Commissioning

The 3rd Health Select Committee Report of Session 2010-11 entitled 'Commissioning' was published on Tuesday 18th January 2011.

This report continues from the previous Health Select Committee’s report on commissioning which found ‘significant shortcomings’ in current arrangements for commissioning in the NHS.

The Committee is mindful that NHS commissioning cannot be considered in isolation from the financial context and states that the ‘unprecedented’ financial challenge to achieve an efficiency gain of 4% per annum is ‘the key priority facing the NHS’. However, the Committee accepts that action to enhance the effectiveness of NHS commissioning is essential if the NHS is to deliver the pace of change necessary in order to achieve the target of £15 – 20 billion in efficiency savings specified by NHS Chief Executive David Nicholson.

The NHS white paper, ‘Equity and Excellence: Liberating the NHS’ announced ‘significant institutional upheaval’ and the Committee notes that this has yet been ‘sufficiently explained given the costs and uncertainties generated by the process’. Though the Committee ‘broadly shares’ the Government’s policy objectives, it does not believe that the approach adopted by the Government represents the most efficient way of delivering those objectives.

The financial challenge is described as ‘high-risk’ and the report states that the white paper ‘increased the level of risk considerably without setting out a credible plan for mitigating that risk’. The ‘failure to plan for the transition’ is emphasised as ‘a particular concern in the current financial context’. The report recommends that PCT clusters be in place by 1 April 2011, in order to ensure that they are able to manage the financial challenge effectively

The Committee then goes on to set out priorities which it hopes the Health Bill will address. These are:

• Performance management
• Lines of accountability between the NHS Commissioning Board, the Department of Health and the Secretary of State
• Arrangements for integrating the full range of clinical expertise into the commissioning process
• Arrangements for reconciling conflicts regarding the separation of the commissioner and provider functions
• Arrangements for protecting and encouraging the commissioning of services that work across social care and health boundaries or are intimately linked
• The conflict between the principle of patient choice and the ability of commissioners to set priorities in the use of resources

The Health Committee intends to follow up this report with a further inquiry over the coming months as the Bill progresses through Parliament, in order to make recommendations to the House about how these priorities can be most effectively delivered.