Engaging with the NHS Commissioning Board
and the impact of the changes in the wider LHE
Simon Weldon, NHS Commissioning Board London Regional Team
London Regional Team
23 October 2012
Role of the NHS Commissioning Board
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Directly commissioning £25 billion worth of services including primary care, some public
health services such as immunisation and screening, and specialised health services.
Allocating £60 billion to Clinical Commissioning Groups and supporting them in the
effective use of that money to buy local services.
Planning for civil emergencies and making sure the NHS is resilient.
Developing relationships and agreements with delivery partners at national level, and at
local level on health and wellbeing boards.
Leading the development of strategy and vision for the NHS, and promoting the
research, innovation and change which will make the NHS world class in all it does.
Setting policies and standards for the NHS, in particular in respect of information,
leadership, competition.
Developing incentives, tools and guidance to help clinical commissioners achieve their
goals.
Operations directorate
• The Operations directorate will be led by Ian Dalton, Chief Operating Officer and
Deputy Chief Executive.
• It will work to achieve shared goals of improving outcomes and delivery of the
mandate, using a single, transparent, rules-based operating model.
• The key functions of the national Operations directorate are:
 To conduct direct commissioning and provide oversight of delivery of primary care
commissioning; specialised commissioning; military health; public health; offender health
 To provide assurance and assessment of Clinical Commissioning Groups
 To be responsible for emergency preparedness.
10 design principles
1. Operate as a part of the NHS Commissioning Board.
2. Fit with the footprint of organisations with which relationships are key to the London
region’s success.
3. Focus on delivering the national commissioning priorities at a regional and local level.
4. Delivery of a national, clinically-led strategy and the creation of a clinically and
financially-viable provider landscape will require significant service transformation and
reconfiguration.
5. Reduce complexity by acting as a link between the public, patients and services at a
local level, and the NHS Commissioning Board and system at a national level.
10 design principles
6. Play a coordinating and oversight role across the NHS in London, ensuring roles and
accountabilities are aligned to delivery.
7. Enable ‘assumed autonomy’, but hold Clinical Commissioning Groups and providers to
account and ensure performance remains high.
8. Have internal clear accountabilities, minimise internal complexity and avoid conflicts of
interest.
9. Localise activity where relationships or local knowledge are key and centralise
activities where economies of scale or skill are achievable.
10. Remain flexible to the changing needs of the local system and population, and of the
national priorities.
Regional Structure:
Regional
Director
Director of HR and OD
Transformation
Director
Business Office
Director of Patients
and Information
Medical Director
Director of
Nursing
Finance Director
Director of
Operations and
Delivery
Commissioning
Director
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What are the immediate challenges?
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Authorisation of CCGs
The planning and contracting round
Managing in year delivery
Setting aspirations
Forming new relationships
Implementing strategic change
Authorisation of CCGs
• The process that establishes CCGs as statutory
organisations – governed in the Act
• Well underway in London and will be
complete by early January
• Establishes the terms under which a CCG will
be authorised
• Principles of assumed liberty and local
planning with partners
The planning and contracting round
• For acute, mental health and community, the planning round will be led by
CCGs
• Commissioning Board a significant commissioner of services; specialised,
public health
• Planning guidance and allocations will be issued in December
Managing in-year delivery
• The need to maintain in year delivery both of
standards and the money is paramount
• The process of managed transition to the new
system organisations has begun
• This creates the platform for the CCGs, the NCB
and the NTDA to carry out their functions
• The process of transition completes at the end of
March 2013
• The first operational challenge the new
organisations face will be the management of
winter
Setting aspirations
• The process of creating the new systems and
authorising CCGs is rigorous
• But authorisation in itself is a moment in time
• The challenges CCGs will face include not only being
great commissioners of their providers but also
describing and setting the aspirations to meet local
health needs with partners
• These aspirations should be drawn from the NHS
outcomes framework
• The new system offers opportunities to consider new
approaches – for example, how to promote wellness.
Forming new relationships
• The changes create a number of new
organisations
• The challenge will be to articulate and define how
these organisations will work together to deliver
benefit
– The CCG should lead the commissioning of local
health care for a population
– The NCB will hold the system accountability for
delivery of the NHS Constitution
– The NTDA will be responsible for the oversight of nonFTs journey towards FT status and for in-year
performance management
Implementing strategic change
• The new system inherits a significant agenda around
strategic change
• This will fall into two, linked areas: reconfigurations
and clinical service redesign
• There are significant challenges associated with the
current programme of reconfiguration both in terms of
securing decisions and also implementation
• In addition, we must also continue to build on the
legacy of the current system with continued work on
cancer, urgent care, integrated care and hospital
standards.
In conclusion
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Authorisation of CCGs
The planning and contracting round
Managing in year delivery
Setting aspirations
Forming new relationships
Implementing strategic change
These are undoubtedly massive challenges
But we also have significant opportunities – all of
us – to shape and design what the new system
delivers
Any questions?
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