Health Committee's 2011 report into commissioning

The Health Select Committee published its report on commissioning on 18 January 2011, the day before the Health and Social Care Bill was introduced in Parliament.

The report responded to the Equity and excellence white paper and expressed concern about the 'significant institutional upheaval' that the government had introduced.

Structural changes

The committee expressed surprise at the extent of structural changes set out in the Equity and excellence white paper, felt it was significantly different to the plans that were set out in the coalition's Programme for government and expressed disappointment that some changes had started before parliament had debated the Health and Social Care Bill. The committee felt that the policy shift had not been sufficiently explained by the government.

The committee acknowledged, however, that as the changes had been made, the transition needed to take place quickly, to ensure the system was managed effectively.

The committee supported the government's proposals to cluster PCTs into fewer organisations as a pragmatic way of managing the transition. However, the protracted nature of the reforms would, in the committee's view, endanger the delivery of the Nicholson Challenge (the requirement to deliver 4% efficiency savings year on year). The committee believed that the PCT clusters needed to 'own' the delivery of the Nicholson Challenge and the change process.

Commissioning

The committee welcomed clinical involvement in commissioning and was encouraged that clinical engagement was drawn from a wide range of expertise. However, the committee highlighted some concerns, which included the potential conflict between commissioning consortia and primary care providers.

The committee was also concerned about patients and public not being sufficiently engaged in commissioning decisions and the need for greater public accountability.

The committee acknowledged that the question of effective commissioning was closely linked to the financial challenges facing the NHS, but suggested that the significant structural reforms would prove to be a distraction away from the most fundamental issues facing the NHS.

Government response

The government responded to the Health Select Committee's report on 31 January 2011.

In its response to the concerns, the government emphasised its belief that extending patient choice was key to driving up the quality of services and user satisfaction. The response challenged the suggestion that choice might be in conflict with clinical or financial priorities.

In response to criticism by the committee that the government's policies would introduce institutional upheaval into the NHS without changing its policy objectives, the government suggested that it was building on the best aspects of the previous government's policies, such as practice-based commissioning and foundation trusts.

In response to criticism that there had been a significant policy shift between the publication of the Equity and excellence white paper and the coalition's Programme for government, published a month earlier, the government suggested that its policies had been a blend of the two coalition parties' manifestos. Those policies that had arisen later, such as the abolition of PCTs, were a natural consequence of bringing together the policies of two different parties.

The government asserted that the central theme of commissioning under its plans was about understanding the needs of local communities, as well as individuals requiring healthcare. Commissioners would also have a greater role in working closely with patients and local people, and would involve a diverse range of health and care professionals when deciding what services it needed to commission. The government stated its intention for a future commissioning system, which was focused on improving quality and efficiency and placed the decision making with those closest to the patients, that is GP practices.

Additional details on transition

The committee had expressed concerns about the pace of change and the potential impact on the system's ability to make the required efficiency savings. However, the government felt it was 'entirely justified' because it enabled GP commissioning consortia to adopt their new responsibilities at their own pace while ensuring a continued focus on efficiency.

The government outlined further details on its plans for transition:

• Throughout 2011/12, groups of GP practices would become pathfinders and would start to take on increasing responsibilities for commissioning, using powers and budgets delegated to them by primary care trusts (PCTs).
• During 2012/13, consortia would be established, taking on full statutory accountability from April 2013.
• The existing PCTs were being formed into clusters (consisting of multiple PCTs managed by single executive teams) and would continue as vehicles of transition between the old and new system until April 2013. The formation of PCT clusters was designed to ensure continuity during the period of transition.