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DH: Health Bill CSU rule 'unreasonable'

DH: Health Bill CSU rule 'unreasonable'

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Large CCGs will be forced to bear the costs of external commissioning support if they want to achieve economies of scale, a DH director has said.

Dame Barbara Hakin, Managing Director of Commissioning Development at the DH, rubbished the view that large CCGs will be able to keep commissioning support in-house, under the health reforms.

Large CCGs will be forced to bear the costs of external commissioning support if they want to achieve economies of scale, a DH director has said.

Dame Barbara Hakin, Managing Director of Commissioning Development at the DH, rubbished the view that large CCGs will be able to keep commissioning support in-house, under the health reforms.

"It is my view looking at the running costs is that even the biggest CCG will have to have some level of external commissioning support if it is to obtain economies of scale," said Dame Hakin in a webinar hosted by the NHS Institute for Innovation and Improvement.

Indicative funding allocations for CCGs are thought to be on course to be published this January.

She also described the bill's rule that commissioning support should not come from the NHS unless housed within a CCG as "unreasonable".

"NHS staff should be able to form social enterprises while working in independent companies," she said.

"The National Commissioning Board is considering a proposal allowing it to 'host' Commissioning Support Units for the first two to three years of their lives to allow them to become established."

She warned of 'conflicting priorities' for commissioning GPs splitting their time between clinical and managerial duties, advocating the simplicity being one or the other.

Do you think commissioning support should be kept with the NHS or opened up to external providers? Your comments (terms and conditions apply):

"Only if you want to see the death and destruction of the NHS should it go to external providers, so a definite yes, it stays within the NHS" – Paul Airey, Wirral

"The population and demography here in Wales and in Scotland has meant that local NHS commissioning had become too costly and ineffective, even given improved money supply; especially incrementally, when provision to meet need was necessarily highly specific, high-tech or scarce for other reasons; and so it was right for the devolved Governments to move back to more centralised commissioning arrangements, with the emphasis being upon the development of clinical networks between and within the replacement enlarged and combined commissionerprovider Boards. It's difficult to see how any independent private commissioning agency could take on commissioning in either Scotland or Wales, except perhaps for cross-border solutions and consultancy re: specialised need. I think this is the same for Rural England and its Islands. In metropolitan conurbations and high-density urban arenas though there is probably scope for the commercial sector both to commission and provide' perhaps offering a chance for some companies to develop particular commissioning expertise; but I don't think it is desirable, unless the ethos of an NHS changes. It is wiser, I calculate, in terms of employee control and costs management to develop any new commissioning initiatives in-house and in partnership where necessary, with Local Government, still within a public service model and with regard particularly to accessing public health and community protection demographics. If such agencies were run like arms-length businesses, but networked within the public sector, one might get the best of both worlds: innovation and efficiency, but without the dreadfully high on-costs of ongoing re-tendering, contract and activity analysis, early or end of term contract closure and problems with commercial information sensitivity, the potential misuse of public information within the commercial sector, & espionage; all of which would make executives and politicians "take their eyes off the ball". The clincher for success in the new confusion of health care in England will be leadership to ensure an unerring focus on matching local need with the availability of Local, National and International resources, within a fluctuating money supply and then, over time influencing the availability of both, accordingly. I don't know a private company that could achieve this whilst also meeting its primary responsibilities to its owners/mutual community/shareholders, because of money supply and scale. I hope this point of view adds to the debate" – Ian Rickard, North Wales

"Kept with the NHS" – Dr Karen Stainer, Nottingham

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