A proposal for the NHS Commissioning Board to be known as “NHS England” is attracting criticism for inflating the organisation’s role and power.
The suggestion is made in a leaked draft of the board’s structure authored by its chief executive designate, current NHS chief executive Sir David Nicholson. It says: “The [commissioning board] has to have a statutory board [which] is potentially confusing. It may therefore be more appropriate for the [commissioning board] to be referred to by another name in practice.
“The government response to the Future Forum requires [clinical commissioning groups] to have the NHS prefix, a geographical description and be referred to as clinical commissioning groups. An alternative description for the [commissioning board], based on this rationale, could be NHS England.”
However, several senior NHS sources said discussions about commissioning board plans had focused on its title and the danger of a perception that the board’s role would extend beyond commissioning.
Some believe the perception would further increase the board’s role and power. As presently proposed it would commission specialist services and primary care, retain other budgets where CCGs are deemed to be not ready, and oversee them when they are.
One well connected strategic health authority director said: “The NHS has [so far] been seen as a system, not one organisation… this looks like they have created a single organisation.”
A leading management figure involved in discussions about the board said the name appeared to be a signal that it “can basically do anything” rather than only commissioning.
NHS Alliance chair Michael Dixon said: “It looks like a centralised organisation. The concern is whether this is going to be an NHS which is run from the consulting room – and the board is supporting – or whether the board is holding the ring for everything, and CCGs are a not very powerful part.”
Foundation Trust Network director Sue Slipman said the board must be entirely focused on commissioning. However, she said the name NHS England suggested there were plans for its role to extend over providers, in which case “that would be a centralisation… and the worst case of all”.
Ms Slipman said the role of the commissioning board, CCGs and health and wellbeing boards in provider failure had not been set out, resulting in a lack of clarity.
Concerns have also been raised about the commissioning board being developed before the appointment of a chair. Senior executives are expected to be named in coming months.
A DH spokesman said a chair would be appointed “in due course”, but could not say whether that meant before October, when the board will be established in shadow form.
Ms Slipman said: “What is due course? They need to be dealing with this as a matter of urgency.”
The leaked draft estimates the board will have 3,500 staff, about three quarters of whom will be based in regional and local settings rather than its Leeds headquarters. The plan also includes a board structure (see above).
A DH source stressed that the leaked document was an “early draft” and said that it was likely to change in response to feedback.
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