Influential MP to demand greater CCG accountability

John Baron is the chair of the all-party parliamentary group on cancer and has led rebellions by Tory MPs over the European Union and against military action in Syria.

He told HSJ he planned to question ministers early this year, particularly about clinical commissioning groups lacking accountability for improving outcomes. He called for NHS England to have a better system for addressing CCGs which did not improve outcomes and services.

Mr Baron’s comments come amid concern about progress on improving UK cancer outcomes. Results from the major Eurocare-5 study, published last month, said UK and Ireland survival rates were low, particularly for kidney, stomach, ovary and colon cancer, although they were close to the average for others. The findings, covering 2000 to 2007, come despite concerted national efforts to improve cancer care since 2000.

CCGs are overseen by local area teams – part of NHS England’s operations directorate – under the national body’s accountability framework. However, Mr Baron said he was concerned no one was identifying where groups were failing to make improvements for particular conditions, such as cancer diagnosis by GPs, and ensuring they “up their game”.

The MP said his group had supported the “focus on outcomes” that the government’s NHS reforms were meant to bring about, despite reservations about the “restructuring”, but he believed the accountability issue had “not yet been sufficiently answered”.

“What happens if CCGs are failing? It is the biggest question of these reforms,” he said. “I am concerned it is not clear in this brave new world where the accountability lies.”

“Where are the levers of change should CCGs be seen to be failing on this [work to improve outcomes]? Not just for cancer but generally.”

A report published by the APPG last month raises concern about the government’s 2011 commitment in its cancer strategy to “save 5,000 lives a year by 2014-15”. The report said a lack of monitoring meant it was unclear whether there had been progress and whether the target would be met.

NHS England national clinical director for cancer Sean Duffy indicated CCGs should focus on improving early diagnosis of cancer in order to improve outcomes. He said: “By concentrating on increasing early stage at presentation and reducing the emergency route for cancer diagnosis, CCGs and providers can work collaboratively to achieve the outcomes we desire. The levers to have this conversation are there and we encourage the health community to engage in this dialogue.

“To help the new system to embed in a collaborative way in 2013-14 NHS England made £2.3m available to strategic clinical networks to support improved awareness of the symptoms.”

NHS England pointed out it could provide support, and ultimately intervene, if CCGs were not able to make outcome improvements they had committed to.

Macmillan Cancer Support chief executive Ciarán Devane said: “There is a real risk that cancer outcomes will not improve unless NHS England urgently clarify the roles and responsibilities of CCGs and area teams to make it clear who is accountable for what.

“Many outcomes can only be improved if all the key bodies, including CCGs, primary care and specialised commissioners, work together. Right now it’s uncertain who is responsible for bringing them together and who will make sure it happens.

“Clearly cancer outcomes are not improving at the rate we need. Without clarity on who is responsible for improving these outcomes we seriously risk falling further behind.”