The NHS should “move on from the debate about national versus local priorities”, the NHS Commissioning Board deputy chief executive has said, previewing the planning framework for next year.
Ian Dalton was speaking at the NHS Alliance conference in Bournemouth last week.
Details of the planning framework for 2013-14 are due to be published in coming weeks, probably on 14 December. It will be renamed from the “operating framework” title used in the past.
Mr Dalton said clinical commissioning groups would be able to set their own priorities for quality improvement although there would also be a “national ask”. National requirements are likely to include targets derived from the NHS constitution such as waiting times, and financial rules, probably including efficiency savings.
He said this meant that, “we need to move on from the debate about national versus local priorities”.
Mr Dalton also said in the new system, “there is not a hierarchical relationship in sight”.
He said there could not be a trade-off for CCGs achieving good performance in 2013-14 and delivering long term service change. They had to “do both”, he said.
The commissioning board’s 27 local area teams are likely to be involved in planning for 2013-14 with CCGs, although Mr Dalton said the teams’ role was not as a “judge”.
The planning guidance is also likely to begin to set out an assurance and escalation framework for CCGs, describing when and how failure will be addressed, including in regular performance reviews.
CCGs’ allocations for 2013-14 are also expected to be published around the same time.
Meanwhile, Mr Dalton played down hopes of a quick move away from the payment by results tariff.
He said the board did not want “to have rules that get in the way of what people want to do” but that “payment by results has in many ways served us really well” and “it will continue to have a role in many areas”.
He said: “It would be misleading people if I said suddenly there is going to be a new system that is going to be launched.
“What I’m saying is the commissioning board will have a dialogue on an ongoing basis with CCGs. There is absolutely a place for both integration and competition.”
NHS Alliance chair Michael Dixon had earlier told the conference that the NHS Commissioning Board should protect CCGs’ freedom and support them in making potentially unpopular decisions about changing services.
He said NHS Clinical Commissioners – a group formed jointly with the National Association of Primary Care – would fight to defend autonomy. He said: “From now on, anyone who wants to mess around with CCGs or their leaders will find themselves looking down the wrong end of the gun.
“This time we will ensure that the ideals that you fought for, actually happen. There will be no replay of the broken promises of the past.
“The current language of the board is exactly right… Those words must now translate into action.”
Dr Dixon said NHS Clinical Commissioners would each year ask CCGs for appraisals of the commissioning board and its local area team in their area.
Bennett: new pricing system is years away
Monitor chief executive David Bennett, speaking at the NHS Alliance conference today, said it will take “years” to design a new NHS pricing and payment system.
He said Monitor was keen to see service provision better integrated, and that “in an ideal world we would [also] be joining up funding of healthcare, social care and elements of prevention”.
Mr Bennett also highlighted the prime contractor model for procuring integrated services.
He said Monitor – which has joint responsibility for developing pricing with the NHS Commissioning Board – would “look at arrangements starting with a clean sheet of paper”.
But he said it could take “a period of many years”. Mr Bennett said: “We are going about it rigorously, but it will take a while.
“One thing we can do is let people know what freedoms they have in the current system. The payment by results system is not as constraining as people imagine.”