NHS England’s spending on commissioning support units topped £125m last year, accounting for more than a quarter of some CSUs’ income, HSJ has learned.

The extent of CSUs’ reliance on the commissioning body for business is revealed in a breakdown of their income sources, released to HSJ under the Freedom of Information Act.

Although NHS England - which hosts all CSUs - had sought to withhold the data to protect their “commercial confidentiality”, the data was released after it received advice from the Information Commissioner’s Office.

According to the breakdown, NHS England bought over £125m of services from the 19 CSUs operational in 2013-14, accounting for 16 per cent of the sector’s £808m revenue.

Almost 75 per cent of CSUs’ income - some £602m - came from clinical commissioning groups, and nearly 10 per cent - a total of £80m - came from “other sources” such as provider trusts and local councils.

HSJ analysis shows six CSUs received more than 20 per cent of their income from NHS England.

The North of England CSU received more than a quarter of its £56m income from NHS England after taking on several contracts from NHS England, including those for GP IT services, which were previously held by primary care trusts on its patch.

The CSU has also won contracts to provide business intelligence for specialised commissioning in the north, and is one of several CSUs paid to assure local better care fund plans.

It has also won two further contracts jointly with the Cheshire and Merseyside CSU for patient engagement and pharmacy support in the north.

Since the beginning of 2014-15, the CSU has also begun working with NHS England and some acute providers to help validate elective waiting lists.

North of England managing director Stephen Childs said he expected the value of the work coming to CSUs from NHS England to grow.

“NHS England might be using CSUs now as part of the commissioning system to tackle some of the problems they face and possibly compensating for parts of NHS England where they might lack capacity and capability,” he said.

CSU income 2

South CSU is among the most reliant on CCGs, which account for 84 per cent of its income against an average across all CSUs of 75 per cent.

With some CCGS deciding to bring support services back in-house, such a reliance could leave CSUs at risk of significant budget cuts.

However, Mark Smith, director of strategic development at the South CSU, said the risk was spread because it served 19 CCGs and was developing an alliance with another CSU - South West - which had a more diverse portfolio.

HSJ analysis showed that many alliances or planned mergers between CSUs will help diversify the customer base of each grouping.

Most CSUs are forming such groupings to secure places on NHS England’s lead provider framework, and NHS England has indicated that CSUs that fail to make it onto this framework will not survive.

The partnership between South CSU and South West CSU brings together one highly reliant on CCGs with another with less exposure to that income source.

Such a pattern is repeated in other alliances. North Yorkshire and Humber CSU had a higher than average income from CCGs in 2013-14, while its partner - West and South Yorkshire and Bassetlaw CSU - received a significant amount of income from NHS England.

Meanwhile, Arden CSU was heavily reliant on CCGs, but is partnering with Greater East Midlands CSU, which won significant contracts with NHS England and Public Health England.

Staffordshire and Lancashire CSU is able to offset its reliance on CCGs by taking over Central Midlands CSU, which in 2013-14 gained 17 per cent of its revenue from outside the NHS commissioning system – more than double the average rate.