NHS England has been asked by the Public Account Committee (PAC) to clarify how many CCGs it expects there to be by 2021 and what action it will take to ensure they are all performing effectively.
A report published by PAC today also said NHS England should clarify how it will ensure all CCGs have ‘high quality leadership’ as they move towards making decision across larger populations.
PAC said that since 2012, the NHS has seen ‘confusing and rapid’ changes in organisational structures that made it difficult for taxpayers to understand who is accountable for health spending and performance.
Through a series of recommendations to NHS England and the Department of Health and Social Care, PAC suggested that ‘getting the commissioning structures right’ will be critical for the delivery of the long-term plan’.
Fewer CCGs
The report highlighted that there has already been a considerable reduction in the number of CCGs since 2013, when there were 211 CCGs – compared to 195 in 2018.
Speaking before PAC in January, NHS England chief executive Simon Stevens confirmed that there will be a reduction in the number of CCGs to match the number of ICSs as part of the long-term plan.
The PAC report said it is not clear yet how many CCGs there will be by 2021.
There have been eight formal mergers since 2013 and it is also becoming more common for CCGs to share an accountable officer with at least one other CCG, the report said.
Last year, CCGs were asked to reduce administrative costs by 20% by 2020/21, which PAC commented could result in greater collaboration between CCGs.
The PAC report said: ‘When reporting back to us at the end of 2019, NHS England should provide an update on what it expects the structure of NHS commissioning to be by 2021.
‘This should include: how local circumstances are being taken into account as it determines the structure of CCGs and integrated care systems; an update on the expected number of CCGs; the number and configuration of integrated care systems; and an estimate of the redundancy costs CCGs will incur.’
Performance and leadership
PAC said that as CCGs move toward commissioning services for a wider portion of the population, it is essential that NHS England takes action to ensure all CCGs are ‘performing effectively’.
NHS England currently considers 24 CCGs to be failing or at risk of failing.
High quality leadership is another element CCGs struggle with, as stated by NHS England, which in 2017/18 considered only 54% of CCGs to have good leadership and said it was concerned about the difficulties CCGs face when trying to attract and retain good leaders.
The PAC report said: ‘NHS England should report back to us by the end of 2019 on the actions it has taken to ensure all CCGs are performing effectively and have high quality leadership as they take on responsibility for commissioning across larger populations.’
Commenting on the report, PAC chair Meg Hillier MP said: ‘Standards must improve significantly as CCGs take on the commissioning of services across larger populations – a change which runs the risk of them losing focus on the particular healthcare needs of local people.
‘We will follow developments with interest and expect NHS England to provide us with a detailed update by the end of the year.’
Other recommendations include making sure that local GPs continue to have ‘input into CCGs’ decisions and that ICSs are held to account for ‘their joint decisions and responsibility for improving the health of their population’.
NHS Clinical Commissioners chief executive Julie Wood said: ‘The commissioning landscape is undoubtedly evolving but clinical commissioners still have a critical role in transforming health and care for the better. CCGs have already been taking strides to work more efficiently and collaboratively across larger footprints whilst maintaining their links to local populations.
‘Although there is a mixed picture of performance, the PAC recommendations helpfully highlight areas of support that CCGs will need as they look to deliver the long-term plan, for example, to clarify governance and accountability, support their leaders, and a clear final number of ICSs. It also highlights the importance of getting proposed legislative changes right as they could smooth the path to integration – something we have been saying on behalf of our members for some time.’
