NHS bodies ‘failing to function effectively’ say Government auditors
SOME CLINICAL Commissioning Groups are failing to function effectively or hire and retain the high-quality staff they need, a report claims today.
More than half of CCGs, which plan and commission health care services for their local area, were rated by NHS England as either ‘outstanding’ or ‘good’ in 2017-18, but more than 40 per cent were rated as either ‘requires improvement’ or ‘inadequate’ with 24 failing, or at risk of failing.
The National Audit Office (NAO) said that while most stakeholders provide a positive view of their CCGs, neither the Department of Health and Social Care nor NHS England have assessed their progress in achieving their policy objectives.
Amyas Morse, the head of the NAO, said today: “We have seen almost three decades of change to NHS commissioning. It would be a huge waste if in five years’ time NHS commissioning is undergoing yet another cycle of reorganisation resulting in significant upheaval. The current restructuring of CCGs must deliver balanced and effective organisations that can support the long-term aims of the NHS and deliver a muchneeded prolonged period of stability.”
CCGs were established as part of the Health and Social Care Act in 2012 to help health services be more responsive to patients’ needs and to align clinical and
financial decision-making. Since being introduced, their scope has expanded to take greater responsibility for commissioning GP services and integrating health and social care systems.
An increasing number of CCGs are spending more than they had budgeted for. In 2017-18, 75 of 207 CCGs (36 per cent) overspent by a total of £213m. This compares with 57 CCGs in 2016-17 and 56 CCGs in 2015-16.
As part of their total budget plan, CCGs have consistently saved on funds allocated for their running costs, which has been reduced from £1.35bn in 2013-14 to £1.21bn currently. In November 2018, NHS England confirmed that CCGs’ running cost allocation would reduce by a further 20 per cent by 2020-21.
Mr Morse said CCGs have struggled to attract and retain high-quality leadership. While 54 per cent of CCGs were assessed by NHS England to have good leadership, issues around recruitment and retention include a reluctance among staff to step up to senior positions because of increased pressure, the uncertain future of CCGs and a lack of access to training and development.
Commissioning was introduced into the NHS in the early 1990s, when the purchasing of healthcare services was separated from their delivery. Since then there have been several changes to the structure of NHS commissioning organisations and their population coverage.
The structure of CCGs is evolving, with mergers, shared senior management teams and increasing joint working.
This is being prompted by factors including wider changes across the NHS, budgetary pressures and as CCGs’ understanding of the most appropriate commissioning structure for their local area develops.