The Department of Health is set to impose a single operating model on primary care trust clusters in order to maintain a grip on NHS finances, HSJ can reveal.
The step follows mounting concern within the DH, Number 10 and the Treasury about the NHS’s ability to achieve £20bn of savings while it undergoes a huge organisational shake-up.
The operating model is due to be launched on 12 July at a meeting of cluster chief executives hosted by NHS chief executive Sir David Nicholson and national director of quality and productivity Jim Easton. It will be the first time clusters from across the country have met at one event.
The model, which is still being developed, is expected to set out a single strategy for the way clusters control finances and performance manage emergingcommissioning consortia.
A DH source said it was “about creating a transitional operating infrastructure for a single NHS Commissioning Board”.
A second DH source said: “The NHS is creaking and it needs strong control over the money. Strategic health authorities and clusters will become the mechanism around which the commissioning board gets control and traction in the system.”
The source expected this to be set out by Sir David, who is also chief executive-elect of the Commissioning Board, at the July meeting.
The operating model is expected to clarify clusters’ roles and structures and set out a more unified approach to managing budgets.
The guidance could also mandate that PCTs within a cluster share a single group of non-executive directors, sources said. Under the present guidance, issued in January, they are allowed to retain separate non-executives for each PCT.
A senior SHA director said: “Whatever structure there is under the commissioning board, it will be expected to operate as a single national system. We won’t have 10 ways of doing stuff… there will be one way. We won’t have organisations with their own strategies.”
Clusters are expected to take over important performance and finance management tasks from SHAs. A letter from Sir David to NHS South Central urges the SHA to “increase the pace of… development and empowerment” of PCT clusters because they will soon be taking on some SHA functions, “and need to be in a position to pick this up effectively”.
A senior SHA director said the functions being picked up by clusters included attempting to tackle local financial issues without the help of “risk pooled” sums of money, which have historically been distributed by SHAs.
The source said the single operating model would help Sir David and the emerging NHS Commissioning Board to secure close control of how this task is managed. However, this requirement on clusters could be eased if delays to the government’s reforms mean the abolition of SHAs is delayed.
HSJ has this week uncovered significant variation in the extent to which PCTs and clusters are sharing financial responsibilities and staff with consortia (see analysis). The shape and size of clusters also varies widely.
But Mr Stout warned clusters needed flexibility, otherwise “there’s a risk that the work clusters are doing now could get overturned by implementation of a standard approach and set back some of the progress”.
Mr Stout added: “If you’re going fast and are delegating all your QIPP savings to consortia, slowing that down could be incredibly damaging to the relationship with and development of consortia.”
The move to a single operating model for clusters has emerged amid growing fears about the possibility of the NHS failing to hit its target of £20bn savings by 2014-15.
HSJ understands the expert group advising Number 10 on the NHS focused almost solely on financial concerns when they met with the prime minister’s health adviser Paul Bate last week.
The group, whose members include King’s Fund chief executive Chris Ham, Nuffield Trust chief executive Jennifer Dixon and University College London Hospitals Foundation Trust chief executive Sir Robert Naylor, discussed whether the QIPP challenge was realistic.
They also discussed the “system-wide” leadership required to ensure savings targets were met when SHAs were abolished, potentially involving a stronger role for clusters.
There was a lively debate over the need for more top-down control during the transition, HSJ understands.
But a cluster chief executive said more control from the centre would make little difference to the “fanciful” QIPP challenge and overperformance by hospitals would only be addressed by significant changes to the payment by results system.
“It feels more than a little improbable that we can deliver the levels of savings that are required this year. If that’s what’s being fed up to ministers then that’s a good thing,” he said.
Contrasts across the PCT clusters
|Structure||Inner north west London: 10 executive directors, including three public health directors||Southampton, Hampshire, Isle of Wight and Portsmouth: 18 executive directors, including four chief finance officers|
|Budgets||NHS Hull: Delegating 17 per cent of budget to commissioning consortia from September 2011||NHS East Riding: Delegating 69 per cent of budget from September 2011|
|Assignmentof staff||NHS Bristol, NHS North Somerset andNHS South Gloucestershire: no staff assigned to commissioning consortia||NHS Derbyshire County and Derby City: Derbyshire County has assigned two senior members of the finance team. A further 12 finance team members have been assigned as “consortia facing”|