Published: 29/09/2005, Volume II5, No. 5975 Page 5
Commissioners should be held to account for the state of all NHS services they buy for their local populations from 2008, according to the Healthcare Commission chief executive.
Anna Walker told HSJ at the Labour Party conference in Brighton that this was likely to mean fewer inspections of providers in the future because her organisation's focus would be on the effectiveness of commissioners.
She said she had 'no doubt in her mind' that once commissioning functions have been strengthened through the current reform of primary care trusts 'you can look very differently at the amount of regulation that the Healthcare Commission does'.
Ms Walker added: 'It is absolutely right that when you get to a world in which the commissioning function is enhanced, as the government is proposing to do under its Commissioning a Patient-led NHS [policy], then you would expect the regulatory system to have a lighter touch, because you would expect the driver to be the commissioner's contract.' Under the policy, PCTs will no longer provide services themselves but buy them from elsewhere.
Last month, the Healthcare Commission said it would not be judging PCTs on the performance of commissioned services in 2006 because it had to be realistic about what they could achieve in the first year of a new inspection regime.
The model Ms Walker is considering for 2008 echoes that of its sister organisation the Commission for Social Care Inspection, which gives star-ratings to councils on the social care services they procure. CSCI is due to be merged with the Healthcare Commission in 2008.
'If you look at CSCI, what they do is assess the commissioning function. You wouldn't need to do so much [in health], and you might need to look for something different.
You might be looking at it to see how well the commissioner is commissioning in practice.' She said the commission might look at the performance of providers as part of the rating of commissioners. Spot checks might also be carried out on providers 'for consumer protection purposes'.
Ms Walker added that there is 'a great debate' over the extent of spotchecking of providers, but she felt it should be kept to a minimum. 'What I personally would argue is you only go in when you have reason to be concerned, otherwise you leave it to the commissioners, ' she told HSJ.
The commission's signal on its future strategy was welcomed by Foundation Trust Network director Sue Slipman, but she said such a move would have to be 'backed up by very clear national frameworks so that people know what they are expected to deliver through the contract'.
Ms Slipman also called on the commission to think about how it can allow foundation trust governors and their members to have freedom to set local targets which meet locally identified priorities.
NHS Alliance chief executive Dr Michael Dixon said the move was a logical step, but warned against acting too quickly.
'It would not be appropriate in the short term while commissioners are trying to get their feet under the table as part of Commissioning a Patient-led NHS, the reconfiguration and changes in providers, ' he argued.
And National Association of Primary Care chair Dr James Kingsland said: 'It will be the commissioners who are determining the access and the quality responsiveness of their secondary carers, and if they are making a bad job of it they shouldn't be commissioning any more. Practice-based commissioners have then got to be held to account for the services they are commissioning.' Bill Moyes, chair of independent regulator Monitor, welcomed Ms Walker's comments and added: 'I hope the DoH eventually will assign waiting lists and targets to purchasers rather than providers as that would be the logic of the system.' l A new national director for occupational health will be appointed jointly by the DoH and the Department for Work and Pensions. The director will oversee the implementation of the green paper on health, work and wellbeing to be published in the autumn, work and pensions secretary David Blunkett announced at conference.
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