Stevens promises tougher line on struggling CCGs

The NHS England chief executive said his organisation would now be taking a tougher approach to the “small number of CCGs that are getting into serious difficulties”.

He said: “CCGs… have done incredibly well in shouldering responsibility for two thirds of the health service’s budget, and the proposition that local clinicians and communities should be able to shape their own destiny is a good one.

“That’s one of the reasons why one of the first things I did was to seek to give those that were able and wanted it more clout over the total pound that’s being spent on the NHS in their local area [by asking them to co-commission primary care].

“But the quid pro quo is we’ve also got to be transparent about the performance of CCGs and the contribution they’re making to the sustainability of their local health system. That means we’re moving away from the phase one, which was initial setup and assurance, to phase two, which is [characterised by] support but differentiation.”

He added: “Where you have got a small number of CCGs that are getting into serious difficulties then we are going to need a more vigorous support mechanism. Equally for the vast majority of CCGs I want to give them far more power.”

Mr Stevens said NHS England’s default option for CCGs with severe problems had been to change their senior leaders, recent examples including Barnet and Bedfordshire CCGs, but that the organisation would now also be introducing “some other options”.

“Those other options could be other CCGs doing it on behalf of [the CCG], it could be a local authority in a relationship with the NHS, [or] it could be an integrated provider as part of our vanguard programme, taking delegated responsibilities.” Decisions would depend on each CCG’s circumstances, he indicated.

The change in approach reflected Mr Stevens’ desire to have “a mixed set of options in terms of the way commissioning develops”, he said.

Asked how quickly the new approach would begin, he said: “We will do that during the course of 2015-16, in the small number of geographies that clearly need it.”

Mr Stevens also said NHS England had found that, when it looked at the CCGs that have been struggling, they had “disproportionately… not been using [commissioning support units] or shared back office support”.

HSJ asked the NHS England chief executive about the government’s cities and local government devolution bill, which would give ministers power to transfer powers from NHS authorities to new combined city-wide authorities.

The legislation is intended to be used for areas like Greater Manchester, where there are proposals for devolved and shared NHS and social care budgets, alongside devolution and sharing of many other functions, but it is as yet unclear how it will be used in practice in relation to the NHS.

Mr Stevens said he favoured “giving ourselves more options where it makes sense. I’m not supportive of these things being imposed on the NHS but I am supportive of having the option”.