The House of Commons’ new Health Select Committee is to hold an inquiry into how the coalition government intends to resolve the issues which have undermined the effectiveness of commissioning in the NHS.
In its final substantive report, published on March 30, the Health Committee in the last Parliament reviewed the progress of commissioning in the NHS. Among its conclusions were that: “weaknesses remain 20 years after the introduction of the purchaser/provider split;” and that: “weaknesses are due in large part to Primary Care Trusts (PCTs)’ lack of skills, notably poor analysis of data, lack of clinical knowledge and the poor quality of much PCT management. The situation has been made worse by the constant re-organisations and high turnover of staff.”
Noting that the coalition has “made it clear that, like its predecessor, it regards more empowered and more effective commissioning as the key to successful delivery of its objectives for the NHS,” the Committee says it is launching this inquiry in the belief that it can contribute to the debate about the implementation of policies for commissioning as outlined in the new White Paper: Equity and Excellence – Liberating the NHS.
The Committee’s inquiry will focus in particular on the following themes:
Clinical engagement in commissioning: – how will commissioners access the information and clinical expertise required to make high quality decisions about the shape of clinical services? – how will commissioners address issues of clinical practice variation? – how will GPs engage with their colleagues within a consortium and how will consortia engage with the wider clinical community? – how open will the system be to new entrants? – will care providers be free to offer new solutions which offer higher clinical quality, better patient experience or better value? – will commissioners be free to access new commissioning expertise? – will potential new entrants be free to offer alternative commissioning models? and – what arrangements will be made to encourage the Third Sector, both as commissioners and providers?
Accountability for commissioning decisions: – how will patients make their voice heard or their choice effective? – what will be the role of the NHS Commissioning Board? – what legal framework will be required to underpin commissioning consortia? – how will commissioning interface with the Public Health Service? – how will commissioning interface with Health Watch? and – where will the buck stop when commissioners face hard choices?
Integration of health and social care: – how will any new structures promote the integration of health and social care? – what arrangements are proposed for shared health and social care budgets? – what will be the role of local authorities in public health and commissioning decisions? – how will the new arrangements strengthen commissioners against provider interests? – how will vulnerable groups of patients be provided for under this system? and – how will the proposed system facilitate service reconfiguration?
Transitional arrangements: – will the new arrangements safeguard current examples of good practice? – who will drive innovation during the transitional period? and – how will transitional costs (redundancy etc) be minimised?
Resource allocation: – how will resources be allocated between commissioners? – what arrangements are proposed for risk sharing between commissioners? and – what arrangements will be made to safeguard patient care if a commissioner gets into difficulty?
Specialist services: – what arrangements are proposed for commissioning of specialist services? and – how will these arrangements interface with the rest of the system?
This is an extensive list but is not intended to be exhaustive, and comments on any other relevant aspects of commissioning will also be welcome, says the Committee, which is inviting short written submissions – preferably by email and of no more than 3,000 words – from interested organizations and individuals by October 6.
