Evidence submitted by Specialised Healthcare
Alliance (WP 95)
The Specialised Healthcare Alliance (SHCA) is
a coalition of forty patient-related groups supported by seven
corporate members. It has been set up to campaign on behalf of
people with conditions which require specialised medical care.
Effective commissioning is essential to ensure
the NHS can plan services for patients with rare and often expensive
conditions. This was recognised last year when Lord Warner invited
Sir David Carter to undertake a review of specialised commissioning
arrangements in England. The subsequent report recommended the
establishment of Specialised Commissioning Groups (SCGs) aligned
with the new Strategic Health Authority (SHA) boundaries with
responsibility for jointly determining commissioning arrangements
on behalf of all PCTs in the area.
The recommendations of this comprehensive review
have largely been accepted, with key elements incorporated in
the recently published Commissioning Framework.
Recent structural changes within the NHS, coupled
with the Agenda for Change programme, have given the SHCA cause
for concern in relation to whether the NHS has the necessary workforce
capacity and expertise to implement the new arrangements.
Agenda for Change has been subject to different
interpretation in various areas of the country and in some cases
this is understood to have resulted in pay reductions for a number
of experienced commissioners. This seems unfortunate at a time
when commissioning expertise is recognised to be in short supply.
The SHCA recognises that the Department of Health
aims to improve commissioning skills within the service as a requirement
of successful reform. The Fitness for Purpose reviews currently
underway within PCTs are intended to lend support. The Alliance
notes with some concern, however, the emphasis on procurement
of extensive commissioning services from the private sector as
apparently attractive solution to current skill shortages.
The SHCA has no philosophical objection to the
use of private sector skills but considers it important to ask
whether there is an adequate pool of commissioning expertise available
within the private sector. Commissioning, and in particular specialised
commissioning, is complex and requires an understanding of the
condition in addition to the ability to work with providers.
The SHCA is concerned that the current emphasis
on purchasing commissioning skills from the private sector, rather
than developing them within the NHS, may precipitate recruitment
from the public sector into the private sector at higher rates
of pay exacerbating shortages within the NHS and causing it to
buy back expertise at an inflated price.
In the SHCA's view, the primary emphasis needs
to be on development of commissioning skills within the NHS if
trusts individually and collectively, through SCGs, are to fulfil
their responsibilities.
Specialised Healthcare Alliance
7 November 2006
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