​PAC calls for clarity on commissioning structure

The call comes from the influential Public Account Committee as it published its report on local commissioning bodies. Clinical commissioning groups described the changes in commissioning structures since 2012 as ‘confusing and rapid’. The recent NHS long-term plan has now set out the intention for integrated care systems to cover the whole of England by 2021.

While it is thought that there is likely to be one CCG per ICS – with ICSs built on the existing 42 sustainability and transformation partnerships – the actual preferred structure is still not clear. The PAC called on NHS England to provide an update by the end of 2019 on how this structure will look. In particular, it wants to know how local circumstances will be taken into account and how many CCGs and ICSs there are expected to be.

The committee also raised concerns about the impact on patient outcomes if CCG performance did not improve, especially as they take on this broader role. ‘NHS England rated the performance of four in every 10 CCGs as either inadequate or requiring improvement last year,’ said PAC chair Meg Hillier (pictured). ‘Standards must improve significantly as CCGs take on the commissioning of services across larger populations – a change which runs the risk of them losing focus on the particular healthcare needs of local people.’

The report also warned that as ICSs develop, accountability systems will be weakened and the performance of CCGs will become less transparent. While the committee welcomed the move towards more integrated planning and commissioning, it said it needed to be clear who was ultimately responsible for decisions.

The committee said the Department of Health and Social Care should expand on the current description of integrated care systems and how they will be held to account for joint decisions and responsibility for improving the health of their population.

Julie Wood, chief executive of CCG representative body NHS Clinical Commissioners, said CCGs still had a ‘critical role’ in transforming health and care and were already working more collaboratively across larger footprints.

‘Although there is a mixed picture of performance, the PAC recommendations helpfully highlight areas of support that CCGs will need as they look to deliver the long-term plan, for example, to clarify governance and accountability, support their leaders, and a clear final number of ICSs,’ she said. ‘It also highlights the importance of getting proposed legislative changes right as they could smooth the path to integration – something we have been saying on behalf of our members for some time.’