The ‘first 100 days of clinical commissioning groups (CCGs)’ is the round table discussion in this issue of The Commissioning Review. Most organisational changes are judged by the first 100 days of their being. Governments are supposed to set out and implement the changes they want in those first 100 days and CCGs will be no different.
The ‘first 100 days of clinical commissioning groups (CCGs)’ is the round table discussion in this issue of The Commissioning Review. Most organisational changes are judged by the first 100 days of their being. Governments are supposed to set out and implement the changes they want in those first 100 days and CCGs will be no different.
For me, the real issue will be deciding who is in charge. There are so many new bodies with new roles and statutory responsibilities that will need to determine their place in the structures. NHS England, formerly known as the NHS Commissioning Board, with its regional and area teams will be commissioning primary care and specialist care as well as helping CCGs with conditions become fully authorised.
Monitor and the Trust Development Agency have oversight of hospitals. In primary care, regulation is covered by the Care Quality Commission (CQC) and Healthwatch as well as the standard regulatory bodies of General Medical Council (GMC) and the Nursing and Midwifery Council (NMC).
The Clinical Senates and the Academic Health Science networks will provide strategic clinical advice. Health and wellbeing boards (HWB) sit within local authorities and control public health spend and then, finally there are the CCGs.
With this plethora of organisations and boards, it is little wonder the system is confusing. The NHS was set up 65 years ago but it has taken a change in the law to finally integrate health and social care.
My belief is the HWB will be the place where true power will lie, with locally accountable councils and CCGs coming together to decide the strategic direction of health and social care.
The moving of public health to the council will ensure we use the joint strategic needs assessment effectively and commission care that benefits every member of society not just the deprived, the elderly or the chronically sick. The prevention issue must be addressed here, so we invest properly in the wider determinants of health such as housing, education and crime. We need to focus on developing a health service not an illness service. We need to challenge each other to co-commission irrespective of our individual organisational drivers.
The transparency of decision-making will be key to the success of HWBs. They will be the safe place to have the difficult conversations about what and where to commission, but more importantly what to decommission. The long-term strategic configuration of where care is delivered will be decided rationally and responsibly by the system leaders.
Based on best practice and evidence with emphasis on outcomes, the difficult decisions of reconfiguration can be made free from the Kidderminster syndrome of political interference.
Local politicians, clinicians and patients will finally be brought together with their statutory responsibilities to make informed choices and implement them.
With advice from the clinical senates unshackled by partisan pulls of self-preservation or empire building, we will be able to commission the best services for our patients and public. By engaging in the Public Service Networks it should be possible to engage the technology available now to build the platform for 21st century health and wellbeing agenda.
There are so many new technologies and communication aids that can be utilised both by he professionals and the public to help monitor and prevent illness.
Telehealth and telemedicine should be embraced and embedded in daily practice.
The digital revolution needs to hit the health and social care world with electronic care records that can be seamlessly shared between all providers of health and social care; from the ambulance, hospitals, primary and community care to the social workers. Superfast broadband and cloud-based technologies will transform care for even the most technophobic user.
The new 111 service is a really exciting prospect for simplifying the public health system. With a robust directory of local services backed up by the technology, there is a real probability that patients can access the right healthcare at the right time by the right person in the right place.
