The Health Committee of the House of Commons today publishes a report on NHS Commissioning (Third report of Session 2010–11), concluding that more effective commissioning is key to delivery of efficiency gains
Launching the report Stephen Dorrell, Chair of the Committee, said:
"The value of effective and accountable healthcare commissioning has been discussed for 20 years. During that time the NHS has met the financial cost of a commissioning system, but has repeatedly failed to take full advantage of the opportunities which commissioning should create to improve the quality and value of the services provided.
The challenging financial context in which the NHS now operates reinforces the requirement to take full advantage of these opportunities. Today’s report reflects the commitment of the Committee to engage in the debate about how this is best done."
The report's central conclusions are:
- The NHS needs to make unprecedented efficiency gains if it is to meet rising demand for healthcare against the background of budgets which are broadly stable in real terms (the Nicholson Challenge)
- More effective commissioning is key to the delivery of this requirement for unprecedented efficiency gains
- The White Paper proposal to abolish Primary Care Trusts and transfer commissioning responsibility to GP-led consortia was not foreshadowed in the Coalition Programme and came as a surprise to most observers
- This "surprise" approach created uncertainty among commissioners and therefore increased the risks and costs associated with delivery of the Nicholson Challenge
- The pace of events since publication of the White Paper has required a pragmatic management response ahead of Parliamentary consideration of the proposals
- The Committee intends to follow through its report with further work on the detailed proposals for commissioning in the Government’s forthcoming Health Bill
"The report sets out the crucial issues which the Committee believes the Health Bill should address and which it intends to follow up" adds Mr Dorrell.
- The key is the development of a commissioning structure which is both effective and accountable
- This principle of accountability must apply through ministers to Parliament, as well as to patients and local communities
- Effective and accountable commissioning requires the engagement of the entire clinical community; GPs have a major role as a catalyst for this process, but not as the ultimate arbiters of all commissioning decisions
- Commissioners need to be able to adopt integrated service solutions (which cross institutional boundaries) when these offer best value
- Commissioners need to be able to consider innovative proposals for primary care – as well as for hospital care
- Commissioners need to be able to consider more effective structures for managing the interface between the NHS and Social Care
- Commissioners need to be able to realise the benefits which may be available to patients from major service reconfiguration
- Commissioners need to be able to reconcile conflicts between enhanced patient choice and the commissioner’s own financial and clinical priorities
"The Health Bill represents a major opportunity to get these policy questions right. The Health Committee believes these objectives are shared across the political spectrum and will make further recommendations about how they can best be delivered," adds Mr Dorrell.
The White Paper Equity and Excellence: Liberating the NHS, published on 12 July 2010 set out the plans of the Coalition Government to improve NHS Commissioning through the creation of General Practitioner consortia.
The inquiry conducted to produce this report set out examine these proposals.