Commissioning - Health Committee Contents

1  Introduction

1. The Department of Health states that "the central theme of NHS commissioning" is:

    understanding the health needs of a local population or a group of patients and of individual patients; working with patients and the full range of health and care professionals involved to decide what services will best meet those needs and to design these services; creating a clinical service specification that forms the basis for contracts with providers; establishing and holding a range of contracts that offer choice for patients wherever practicable; and monitoring to ensure that services are delivered to the right standards of quality.[2]

2. Although the term "commissioning" has only been in use since the 1990s, the functions it refers to have been present, in one form or another, since the inception of the NHS. It has always been necessary to determine the health needs of the population and to design services accordingly, with due regard to the available level of resources. The NHS has also always aspired to ensure that its services meet high quality standards.

3. From 1948 to 1991 the NHS was largely a managed service, with the notable exception of primary care, which was provided on a contractual basis by independent practitioners such as GPs. From 1991 a "purchaser / provider split" was also instituted in respect of hospital and community services, with the creation of freestanding NHS Trusts in place of directly-managed provider units. Despite many changes since then, the purchaser / provider split has persisted, with an established consensus among the three main political parties that such a split is necessary.[3]

4. As the process of contracting for services has developed, commissioning, in its current form, has become increasingly important to the effective functioning of the NHS. Despite its importance, however, there are longstanding and widespread concerns about how well it is actually done and how much benefit is derived from the substantial process costs incurred. Throughout two decades of frequent reorganisation in the structures of the NHS, many of which were designed at least in part to enhance the effectiveness of commissioning, this objective has remained largely unfulfilled.

5. The White Paper Equity and excellence: Liberating the NHS, published on 12 July 2010 sets out the plans of the Coalition Government to try to improve on this performance. It contains a further iteration of the structure of commissioning, based on the creation of General Practitioner commissioning consortia.

6. In the light of the disappointing history of the development of commissioning, the report of our predecessor Committee published on 30 March 2010,[4] and the Coalition Government's White Paper, the Committee announced on 27 July 2010 that it proposed to undertake a follow-up inquiry, with the aim of discovering whether the changes proposed by the Government were likely to learn the lessons of history and deliver the promise to make commissioning more effective. (Our terms of reference are set out in full in Annex 1.)

7. During the course of our inquiry, 142 memoranda of written evidence were received and six evidence sessions were held. Oral evidence was taken from: officials at the Department of Health; the Royal College of General Practitioners; the British Medical Association; the National Association of Primary Care; the NHS Alliance; individual GPs; academics; the King's Fund; the Nuffield Trust; Care Trust and Primary Care Trust officials; the NHS Confederation; National Voices; the Patients Association; Mind; Age UK; UNISON; the Local Government Association; the Association of Directors of Public Health; NHS Partners Network; and the Secretary of State for Health, Rt Hon Andrew Lansley CBE, MP. We thank everyone who took the time to contribute to our inquiry.

8. We gained many useful insights when we visited City and Hackney PCT on 14 December, meeting senior staff from the PCT and East London and the City Alliance, as well as GPs from the East London Integrated Care consortium. We are most grateful to all those who took the time to give presentations to us and answer our questions, to the PCT for arranging the visit and to the Lawson Practice for playing host to us.

9. Our Specialist Adviser for this inquiry was Kieran Walshe, Professor of Health Policy and Management at Manchester Business School, whom we thank for his assistance.[5]

2   Department of Health, Liberating the NHS: Commissioning for patients, July 2010, para 1.7 Back

3   It is true that by 2002 the purchaser/provider split had been abolished in respect of community services but the split is actually now being recreated in this regard, under the Transforming Community Services programme, with these services once more ceasing to be directly managed. Back

4   Health Committee, Fourth Report of Session 2009-10, Commissioning, HC 268-I Back

5   Professor Walshe did not declare any interests. Back

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