The NHS Long Term Plan is the latest change in three decades of changes to the structure of NHS commissioning organisations. The Long Term Plan sets out the intention for Integrated Care Systems to cover the whole of England by 2021. This will result in a significant reduction in the number of Clinical Commissioning Groups (CCGs).
The changes in organisational structures since 2012 have been particularly confusing and rapid. The changes make it challenging for taxpayers to understand who in their local area is accountable for health spending and performance. It is important not to lose sight of the need for robust accountability structures which make it clear who is ultimately responsible for planning and commissioning decisions and to make this transparent to the public. The alphabet soup of health bodies that has grown up has done so, in many instances, without clear governance and accountability.
Many CCGs are currently underperforming and this will need to improve as they take on the responsibility for commissioning services across larger populations.
Getting the commissioning structures right will be an important part of delivering the NHS Long Term Plan. This will need to include: establishing appropriate structures for Integrated Care Systems and CCGs; ensuring CCGs take account of the needs of local populations as commissioning is undertaken at a larger scale; having clear accountability structures in place as planning and commissioning decisions are made jointly across the organisations within Integrated Care Systems; and ensuring legislative changes support the delivery of the NHS Long Term Plan. At the same time the public need to know how these changes will benefit healthcare and health outcomes in their area.
Published: 8 March 2019