What can clinical commissioning groups find out from Oxfordshire?

‘Disrupting the health workforce in securing alter … is essential. New patterns of care will produce winners and losers,’ says Richard Vize. Photograph: Tom Jenkins

The unravelling of the plans by Oxfordshire clinical commissioning group to introduce outcomes-primarily based service contracts shows that even though commissioners have the money, companies are still running the program. What will it consider to break their energy?

Oxford well being basis believe in and Oxford University hospitals trust’s forceful objections to ideas for outcomes-based mostly commissioning of adult mental overall health, maternity and older people’s providers integrated the truth that the modifications would introduce new economic and clinical risks and impact the local wellness workforce. But they supported the general aims, of program.

Tell any discussion on public service reform that the public sector demands a new mindset to threat, and you can be sure that your comment will be greeted with vigorous nods. But commissioners and companies require to flip those sentiments into action. If introducing new dangers is going to be an acceptable cause for torpedoing reform proposals, then we will remain lumbered with the old hazards of working out of money whilst fitting our patients into solutions as an alternative of creating solutions round patients.

Disrupting the wellness workforce in securing adjust isn’t just a risk – it is vital. New patterns of care will generate winners and losers among personnel.

A gateway overview of Oxfordshire’s proposals by the Division of Wellness in light of the providers’ objections has far more than a whiff of political expediency. Drinking deep from the well of civil services clichés, it concludes that the CCG ought to see 2014-15 as “a transition year” with a “want to review the scale and variety of providers”. All this should be completed “having carefully imagined by way of all the implications”. And of course it calls for piloting.

Tellingly, the evaluation recommends involving the current suppliers in developing the new providers. While this might nicely be the right strategy on numerous events, it must surely be up to commissioners to decide whether or not it is in the greatest interests of sufferers. If, for example, a CCG believes an incumbent does not have the vision or expertise to build a new kind of services, certainly it must have the discretion to pursue a diverse route.

So the DH talks hard about enhancing the patient expertise, focusing on outcomes and employing competitors to carry about adjust, but when it comes to politically contentious selections – particularly ones affecting the prime minister’s constituency – it runs away.

The unravelling of the Oxfordshire strategies is very likely to be seen as a victory for inertia. It gives the message to trusts that if they resist difficult the DH and commissioners are probably to back down. It also reinforces the belief that in spite of the wellness reforms rebuilding the total NHS close to a commissioning program, the power of companies is undiminished. A mere act of parliament is no match for them.

CCGs could very easily consider away the lesson that ambitious changes this kind of as demanding incumbent providers and commissioning for outcomes will fail, and that they should opt alternatively for incremental adjust.

But if that takes place, clinical commissioners will have demonstrated that they are incapable of reforming the health service. Rather they ought to understand from Oxfordshire’s expertise about how to put together the ground for change.

It is clear from divisions in Oxfordshire CCG’s own ranks that it could have made a much better job of creating a coalition of support for its radical programs. Contracting is only a strong tool for large-scale change if it is accompanied by convincing clinical evidence and political support.

Many providers and CCGs are beginning to create robust and trusting relationships, on which they are developing a shared vision of the require to alter. But the place the partnership is much less constructive, CCGs simply do not have the clout to batter by means of modify in the encounter of concerted opposition. If pushing through adjust involves having a scrap with the incumbent provider it will need political guile, and tons of it. Commissioners cannot let providers to be witnessed as possessing the exclusive right to represent patients’ interests.

This article is published by Guardian Specialist. Join the Healthcare Professionals Network to obtain regular emails and exclusive delivers.

What can clinical commissioning groups find out from Oxfordshire?