Will the new NHS Commissioning Board think about research?

Posted on July 29, 2011 by

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One of the big new structures in the reorganised NHS is the National Commissioning Board which will oversee all the local clinical commissioning consortia, coordinating at a national level and holding them to account for the quality of their local commissioning decisions and outcomes. Today David Nicholson – who will be the chief executive of this new commissioning board when it is up and running – published his initial proposals for what this will look like and how it will operate Developing the NHS Commissioning Board.

Responding to the NHS Future Forum and the listening exercise, the government committed to embedding a culture of research and innovation in the arrangements for the NHS Commissioning Board so it’s particularly interesting to look at this first sketch of what the board might look like so that we can identify where research is and where we think it should be..

Background

In July 2010, the government published a white paper, Equity and Excellence: Liberating the NHS, which proposed changes to how the NHS works including establishing a new system to commission services with a central NHS Commissioning Board and lots of local clinical commissioning consortia. The Health & Social Care Bill was published on 19 January 2011 and aims to make the legislative changes necessary to put these proposals into action.

The Bill completed committee stage in the Commons where, in response to concerns, it was paused to allow the government to “pause, listen and engage” and make changes to the Bill.

They did this by establishing the NHS Future Forum which, led by Steve Field, set out to “listen” and make recommendations to government on how the reforms should be changed.

The government responded to the NHS Future Forum on 14 June 2011, making several changes to put a greater focus on research in the bill. One of the undertakings they made in their response was to:

ensure that a culture of research and innovation is embedded in the arrangements for both the Board and Public Health England.

They set out their intention to make sure that the systems and processes for commissioning used by the NHS Commissioning Board and clinical commissioning groups ensure that research is promoted, supported and funded by the NHS.

So this report is interesting not just to see what this new NHS Commissioning Board is going to look like but also to see what the plans are so far to embed research in the workings…

So what is the NHS Commissioning Board going to look like?

This report is really just an initial outline of the plans for what the board will look like and where it will fit in the new commissioning system – obviously all the legislation that will underpin this is still being debated.

The report is in three sections, focusing respectively on:

  • the role of the board in the NHS system
  • how the board will work – its processes
  • how the board will be structured – the different roles that will make it up

On the role of the board, the report emphasises the boards national role – supporting consistency not centralisation. It will:

put the ‘N’ in NHS

It talks a lot about how it will ensure that the NHS is patient-centred and includes details on how the board will interact with Healthwatch, local Health and Wellbeing Boards etc to achieve this.

Page 13 has a nice diagram (figure 3) illustrating where the board fits among other organisations, government, patients and the public etc.

On how the board will work the report identifies the core processes to uphold the board’s key values and embed them throughout all aspects of the organisations. The list of core processes doesn’t appear to include anything research or innovation focused:

  • Quality as the organising principle
  • Patient and public engagement
  • Clinical leadership and focus
  • Promoting equality and diversity
  • Reducing inequalities
  • Partnership working

The board will work to continuously improve outcomes as defined by the NHS Outcomes Framework – this framework is basically part of the mandate the Secretary of State for Health sets for the Board, a framework for measuring how well services are improving outcomes for people and setting ambitions for improvement. The NHS Commissioning Board will in turn develop a Commissioning Outcomes Framework to hold local clinical commissioning groups to account.

On the structures and people that will make up the board, it will have a board with a chair and executive and non-executive directors. (As the “board of the nhs commissioning board” is getting confusing, the report suggests that the NHS Commissioning Board may eventually be known by another name – possibly “NHS England”)

There’s a round guesstimate of the number of staff the board will have – about 3500, many involved in liaising with the local clinical commissioning consortia.

The board will have six portfolios, each organised under a director who will report to the chief executive.

  • Finance, performance & operations
  • Commissioning development – this includes a mention of research & innovation “the portfolio would also cover the development of commissioning tools and  commissioning guidance ensuring that patient care is commissioned so as to support the conduct of research in the NHS” which looks to addresses one of the government’s commitments in response to the NHS Future forum that the NHS Commissioning Board will  ensure that treatments costs for patients who are taking part in research are funded.
  • Patient engagement, insight and informatics
  • Improvement and transformation – this portfolio also has a touch of research about it – “driving change and improvement and applying a single evidence-based methodology to the work of the board… …fostering world0class capacity for change” but no direct mention of research or innovation
  • Policy, corporate development and partnership
  • chief of staff

Page 27 has a proposed timeline – we can expect further detail on the operating model and process for the board in Summer/Autumn 2011 and on the structure of the board in Autumn 2011. The plan is for the board to take on its full formal statutory accountabilities in April 2013.

What next?

As the timeline says, we can expect more detail soon. In the meantime, we will look for opportunities to feed in and make sure research and the government’s commitments to embed research throughout the NHS, are taken into account as the board’s structures are developed to make sure it really can deliver this.

And as the Health & Social Care Bill is headed for report stage in the Commons in September, we’ll be following that closely and feeding in – see the letter we recently sent to the commons bill committee outlining the issues for research that still need to be addressed.

Posted in: Policy