Welcome to The Commissioner; and the CCG scorecard that may never happen

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What NHS England isn’t telling you, and more indispensable weekly insight for commissioners. By Dave West

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Introducing The Commissioner

Hello, welcome to HSJ’s new weekly email briefing on the NHS commissioning sector.

The Commissioner will feature quick-read analysis of the most pressing and diverting issues for the sector; unearth what NHS England doesn’t want us to know; and highlight the most interesting stuff that commissioners have been doing.

It would be really helpful if you can let me know how I can improve it, and tell me (confidentially) what you think I should be covering. The Commissioner replaces our previous commissioning newsletter, but still includes links to the top stories.

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Dave West, senior bureau chief, HSJ

Why the CCG scorecard may never happen

Jeremy Hunt has been talking about imposing a new suite of performance metrics since 2014. Thanks to officials’ efforts in moderating and deferring the “CCG scorecard” plan, this has been a long process.

It looks to me like it still might never arrive – at least not in the hard-hitting format initially envisaged by the health secretary.

His original idea for a points-based system was seen away last year, but in autumn he resumed his push for a new ratings regime, using a series of Ofsted/CQC style labels. Speaking at October’s HSJ annual lecture Mr Hunt said CCGs would be issued their first ratings in six clinical areas “by June [2016]”.

Detailed proposals for a new assessment framework were published last week. In relation to the clinical areas ratings, they say only that a “beta” version of these will be published “as soon as possible” – suggesting further slippage beyond June is likely.

On top of that, I’m told the expert chairs hired to advise on the condition-level indicators might themselves decide to further slow or modify the process. They are concerned there won’t be enough information to issue credible ratings this summer, and would rather take a more supportive approach than labelling groups as “inadequate”, as Mr Hunt would like.

There are many reasons why a high profile CCG ratings system is a bad idea. Here are the strongest:

CCGs are the wrong place to focus. The NHS is trying to plan – and measure itself – as a whole system, normally in patches bigger than CCGs (see this week’s sustainability and transformation plan guidance). Meanwhile, some CCGs are realising they are not best placed to make changes in their areas and handing responsibilities to providers, GP groups, councils and “devolution” authorities. NHS England has tried to account for this in the assessment framework, with a strong focus on STPs and implementing new care models. But a CCG rating will only serve to sharpen the focus on individual CCGs.
The King’s Fund told the Department of Health that giving CCGs credible aggregate ratings would require substantial human judgement about things like leadership and planning – not just looking at data. The idea that NHS England at any level, or its expert advice panels, will put in enough resource to make judgements properly is fantasy. Thankfully there is little desire to set up a CQC-like inspection apparatus for commissioning. NHS England’s guidance says most of its (54) indicators will be updated and made public every quarter. This doesn’t seem very achievable, either.
One of the justifications given for the regime is it will allow NHS England to intervene in CCGs with problems. It has been suggested they could have leaders replaced; be merged or broken up; or have responsibilities passed on to other CCGs, providers or local authorities. But this is already happening. Many chiefs and chairs have been moved on, and CCGs have been pressed into sharing leadership and outsourcing functions. There are legal and practical problems with ordering troubled CCGs to give up their powers – the scorecard won’t solve them.

All this leaves Mr Hunt fairly alone in his quest for a new ratings regime. With his attention on ever more fraught battles on other fronts, there’s a good chance that when a new ratings system does arrive, it will be much watered down and given little prominence.

This week’s top news

Unpicking the Lansley Act

Oxfordshire CCG and county council have asked the government for powers to jointly commission all the area’s specialised services, primary care, social care and public health services. It would get them close to the unified responsibilities of Oxfordshire PCT before the Health Act 2012 – a point not lost on the CCG, which has highlighted this.

For its own part, Oxfordshire CCG appears to have achieved turnaround in leadership and financial fortunes over the past couple of years. It might not get approval for all this (NHS England has been and remains very circumspect about devolving its control), but large, well-led CCGs are in a good position to get at least some of what they are after.