Commissioning Support Bulletin – Issue 5

• Welcome
• NHS BSA agrees to be the employer for CSU staff
• CSUs to finalise staffing structures
• Appointments update
• Implementation of the single finance system gets underway
• Assurance to focus on granting greater autonomy
• NHS CB indicates its requirements for communications and engagement services
• Business intelligence services progress
• Integrated Commissioning Conference, 29 October 2012
• News in brief

 

Welcome

Welcome to the latest Commissioning Support Bulletin and my first as Transition Director for Commissioning Support at the NHS Commissioning Board (NHS CB).

My role is to support both the setting up of successful commissioning support units (CSUs) and to have oversight of the overall organisational performance of CSUs.

To do this I’ll be working closely with CSU MDs and their teams over the coming months. A great deal of the expertise and capacity to support clinical commissioning rests with NHS staff in PCTs, and I am clear that CSUs need time and support to develop high quality and responsive services for CCGs.

In particular, my focus will be on:

• Supporting CSUs to enable you to provide great commissioning support services to CCGs, to support CCGs through authorisation and to help CCGs to deliver their responsibilities from now onwards.
• Ensuring CSUs are as individually autonomous and self sufficient as possible, whilst being safely hosted by the NHS CB.
• Ensuring CSUs develop to become specialist suppliers of the work that underpins clinical commissioning; and that they help drive efficiencies in the NHS.
• Over the next six months especially, asking CSUs to seize their opportunities and use available expertise to contribute to ensuring the safe transfer of responsibilities within the NHS commissioning system during the process of transition. In particular, CSUs have a vital role to play in the planning/contracting round with regard to the process of contracting and other transactional activities.

Of course, we are moving into another new phase as the NHS CB is today formally established as an independent body, at arm’s length to the Government.  This will allow it to carry forward the preparatory work begun as the NHS Commissioning Board Authority, while taking on initial statutory responsibilities, most notably the authorisation of CCGs.

This means NHS CB Regional Directors have today taken on management responsibility for the teams managing both 2012-13 operational delivery and planning for 2013-14. NHS CB leaders working in this way will be accountable to their new organisations for future planning and development and be accountable to PCTs/SHAs for relevant delivery and performance in the current system for 2012-13.

Until April 2013, SHAs and PCTs retain their statutory functions and governance arrangements. There will be no formal transfer of statutory functions, accountability, budgets or employment of staff before then.

Today’s bulletin also provides an update on the important agreement between the NHS CB and the NHS Business Services Authority which will be the legal employer for CSU staff for the period of hosting. Importantly for our future direction of travel, this agreement signals that CSUs are separate from the rest of the NHS CB and are to become independent. It also allows the NHS CB to manage the potential conflicts that might arise when holding CCGs to account at the same time as providing their support. There are more details below.

An extensive piece of work is now underway which will enable the externalisation of CSUs by 2016. Crucially, we will not be making any formal decisions or announcements until we have developed the strategic policy approach. However, we will be engaging stakeholders in the development of the work as it progresses over the coming months.

As you may already know, we commissioned a report into externalisation options from Price Waterhouse Coopers to feed into the policy development work, and we aim to publish an externalisation strategy in Spring 2013.

I hope you will enjoy the rest of this bulletin and please do continue to keep in touch with my team at the NHS CB and let them have your thoughts and feedback on our work. To send your comments, or join our mailing list, contact us at commissioningsupport@dh.gsi.gov.uk

Andrew Kenworthy

Transition Director of Commissioning Support

 

NHS BSA agrees to be the employer for CSU staff

The NHS Commissioning Board Authority and NHS Business Services Authority (NHS BSA) have agreed that the NHS BSA will provide an employment partnership service for commissioning support unit (CSU) staff during the hosting period up to 2016.

This means the NHS Commissioning Board (NHS CB) will host – provide oversight and direction to – CSUs, while the NHS BSA will be the legal employer of CSU staff.

This is to ensure there is a degree of autonomy and independence for CSUs as they move along the path to externalisation by 2016.

While hosted, CSUs will be supported in a way that maximises their ability to provide services which are sustainable in a competitive marketplace. They will be responsible – as far as possible – for their own affairs, and increasingly act as separate organisations with their own quasi Boards and committees.

The formal arrangements are still being worked through and will be governed by a memorandum of understanding which makes explicit the roles, responsibilities and accountabilities of the NHS CB, the CSUs, the NHS BSA and the Department of Health.

NHS BSA employment policies will apply to CSU staff, while all other policies will be those of the NHS CB, and CSUs will need to comply with its policies and processes.

All HR and employment services will be provided by the CSUs for their own staff.

There will be no changes to NHS staff terms and conditions. The national HR transition policy and process will apply to those NHS staff who are transferring to CSUs and Agenda for Change terms and conditions and pay scales will be used by CSUs while hosted by the NHS CB.

 

CSUs to finalise staffing structures

The NHS Commissioning Board (NHS CB) has asked clinical commissioning groups (CCGs) and commissioning support units (CSUs) to ensure they are clear about what level of resource is available for commissioning support services by the end of October 2012.

This will enable both CCGs and CSUs to finalise their staffing structures and recruit in line with the national HR transition process.

The NHS CB has indicated to CSUs that there is no model CSU structure, but that decisions about organisational structure depend on the requirements of the local health economy and the local strategy for improving health outcomes.

As part of CCG authorisation, and the checkpoint process for CSUs, both CCGs and CSUs will be assessed on the balance and allocation of staffing resources within their respective organisations.

 

Appointments update

Further managing directors (MDs) have been appointed to lead commissioning support units (CSUs) and 21 of the 23 CSUs now have an MD.

Recent appointments include:

• David Stout – previously Deputy Chief Executive of the NHS Confederation – who has been appointed to lead Essex CSU and Hertfordshire CSU. They will continue to be run as two separate CSUs.
• Tim Andrews, who has been appointed as MD of Cheshire, Warrington and Wirral CSU and of Merseyside CSU, and who will lead both organisations. Tim was previously interim MD of Cheshire, Warrington and Wirral CSU and MD of the Commissioning Lab.
• New arrangements for commissioning support services in Cumbria and Lancashire have also been agreed. Derek Kitchen, currently MD of Staffordshire CSU, has been appointed MD of Lancashire CSU and will lead the two separate organisations. Cumbria CCG is to source its commissioning support services from North East CSU, which is led by Stephen Childs.
• Dr Leigh Griffin, who has been appointed as MD of Greater Manchester CSU. Leigh is currently Deputy Chief Executive of the West Mercia PCT cluster.

Clearly where there is a joint MD there will be some joint arrangements and services between the two CSU organisations, but formal mergers are not currently being planned.

The recent changes have been designed to ensure maximum stability, support and continuity for CCGs as they continue to prepare for and progress through authorisation, while at the same time ensuring CSUs are as good as they possibly can be by April 2013, by enabling them to further develop and improve their service offers and maximise new opportunities for the benefit of customers.

Finally, the finance director recruitment process has begun and interviews are currently being held, with the first appointments due shortly.

 

Implementation of the single finance system gets underway

The programme to implement the Integrated Single Financial Environment (ISFE) for clinical commissioning groups (CCGs), commissioning support units (CSUs) and the NHS Commissioning Board (NHS CB) starts in October.

Dates for implementation workshops are currently being finalised by NHS Shared Business Services (NHS SBS).

These will be very practical in nature, giving an overview of the programme and giving organisations the opportunity to assess what they will need to do to ensure operational readiness.

In April 2012, the NHS Commissioning Board Authority signed a contract with NHS SBS to provide an ISFE service to CCGs and CSUs from April 2013.

The use of the ISFE has been agreed to ensure proper financial and corporate governance, financial consistency and proper risk management relating to the transfer of financial information and the adoption of best practice in business processes.

The ISFE will create a basic common infrastructure which will be cost-effective and save time for organisations in terms of development.

The NHS SBS ISFE service is already the most widely used finance and accounting system in the NHS by both commissioners and providers.

It will be one of the requirements of the authorisation process that CCGs use the integrated system and the NHS CB will meet the contract costs in full for CCGs.

If you have any questions relating to ISFE, please contact peter.kidd@nhs.net

 

Assurance to focus on granting greater autonomy

The NHS Commissioning Board (NHS CB) is currently carrying out a review and risk assessment of commissioning support units’ (CSUs) full business plans – Checkpoint 3 – in order to provide further feedback on their development.

As part of this review, it is exploring further how partnerships between CSUs and the private sector will best benefit the CSU business model and future externalisation.

The NHS CB is encouraging CSUs to start to explore and develop partnership agreements, but we need to ensure they are compliant with the legislative framework. Further work is on-going with CSUs to explore these partnerships in more detail.

Following Checkpoint 3, CSUs will start to be granted greater autonomy, and the NHS CB will begin to adopt a risk-based approach to assurance.

This will be known as a ‘licence to operate’, in effect a way of working between the NHS CB and CSUs through which freedoms and delegated powers are granted by the NHS CB to each CSU.

Through this approach, the NHS CB will set out the scope of service delivery so that the NHS CB can be confident that each CSU is providing only those services that are financially viable and that each CSU has sufficient financial contingencies to cover agreed risks. CSUs with a higher risk profile will have greater levels of intervention than those with a lower level of risk.

The NHS CB will also start to trial a ‘balanced scorecard’ approach from November – so that CSUs are formally reporting progress across four assurance domains (customer, business, delivery, staff) on a monthly basis.

Checkpoint 4 in November will involve a review and assessment of CSUs’ financial risk.

 

NHS CB indicates its requirements for communications and engagement services

The design of communications and engagement services in the NHS Commissioning Board (NHS CB) and commissioning support units (CSUs) is moving forward.

The NHS CB has now set out the design of its in-house communications function, and has indicated to CSUs how it would like its regional offices and the local area teams (LATs) to be provided with communications support.

Two CSU communications collaboratives will provide communications support for the NHS CB’s regional offices and LATs. One of the CSUs will be in the South (covering London and South of England) and one in the North (covering North of England and Midlands and East).

The teams will provide support to the NHS CB regional directors and the LAT teams, including communications advice, local and regional media management and stakeholder support.

The four CSU communications collaboratives will also be able to bid for work from the NHS CB’s national communications team. They will also be expected to work within shared systems for media and stakeholder management with the national team, to ensure communications are joined-up and well-managed.

The high level configuration of the ‘scale’ communications and engagement services was agreed in September 2012.

Four communications collaboratives were agreed with a lead CSU in each:

Communications collaborative	Lead CSU
North of England	West Yorkshire CSU
Midlands and East of England	Birmingham, Black Country and Solihull CSU
London	North West London CSU
South of England	Commissioning Support South CSU

Work is now underway to develop how the collaboratives will operate.

All CSUs planning to provide communications and engagement services, whether locally or at scale, are having their proposals tested through their full business plans at Checkpoint 3 and have been asked to demonstrate their involvement in a communications collaborative whether or not they intend to buy scale services from the lead CSU.

The arrangements will be subject to the further checkpoints and the approval of the NHS CB later in the year.

All communications collaboratives will be expected to operate within a framework of agreed principles that include a clear mission statement and terms of reference, leadership by one CSU and a dedicated individual or core group to ensure all members are communicating effectively. The lead CSU will need to meet required standards as a supplier and will also need to ensure the quality of professional communications leadership across the collaborative.

For further information please see the document Configuration of NHS communications and engagement services agreed.

 

Business intelligence services progress

Significant work is underway to ensure the data management and integration centre (DMIC) governance structures, infrastructure architecture and collaborative arrangements are in place by the end of October 2012.

DMIC leads met in early September 2012 and agreed to provide progress against nationally defined milestones for the establishment of DMICs on a monthly basis to the NHS Commissioning Board’s (NHS CB) commissioning support team.

The Technical Group also met in September 2012 and discussed how data flows are being managed to meet the agreed logical data model, and information governance requirements and their impact on data flows. The group also reviewed options for designating DMICs in organisation codes for national systems.

Both groups will be meeting monthly.

 

Integrated Commissioning Conference, 29 October 2012

The NHS Commissioning Board (NHS CB) and the Local Government Association (LGA) are organising a joint conference aimed at NHS commissioners, providers and local authority colleagues.

Integrated Commissioning for Better Health and Care will take place in London on Monday 29 October 2012. The conference will promote examples of shared learning around integrated services, system leadership, joint planning and sector led improvement and innovation. It will highlight the opportunities that exist to commission services in a more integrated way with emerging partners. It will also outline how the NHS and local government plan to work together at a national level to support local commissioners and will seek the views of attendees about what support would be helpful at a local level to promote integration.

Confirmed speakers are:

• Sir David Nicholson, Chief Executive, NHS CB
• Councillor Sir Merrick Cockell, Chairman, LGA.

The event is free to NHS colleagues.

 

News in brief

• For updates relating to CCGs and authorisation, please see the latest Bulletin for proposed CCGs.

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