Friday, 14 June 2013

Holding Course

2 months after major reforms, and the official birth date of clinical commissioning, there's a debate about the role of CCGs.  Whilst not unexpected, it does seem premature.

A Foundation Trust Chief Executive told me last week that clinical commissioning was the best thing to happen during his time in the NHS.  The increased level of clinical conversations, the focus on patients had helped his organisation and was a welcome change.  

So is now really the time for a change in direction?  Is the agenda different?  Undoubtedly there is a need for integration, for joint working with social care.  But this isn't new.  There is a need to understand the impact of conflicts of interest, but it's difficult to think of any organisation with no conflict whether political or as a provider of services.  

The goal of integration does not need a mandatory change of commissioning responsibility or NHS budgets, but a change in working and behaviour.

CCGs across the country are working to achieve integration and are working in partnership with local authorities.  Health and Wellbeing Boards are now established, but are not tested by an authorisation process and vary in membership and readiness to govern.  Some have had significant turnover in membership and political ideology following local elections.  

The NHS needed to change.  Now is the time to give clinical commissioning some time, the space it needs to succeed.  I'm confident it can, but we need to retain the sense of clinical responsibility for our patients, to continuously improve outcomes.  This won't come from advisory roles.  We have a real opportunity to change the way clinicians and managers view the NHS and its outcomes for patients.  Responsibility is key.

Apparently less than a third of people are aware there has been a major NHS reform.  Their focus is on provision, on their local services.  Satisfaction in the NHS remains high.  Changing commissioning roles too early may weaken the NHS and is unlikely to be of significant political benefit.

We are very much aware of the importance of time as clinicians, of giving treatments the opportunity to work.  Let's do the same with the NHS.