing its biggest ever challenge, with the £20bn productivity requirement alongside the huge pressures facing the social care system and the need to continue to drive up quality of care. To meet this challenge we will need strong leadership and management.

“International comparisons show us that the NHS has a low spend on management relative to other systems. We need to be confident that the proposals for the NHS Commissioning Board and clinical commissioning groups will deliver a health system with the necessary capacity.”

Referring to the risks identified by the board, Mr Farrar said: “The board itself recognises there are significant risks in reducing the level of management in the new system.”

He added: “As the trade organisation for the health service, we have consistently backed the delivery of efficiencies to ensure the maximum resource is available for commissioners to put into patient care for their populations. But, the levels of management set out here could pose a real danger to effective patient care.

“It doesn’t matter whether the people filling these positions have an administrative or a clinical background, the fact remains that if insufficient money is spent on the organisation of care then patient outcomes will suffer.

“I am really worried that we are reducing this capacity to dangerously low levels. I fear that this level of reduction will undermine the ability of the NHS to achieve the tasks it will be set. We urge them to reconsider the level of resource they dedicate to the organisation of patient care.”

The commissioning board design says its total running cost budget - including management staff - will be £492m. Meanwhile, CCGs running costs, which will cover their commissioning support services, are to be fixed at £25 per head - or around £1.25bn nationally.

Based on the DH’s expectation that the total health system running costs will be £3bn in 2014-15, the figures appear to leave a massive £1.3bn for management of public health services, and the DH itself.

Commissioning board managing director Bill McCarthy, speaking to HSJ earlier in the week, said it had to make the proposed reduction in management cost to help meet the need for huge efficiency savings in the service.