Wednesday, 14 November 2012

The Importance of the Commissioning Assembly: Systems and Assurance

Today was the first meeting of the NHS Commissioning Assembly, bringing together senior figures within the NHSCB and CCGs. Its aim is to ensure that the new commissioning system is effective, accountable and works as a whole. It's important it succeeds. Patients may not care which level or organisation commissions their service, just that it is available, high quality and safe. But by looking at the different organisations potentially commissioning care for patients the challenge for the system is clear.

She was 60 and had terminal lung cancer. She'd had lots of investigations, treatment, the works. She was comforted by an excellent community nursing team, Macmillan nurse and the local hospice, as well as her GP. She assumed her care was well coordinated, that transition between services was seamless.

She wished now she had stopped smoking. She had tried. She had rung the smoking cessation service, but limited access and work commitments prevented her engaging fully.
Commissioned by public health/local authority.

When she had started coughing she was prompted to see her GP by a local lung cancer awareness campaign.
Commissioned by public health/local authority

Her GP, who was unaware of the campaign, saw her in a routine appointment 4 days later.
Commissioned by the NHSCB

A chest X-ray was arranged at the local hospital. This was abnormal and an urgent appointment was made at the local chest clinic.
Commissioned by the CCG

Lung cancer was diagnosed, and a referral made to a tertiary care centre. Chest surgery was performed.
Commissioned by the CCG with input from the regional cancer network

Oncologists recommended radiotherapy and a new form of chemotherapy.
Commissioned by the NHSCB as a specialised service with input from the regional cancer network 

Treatment was eventually unsuccessful and care was provided by the local palliative care and community nursing teams with hospice input.
Commissioned by the CCG with additional voluntary sector funding.

Decisions made at each level have effects throughout the the system. It's vital we work together. Health and Wellbeing Boards will play an important role in linking clinicians and local authorities. Annual assurance of CCGs by the NHSCB will be important. However, true quality and planning oversight will require a systems view, across localities. Quality Surveillance Groups across local area team footprints will be key but must not transfer control or responsibility centrally. We all have responsibility for this patient. I'm optimistic the Commissioning Assembly will facilitate this. The will to work together is definitely there.  Now to make it happen.

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