Commissioning Support Bulletin – Issue 4

• Welcome from Dr Joe Rafferty
• Commissioning support appointments
• Configuration of ‘scale’ services finalised
• Checkpoint 3 update
• CCG authorisation: commissioning support supplement
• HR update
• Finance director appointments process
• Branding and identity
• Ready Reckoner 2
• Scenario report helps shape CCG development
• News in brief

Welcome

First I’d like to welcome the appointments of Bob Ricketts and Andrew Kenworthy to the national team at the NHS Commissioning Board Authority. Also congratulations to the newly appointed commissioning support unit (CSU) managing directors. Very welcome appointments all.

In this issue I’m pleased we’re also able to report the outcome of the business review of ‘scale’ services. These configurations – along with the appointment of 15 managing directors, and the decision made last month that the NHS Commissioning Board (NHSCB) will host 23 CSUs – go a long way to providing stability and enabling CSUs to take forward their work with confidence.

Clearly, there is a great deal of work to be done and a lot to be gained over the coming period as we start to put the final structures, plans and arrangements in place to develop a sustainable network of CSUs. This work will now be led by the CSU Transition Programme team which will be fully put in place over the coming weeks. The commissioning support strategy, market development and externalisation team will work closely with the transition team and ensure the longer-term programme is developed and delivered. Key pieces of work will include the development of a standard contract, an options appraisal of externalisation options, a CCG procurement framework, market development, and commercial development for CSUs.

The CSU Network – which involves the Board Authority’s team and CSU managing directors – met this week to discuss key elements of both the transition and longer-term programmes. An important discussion took place on hosting, the hosting charge, the licence to operate and governance.

There is more work to be done before we are ready to publish the hosting guidance in October but a key message is that the NHSCB is keen to keen to strike the right balance between accountability and flexibility and, crucially, will need CSU support to make this approach work effectively.

On the licence to operate, CSUs are likely to be licensed to support CCGs to commission from the moment of authorisation. We have still to define what this will mean, and the relationship between CSUs and the NHSCB in terms of freedoms, intervention and delegation, and the hosting guidance will describe this further.

The network also heard an initial outline of what the NHSCB is likely to want to commission from CSUs, a session on equalities, and speakers from John Lewis and the Cabinet Office.

I also want to emphasise the importance of Checkpoint 3 and be clear that the outcomes will feed into the licence to operate decision. Our plan is to make the assessment as rigorous and robust as possible with clear interventions put in place for any plans that do not meet expectations. It is important to note that there may still be potential variations in size and shape, along with adjustments to management configurations, to ensure that all CSUs are as efficient as they can possibly be.

Finally, I wish you all a pleasant summer and – as I will be leaving at the end of August – thank you for your contributions to the development of CSUs and wish you all very well for the future. Please do continue to keep in touch with the team and let them have your thoughts and feedback on any aspects of our work. To send your comments, or join our mailing list, contact us at commissioningsupport@dh.gsi.gov.uk

Dr Joe Rafferty
Director of Commissioning Support

Commissioning support appointments

The NHS Commissioning Board Authority has this week appointed Bob Ricketts as Director of Commissioning Support Strategy and Market Development in its Commissioning Development Directorate. Bob is currently Director of Provider Policy at the Department of Health.

In addition, Andrew Kenworthy – currently Chief Executive of NHS South East London PCT Cluster – will be joining the Board Authority’s Commissioning Development Directorate via an IMAS assignment as Director of Commissioning Support Unit (CSU) Transition Programme until a substantive appointment is made.

The following CSU managing director posts have also been recruited to:

• Alison Hughes, West Yorkshire CSU (previously interim managing director for West Yorkshire CSU)
• Nick Relph, South London CSU (previously interim managing director for South London CSU)
• Daryl Robertson, Kent and Medway CSU (previously interim managing director for Kent and Medway CSU)
• Maddy Ruff, North Yorkshire and Humber CSU (previously interim managing director for North Yorkshire and Humber CSU)
• Clodagh Warde Robinson, Surrey and Sussex CSU (previously Deputy Chief Executive/Director of Strategy and New Business at Sussex Community NHS Trust).

In addition, Professor John Parkes was announced as managing director of Greater East Midlands CSU on 16 July – he was previously Chief Executive of Chief Executive of NHS Milton Keynes and NHS Northamptonshire PCT Cluster.

The interview and recruitment process is ongoing for the remaining eight CSU managing director posts.

Configuration of ‘scale’ services finalised

The outcome of the business review and assurance process for the majority of the ‘scale’ commissioning support services has been agreed.

CSUs which applied to provide scale services were assessed by the Board Authority according to a set of tests to ensure that:

• They are able to deliver against defined standards, based on current industry standards
• The cost structure is appropriate and sustainable
• There is the right capacity and capability to deliver high quality services across the appropriate geographical footprint.

The tests were designed to ensure that the services provided by the CSUs are built upon best practice industry standards so that they remain competitive in a future market once CCGs begin to undertake their procurements for commissioning support.

The Board Authority has named those CSUs which will be offering business intelligence, healthcare (clinical) procurement, and business support services – three of the four scale services. Work is ongoing to finalise the configuration for the communications and engagement services and there are likely to be four or five centres.

Business intelligence

Business intelligence services comprise data management and integration centres that provide data validation, integration and storage to cleanse, validate and link national and local data sets, so that meaningful conformed data is available for further analysis by CCGs and CSUs.

All nine CSUs which submitted applications have been approved to provide business intelligence services. The nine centres are: North West collaborative; North East and North Yorkshire and Humber collaborative; South and West Yorkshire collaborative; Greater East Midlands; London collaborative; South collaborative; Central Southern; Best West; Birmingham, Black Country and Solihull.

A number of CSUs are still considering their arrangements to deliver these services.

Healthcare (clinical) procurement

Healthcare (clinical) procurement services comprise: market management activities such as market engagement, market analysis and market development; and procurement strategy and activities such as procurement project management, commercial and procurement strategy development, or technical advice around process compliance.

Thirteen CSUs were approved to provide healthcare (clinical) procurement services. These are: North West collaborative; North East; South Yorkshire and Bassetlaw; Greater East Midlands; Norfolk and Waveney; Essex; North Central and East London; North West London; Surrey and Sussex; Commissioning Support South; Central Southern; Best West; Birmingham, Black Country and Solihull.

A number of CSUs are still considering their arrangements to deliver these services and will be assessed accordingly.

Business support

Business support services include HR, payroll, procurement of goods and services, legal services, and information management and technology.

Following assessment, all CSUs are planning to provide or source these services on behalf of their customers and are currently developing their plans to ensure they meet industry standards and benchmarks so that they remain competitive in a future market environment.

	CSU scale provider	CSU partners
CSUs providing business intelligence and healthcare (clinical) procurement	North West collaborative	Lancashire and Cumbria Greater Manchester Merseyside Cheshire, Warrington and Wirral
	Greater East Midlands
	Central Southern
	Best West
	Birmingham, Black Country and Solihull	Birmingham, Black Country and Solihull Staffordshire Arden (Business intelligence only)
CSUs providing business intelligence only	North East and North Yorkshire and Humber collaborative	North East North Yorkshire and Humber
	South and West Yorkshire collaborative	West Yorkshire South Yorkshire and Bassetlaw
	London collaborative	North West London North Central and East London South London
	South collaborative	Commissioning Support South Surrey and Sussex Kent and Medway
CSUs providing healthcare (clinical) procurement only	North East
	South Yorkshire and Bassetlaw
	Norfolk and Waveney
	Essex
	North Central and East London
	North West London
	Surrey and Sussex
	Commissioning Support South

Checkpoint 3 update

The detailed Checkpoint 3 process and outcomes will be discussed with commissioning support unit (CSU) managing directors today at the Commissioning Support Network meeting.

The outcome of Checkpoint 3 will be a provisional ‘licence to operate’ for each CSU. This will have conditions attached if the CSU needs further development and support.

Detail will also be given about the next steps in the CCG and CSU staff surveys and the CSU site visits. These will take place in October and the panel will include representatives from the NHS Commissioning Board Authority and SHA clusters and independent business experts.

The outcomes of Checkpoint 3 will be moderated and are due to be presented to the NHS Commissioning Board in October.

CSUs will also receive guidance on the balanced scorecard, the principal tool by which the Board Authority will track and monitor CSU development, this week.

CCG authorisation: Commissioning support supplement

A supplement has been produced for CCG authorisation assessors which focuses on CCGs’ commissioning support arrangements. It particularly looks at the tests that will be applied for those CCGs which will be providing all their support functions ‘in house’.

The purpose of the document is to help assessors determine whether CCGs have assessed the quality and value-for-money of their support arrangements (whether these are in-house, shared or bought in) and that the evidence submitted is sufficiently robust and can be assessed transparently, consistently and fairly.

The document sits alongside the other assessor guides and is available on the resources for authorisation page.

HR update

A draft guide to help commissioning support units (CSUs) with HR and recruitment has been circulated for comments to CSUs.

CSUs will be large organisations with a significant turnover so it is vital that they secure the best talent from the outset and that appointments are made in a timely way which enables staff to make the right choice of roles. At the same time, newly appointed managing directors should have the opportunity to create the structures they see as optimum for their organisation, within principles agreed with the unions.

Appointments and transfers of staff must be in line with the principles in the overarching HR Transition Framework and the People Transition Policy for the NHS Commissioning Board, and the national policy and process on filling of posts in receiving organisations.

The governing body of a CSU cannot be a ‘Board’ or have non-executive directors. CSUs are however encouraged to consider proxy arrangements to ensure lay involvement.

In addition, three further generic ‘Very Senior Manager’ CSU job descriptions for the following roles have been developed: chief operating officer, director of HR and corporate governance and director of commercial and contracting services.

These job descriptions are currently being evaluated. While there is no mandate to use these job descriptions, the intention is that they can be used by managing directors to quickly identify successful candidates for senior roles within their senior leadership teams.

Finally a Commissioning Support HR Working Group has been established, chaired by Jan Hull, Managing Director, Best West CSU.

Its initial priority is the development of an HR framework, within the overall governance requirement of the NHS Commissioning Board Authority.  Debbie Hilditch, South Yorkshire and Bassetlaw CSU, will also pay a key role in the group, particularly supporting Jan in her work as Chair.

The group will consist of up to three HR and organisational development directors and up to five HR practitioners. CSU managing directors have been asked to send in their nominees for the group and the first meeting will be in August.

Finance director appointments process

The commissioning support unit (CSU) finance director appointment process will begin on 10 August with the launch of a dedicated recruitment website. The appointing officer for these vacancies will be the substantive managing director for each CSU. Where a substantive postholder is not in place, the appointing officer will be a finance professional at ‘Very Senior Manager’ grade nominated by Paul Baumann, Chief Financial Officer, NHS Commissioning Board Authority.

The finance director appointment process will include a first phase for those ‘at risk and affected by change’. The process will be managed by the Board Authority and all NHS candidates will complete a finance accreditation process.

The closing date for applications is 24 August and interviews will commence in September.

A second recruitment phase will be used if there are any remaining vacancies after the first phase.

Branding and identity

Following the recent announcement that all 23 NHS commissioning support units will progress to be hosted by the NHS Commissioning Board during the transitional period, a decision has been made to clarify the naming conventions. The NHS Commissioning Board Authority is now using the term ‘commissioning support unit’ or ‘CSU’, rather than ‘commissioning support service’ or ‘CSS’ so it can begin to distinguish these NHS units from the wider commissioning support services market place.

With regards to branding, whilst it is clear that, as hosted NHS organisations, overarching NHS branding rules and guidelines apply, the Board Authority will want to provide as much flexibility as possible so that each CSU can operate along commercial lines. The plan at the moment is to ask each CSU to submit applications for its future name/identity as part of the full business plan which, pending approval by the Board, will be agreed as part of the license to operate arrangements.

Ready reckoner 2

An updated version of the ‘ready reckoner’ running costs tool has been made available to CCGs this week.

The ready reckoner is an interactive tool that enables CCGs to work through the implications of different commissioning support arrangements and delivery models. It provides the flexibility to work through the potential impact that different populations have on resources and the potential costs for different internal staffing structures and commissioning support options.

It should support CCGs in discussions with PCT clusters and other CCGs about where it makes sense to share functions and enter into more federated models in order to generate better value for money and ensure that future commissioning support arrangements are:

• of sound quality
• affordable
• responsive to their needs.

The tool can be downloaded from the CCG development section of the CCG resources page of the NHS Commissioinng Board Authority’s website.

Scenario report helps shape CCG development

The report of the first CCG and commissioning support unit (CSU) scenario workshop has been published on this website.

The event, which was run in partnership with NHS Clinical Commissioners, and organised by the Health Services Management Centre at the University of Birmingham, involved more than 40 leaders from CCGs, CSUs and the independent sector.

Its aim was to explore the relationships between CCGs and CSUs, and to anticipate some of the likely challenges for CCGs and CSUs so that the Board Authority and partners can focus developmental activities effectively in the coming months.

Key insights from the event include:

• The customer/supplier relationship between CCGs and CSUs should be actively explored and tested in the workplace, until an acceptable balance is achieved which produces the best results for both parties.
• Whilst the subject of leadership is complex and situational (i.e. different styles are more effective in different situations) the prevailing commentary currently is that distributive leadership is the preferred style to operate successfully in a localised, flexible system without a designated system manager. New leaders and new organisations may benefit from leadership development to adapt their styles and hone their skills.
• Organisations within the system will need to learn when and how to take up authority, and when to allow others to lead. This requires sophisticated relationships, processes and leadership behaviours in order to succeed, and this is as much a requirement  for CSUs as  CCGs, as they develop their organisational forms and function.
• The clinical leader’s role needs to be well supported by other commissioning team members and their expertise recognised and used effectively.
• Existing arrangements for working together will benefit from being formalised, reviewed and monitored in the future. CCGs should be able to draw on the proposed framework for collaborative commissioning.  Similar rigour will be required in determining and monitoring commissioning support arrangements.

The Board Authority is using the insights from the report to inform its approach to CCG and commissioning support development over the coming months, and is providing a programme of targeted, practical support to CCGs and CSUs including:

• Guidance for CCGs and CSUs on collaborative commissioning arrangements.
• Guidance for CCGs on procuring clinical services.
• Exploring with CCGs the potential procurement options for buying commissioning support. The draft mandate for the NHS Commissioning Board – Our NHS Care Objectives, which is currently being consulted upon – outlines that the NHSCB will need to set up a new procurement framework to enable CCGs to procure from providers.
• A market development group that includes representatives from local authorities and the independent sector to develop a long term market development strategy for commissioning support. As part of this workstream, there will be a series of ‘market days’ for CCGs in autumn 2012 to support CCGs to become more informed customers of commissioning support and to aid their understanding of a range of potential suppliers in the future.

News in brief

• The first round of appointments to local area team director posts has been made by the NHS Commissioning Board Authority.  The first 16 of the 25 directors have been appointed. More information about these appointments here.
• The NHS Commissioning Board Authority and Local Government Association are organising a joint conference aimed at NHS commissioners and providers and local authority colleagues. ‘Integrated Commissioning for Better Health and Care’ will take place in London on 29 October 2012. The conference will promote examples of shared learning around integrated services, system leadership, joint planning and sector led improvement and innovation. Confirmed speakers to date are: Sir David Nicholson CBE, Chief Executive, NHS Commissioning Board Authority and Councillor Sir Merrick Cockell, Chairman, LGA. It is free to NHS colleagues. More details about the conference.

The latest Bulletin for proposed CCGs is available on the NHS Commissioning Board Authority’s website. All the bulletins can be seen here.

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