Health Matters | Paul Corrigan's blog

One of the main issues for implementing reforms that create new roles is that it is wise to ensure that the people who have to carry out these new roles have the capacity and the skills to succeed.

Just because people were good at doing one thing in the past, doesn’t mean that they will be good at doing something very different in the future.

Looking back on the reforms with which I was involved from 2001-2007, this is the one big lesson I learned. For example – almost by definition – the people that were appointed to run the first set of PCTs had very little experience of running population based commissioning. At the time I remember talking to them about the power that came to them with the cheque book and most of them looked at me as if I was crazy. Very few of them had experienced the power that being a buyer of health care actually gives you over providers.

It took a further 6 or 7 years to get really good commissioning taking place and then only in parts of the country.

Just because you were good at providing health care, it doesn’t follow that you will be any good at commissioning it.

It is therefore an important part of the implementation process for Clinical led Commissioning that leaders of the CCGs face aptitude and attitude tests to ensure that they can do the job. They will go through an assessment centre in the next two months.

Candidates will be expected to demonstrate an ‘understanding that they need to develop’ and a ‘willingness to learn and understand their new roles before they take over’.

Dame Barbara Haskin said that “demonstrating commitment to clinical commissioning groups is vitally important”.

The emerging clinical commissioning groups will sponsor chairs to go through this process and also accountable officers and chief finance officers.

Many of the GPs involved will have been running good GP services but commissioning is different from providing – and it’s important to recognise that.

But a thought occurs to me.

People have been appointed to the National Commissioning Board – as CEOs and executive directors. For the moment we will draw a veil over the nature of the competition process for these jobs, but it is undoubtedly true that, like the leads in the Clinical Commissioning Group, this is a new organisation with new roles in it.

I am sure everyone would agree that Parliament decided to give the NCB its name for a reason. It is, like the Clinical Commissioning Groups, a commissioning organisation. It will itself commission about £30 billion of public funds and it will performance manage the CCGs commissioning the remaining billions.

So like CCGs this is a new organisation. And like CCGs this is a commissioning organisation.

So like CCGs you might reasonably expect that senior executives will be expected to demonstrate an ‘understanding that they need to develop’ and a ‘willingness to learn and understand their new roles before they take over.’

It is therefore obvious that the process senior staff at the CCGs have to undergo should also apply to senior staff at the NCB.

But will the people who are appointed to the CEO and the exec director roles of the NCB have to go through an assessment centre for ‘aptitude and attitude’?

The answer is no.

Yet in fact they need it more than the leaders of CCGs. Nearly every senior executive who has been appointed to run the NCB has no experience of commissioning.

That really should worry someone somewhere.

The fact that leaders of CCGs are being asked if they can “demonstrate commitment to clinical commissioning” may appear a little odd since they are already running such a group.

What would be really interesting would be if the leaders of the NCB were to be asked anything about their commitment to clinical commissioning. They have no track record of such a commitment.

In this new system people who want to run CCGs apparently need to go through an assessment and development centre because they are running a new system of commissioning.

But the exec leaders at the NCB don’t need to do that because……… well at some stage a few years ago they were good at running hospitals.

As I said earlier Just because you were good at providing health care, it doesn’t mean that you will be any good at commissioning it.

I think this is a mistake that will come back to bite the new system and will leave a bite mark that looks a lot like the old system.