This article was first published in the June edition of c’llr mag.
1. Some difficult months ahead
Considerable work is taking place to establish the structures and systems that underpin the reforms – the NHS Commissioning Board, Clinical Commissioning Groups (CCGs) and the Commissioning Support Services (CSSs) that will support their work, the transfer of public health and Healthwatch.
Formal authorisation of new structures will be a major focus; the first of four waves of CCG authorisation, which will involve council views, will commence in July. The NHS Commissioning Board Chair designate, Malcolm Grant, has acknowledged that the next six months will be very difficult as people do their day jobs while shaping the future.
2. CCGs – liberation or control?
The concept of ‘liberation’ is central to the reforms. CCGs in particular were meant to be free to develop innovative solutions. However, many involved in CCGs and other health organisations are suspicious that anticipated freedoms may be eroded. This includes the concern that NHS Commissioning Board will exercise a ‘grip’ over how CCGs operate and that CSSs will be used to promote uniformity.
3. NHS Commissioning Board – liberation or control?
The Health Secretary has directed the shadow Board to adopt a baseline position of ‘assumed liberty’ rather than ‘earned autonomy’ in relation to authorising CCGs, but there are concerns that the Board itself may be subject to
extensive government requirements. The Department of Health (DH) will be consulting on the Board’s first ‘mandate’ over the summer, and this is seen as an indicator of the government’s willingness to release control.
4. Health and wellbeing boards remain optimistic
A recent Kings Fund survey found that HWBs were ‘upbeat’ about their ability to achieve core objectives such as closer integration. HWBs have had a head start with their long lead-in and are well-placed to move speedily from forming to improving health outcomes.
5. ‘Regional’ working will be important
While it is difficult to define exactly what counts as ‘regional’ at present, CCGs and their local authority partners will need to operate beyond local boundaries. As well as sub-national arms of the Board and Public Health England (PHE) there
will be around 25 CSSs around the country which implies that some commissioning will take place over a larger footprint. A priority for the local government sector is to support councils in their health responsibilities at a regional level.
6. Funding may be controversial
The Health Secretary has indicated that CCG funding should consider the age of populations rather than indices of deprivation as the main determinant of health need. Funding for public health would be based on indices of deprivation with a direct expectation that the money would be spent on activity that addresses health inequality.
7. Provider reconfigurations will increase
Plans for changes to NHS services are taking place across the country. Some providers face budget deficits or quality issues or are seen as unsustainable in the longer term. Some areas are seeking major reconfiguration such as
hospital closures, others more modest restructuring, such as consolidating services. Many of these plans will bring challenges for HWBs and health scrutiny.
8. Quality issues
Concerns about the quality of some health and social care providers and also of the regulator, the Care Quality Commission, have an increasingly high profile – for instance, the inquiry into Mid Staffordshire Foundation Trust due to report in the autumn. Most of these problems do not stem from NHS reforms, but may well be seen as associated with them.
9. Regulations will follow
The Act will be supported by a large amount of secondary legislation and guidance including regulations on establishing Healthwatch and on public health issues such as when councils can charge for activity and the process for
consultation on fluoridation. Probably the most controversial regulations will relate to competition and the role of Monitor.
10. Significant appointments are taking place
The appointment of PHE Chief Executive designate Duncan Selbie has caused some surprise given that his background is in the NHS and the DH rather than public health – or local government. Other roles, such as Chair of Healthwatch
England, are being advertised.
LGiU’s member briefing of 5th April 2012 summarises the main features of the HSCA.
Christine Heron is an LGiU associate.