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Lansley letter to NHS CB warns it ‘must transfer power’

by Louise Naughton
23 April 2012

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The first and “overarching objective” of the NHS Commissioning Board (NHS CB) is to ensure its design transfers power to local organisations, a pre-mandate letter from the government has said.

In a letter to NHS Commissioning Board’s Chair Professor Malcolm Grant – seen by GP Business – Health Secretary Andrew Lansley set out the four strategic objectives to which the board will be held accountable:

–       Transferring power to local organisations.

–       Establishing the commissioning landscape.

–       Developing specific commissioning and  financial management capabilities.

–       Developing excellent relationships.

Lansley said the decentrialisation of decision-making and promoting the autonomy of CCGs must be “embedded within the culture of the NHS CB”.

He also said CCGs and their leaders should be “closely involved” in the development of the Board and clinical senates and networks – who will be developed to provide leadership and insight rather than oversight and compliance.

The letter reiterates the importance of CCG freedom and sets out an expectation that the process of budget delegation will “accelerate” to allow more CCGs to operate in this financial year in a similar way to next year.

“Clinical commissioning groups will have the freedom to work with whomever they want to in securing support for commissioning health services,” said Lansley.

“As statutory organisation, CCGs will be able to choose commissioning support from whatever organisations in whatever sectors are best able to meet their needs.

“CCGs will hold the money for commissioning support and there will be no topslicing for this purpose.”

While he acknowledged the need for a central hosting for commissioning support during the development phase, Lansley confirmed the NHS CB will not have a “long-term role” in providing or hosting commissioning support services.

Furthermore, Lansley spoke of his desire that all authorisation conditions will be time-limited rather than enduring.

In order to manage its dual role, the NHS CB has been called upon to establish a “transparent, rules-based system” to address such issues as financial risk pooling, and the necessary interventions for CCG poor performance, distress and failure.

The objectives will be relevant when the NHS CB is operating as a Strategic Health Authority – until October 2012 – and once it is established and in its preparatory phase from October 2012 to March 2013.

The government has begun developing proposals for the NHS CB’s mandate post March 2013, aiming to consult in the summer and publish in the autumn of 2012.