Strategic Re-con figuration
Building a Foundation for a Target Operating Model
Becoming a Foundation Trust
– what are the Issues for
Clinical Commissioning
Groups?
A Toolkit to help
guide Clinical
Commissioning
Groups
1
Contents
•
Foreword -
•
Introduction -
•
Purpose of this guide
•
Role of Clinical Commissioning Groups in Provider Development
•
Provider and Commissioner relationships
•
Options for aspirant FTs
•
Criteria NHS Trusts must meet
•
Traditional route to becoming a Foundation Trust
•
Tripartite Formal Agreements
•
NHS Foundation Trusts - The Benefits to commissioners of becoming a Foundation Trust
•
Health economy issues
•
System connectivity
•
An aspirant Trust’s FT application is a health economy issue
Contents (Continued)
•
Foundation Trust application - building consensus on a target operating model -
•
1. Alignment - the importance to the programme path -
•
2. Organisation baseline - market assessment -
•
2. Organisation baseline - patient flow & market assessment -
•
2. Organisation baseline - business unit performance -
•
2. Organisation baseline - financial position -
•
3. SWOT Analysis -
•
4. Target operating model - option evaluation -
•
Target operating model - option evaluation & criteria -
•
System Designs – organisational models for FTs -
•
4. Target operating model – option evaluation, some system designs for integrating care -
•
5. Stakeholder engagement – importance of involvement -
•
5. Stakeholder engagement -
Foreword
The Government’s ambition is to create the NHS as the best healthcare system in the world and this is rooted in the
three principles of giving patients more power, focusing on healthcare outcomes and quality standards and giving
frontline professionals much greater freedoms and a strong leadership role.
Clinical Commissioning Groups (CCGs) are charged with:
• Creating a strong clinical and professional focus
• Building on and establishing meaningful engagement with patients, carers and their communities
• Establishing clear credible plans to continue to deliver QIPP within financial resources and set quality
standards
• Developing constitutional and governance arrangements that deliver all their duties and responsibilities
• Build collaborative arrangements for system wide and specialist commissioning with other commissioners
e.g. local authorities, NHS Commissioning Board
• Lead the system – leading health commissioning for their population and drive transformational change.
This indicates the important role that CCGs will have in developing and determining the future shape of the health and
social care system. This guide is intended to help CCGs begin to engage in the wider issues of system management and
in particular, issues with their local acute providers
Introduction
CCGs have a clear role in ensuring that the wider healthcare system delivers services that meet the
needs of the local population. In this respect, they will have an increasingly important
responsibility to consider the impact of their commissioning decisions on local healthcare
providers and whether these decisions may have unintended consequences.
Government policy is that NHS hospitals should run their own affairs and be accountable to local
people and patients. This means an expectation that the vast majority of NHS Trusts will become
Foundation Trusts by April 2014, primarily through a locally managed process, with national
support as needed. Becoming a Foundation Trust requires strengthened board governance,
financial disciplines that promote long-term financial viability and a framework to secure delivery
of quality services.
It must be recognised that many of the remaining NHS Trusts have more challenges to resolve to
achieve Foundation status than the early applicants did. These include financial, quality and
governance issues within the organisation themselves, and also, for some Trusts, more deep seated
and long standing issues about, for example, size and location, which limits their capacity to
deliver health services efficiently and effectively. Therefore, this guide will examine the processes
that may be followed, to allow Trusts and their lead commissioners to determine the appropriate
route to financially and clinically secure providers of care.
CCGs have an important role in understanding the internal issues and influencing the external
constraints that such organisations face. The commissioning intentions of CCGs are fundamental
to the business plan of any aspirant Foundation Trust.
Feedback from Department of Health briefing events for CCGs –
sessions on support for FTs/aspirant FTs December 2011/January
2012
• Varying relationships with FTs and aspirant FTs
• Some CCGs recognised as playing important role within meetings, decision making
• Others felt relationship tokenistic or not invited to relevant meetings
• Some CCGs supported by PCTs re FT engagement – unaware of current help at
SHA level
• CCGs with aspirant FTs not clear on support role to FT application
• Where Trusts will not make FT in their own right, CCGs didn’t understand role in
shaping future form of Trusts and required support for proposals
• Recognised need to align Trusts and CCGs going forward
• Would welcome an independent discussion/view of what’s required
Purpose of this guide
This is a practical guide intended to support Clinical Commissioning Groups (CCG) in considering what they will
need to do when anticipating and considering sustainable service provision, service transformation and at the
same time improving quality, innovation, productivity and prevention (QIPP). As part of these challenges, CCGs
will be asked to input to, and influence, the journey of local NHS Trusts to becoming Foundation Trusts.
Target audience
The guide can be used by CCG leaders, clinicians and mangers and PCT cluster leads
How this guide can be used
The guide provides you with a series of tools to help you:
• Benchmark or self assess where you are now, highlight opportunities, gaps and risks
• Facilitate key stakeholders by asking challenging questions and creating the time to
consider the critical issues at a local level
• Give considered responses to SHAs, NHS Trust Development Authority, Department of Health and Monitor
regarding local providers’ pathway to becoming Foundation Trusts
Role of Clinical Commissioning Groups in Provider Development
NHS Foundation Trust
CCGs must:
Maintain an ongoing dialogue with aspirant
FTs, supporting commitments set out in the
Tripartite Formal Agreements (TFAs)
Ensure support and sign-up to the activity levels agreed by
both parties in the NHS Trust plans
Ensure NHS Trusts engage with and endorse provider
strategies that support sustainable local healthcare,
reflecting patient needs
Take actions to ensure appropriate providers and models of
care are available to meet commissioning requirements
Support the development of Trust FT applications
specifically with activity plans and overall health system
strategies
Support Trusts in developing sustainable business
models to achieve FT status
NHS Trust
Provide support to NHS Trusts to ensure they are
aware of the Equality Delivery System
Provider and Commissioner Relationships
Commissioners are focused on commissioning cycle
to prove a balanced foundation for strategic change
A key challenge is designing and purchasing
sustainable service specifications that provide quality
and value for money
Commissioner
Provider
Consumer
The provider will value and prioritise
independence and autonomy acquired
through FT status
The format and content of an FT business
plan is a crucial set of core requirements
The
provision
and security
of local
hospital
services are
vital for
community
confidence,
user stability
and
assurance
Options for aspirant FTs
• The Bill sets the course for all public sector health providers to be Foundation Trusts
by April 2014. The Government is making provisions to abolish the NHS Trust organisational
form in April 2014, in order to ensure that this goal cannot slip
• As a result of this and the abolition of Strategic Health Authorities, all NHS Trusts that
have not gained FT status by April 2012 will be put under the guidance of a newlyconstituted Special Health Authority, the NHS Trust Development Authority
(NTDA)
• The NTDA will have two years from April 2012 to drive Trusts to FT status, OR work on
an agreed solution to their future form, for example merge with an existing FT.
Trusts wishing to gain FT status will have to apply by the 31 March 2013. Clear signals are being
sent to providers indicating that they are co-responsible for achieving this.
• Monitor will continue to assess whether organisations meet the necessary financial and
governance requirements (the “FT Bar”). There will be no lowering of the assessment bar
in order to ensure that organisations will be fit for purpose.
Criteria NHS Trusts must meet
Monitor is responsible for assessing and authorising applicants for NHS Foundation Trust status and for their regulation afterwards.
Before submitting an application to Monitor, trusts have to gain the approval of their Strategic Health Authority (upon abolition of the
SHAs the NHS Trust Development Authority will take on this role ) and the Secretary of State. Part of this key initial approval is the
support of their local commissioners – formerly the PCT, but increasingly of their CCG(s). Once these support areas are secured, the
application goes forward to the Department of Health’s Applications Committee which reviews it and advises the Secretary of State on its
merits. If approval is secured, the Trust then submits its application to Monitor.
SHA led Development Phase
SHA works with Trusts to develop robust and credible
ledTrust
Development
Phaseinclude:
NHS SHA
Foundation
applications. Activities
1. Pre-consultation:
1.
Pre-consultation
•
Trust review
•
Board review
Public
consultation
• 2. Draft
business
plan and financial model
•
Bespoke support
3.
Secretary of State Support Phase
1.
2.
1.
Post consultation
SHA decides that the applicant is now ready to proceed
to: 4.
Historic due diligence
report
2. Public consultation
– minimum 12 weeks
5. consultation:
SHA and trust submit
3. Post
•
Finalisation
of consultation
application
to the
•
Final business plan and financial model
Department
•
Historical due diligence sourced and actioned
•
Board-to-board practice
•
All actions from 1) above, delivered
3.
2.
When SHA is satisfied that Trust is ready,
Secretary
of State
Trust formally
appliesSupport
to Secretary of
State, with SHA
full support
Phase
Applications Committee considers
Applications
committee
applications and
provides advice to
Secretary
of State which
Trusts
be
review
application
and
make
supported to proceed to Monitor for
the
recommendation
to
the
assessment and, if successful,
Secretary of State
authorisation
Final
decision
Secretary
of State
Secretary
of by
State
support
granted
3. Trust is invited to formally
apply to Monitor
1.
Department
of Health
advises Monitor of
Monitor
Phase
supported applicants
1. Application review by the
2. Trusts formally apply to Monitor
Assessment Team
3.
Monitor will carry out its full assessment
Isprocess
the applicant legally
Is the applicant legally constituted?
constituted?
Is the applicant financially viable?
• Is the
Is applicant
the applicant
financially
well governed?
viable?
with the Care Quality
• 4. IsInterviews
the applicant
well governed?
Commission, SHA, and PCTs/CCGs
•
Board to Board
2.5. Interviews
withmeetings
the Care
Quality Commission, SHA, and
PCTs/CCGs
3. Board to Board meetings
4. SHA confirms the Trust is ready to move into
second phase
Commissioner support – vital in
planning, monitoring, and FT
application
Monitor Phase
See next
page
Authorisation
granted
Deferral
Rejection
Traditional route to becoming a Foundation Trust
Intervention Points for CCGs
Secretary of State Support Phase
SHA Led Development Phase
• Commissioner signatory to TFA
•
• Negotiation and Agreement over contract
income
• Negotiation and Agreement over changes
to clinical pathways
•
• Commissioner input to the Trust’s business •
plan and financial model
• SHA/NTDA check commissioner support
for FT application
•
When SHA is satisfied that Trust is
ready, Trust formally applies to
Secretary of State, with SHA full
support
Commissioners provide a letter of
support
Monitor Phase
• DH advises Monitor of the applicant’s
support from commissioners
• Monitor carries out full assessment
process, including direct discussions with
commissioners with focus on commitment
to financial model for Trust, satisfaction
with quality standards of Trust and
commitment to Trust’s clinical strategy
Applications Committee considers
applications and provides advice to
Secretary of State which Trusts be
•Commitment to commissioning plans to
supported to proceed to Monitor for
ensure robustness of aspirant Trust financial
assessment and, if successful,
projections
authorisation.
Final decision by Secretary of State
Tripartite Formal Agreements
The Department of Health has developed new processes to help progress aspirant FTs towards FT status. A key
element of this process is the Tripartite Formal Agreement (TFA). The TFA summarises the main challenges
facing each organisation, the resulting actions to be taken by the Trust, the SHA and the DH. There is an explicit
timescale in this document for the Trust to become an FT. Because of the influence that commissioning
intentions and overall commissioner support to applications have on whether Trust’s financial plans are viable,
the lead PCT for each Trust has also endorsed the TFA. This responsibility will pass onto the lead Clinical
Commissioning Group (CCG) once they are authorised.
The actions outlined in the TFA to become an FT primarily rest with the NHS
Trust board and management, supported regionally by their SHA and
nationally by the DH. When SHAs are abolished in April 2013, the NHS
Trust Development Authority will become responsible for progressing the
remaining Trusts.
The TFA forms the main public document giving the Trust’s commitment to
becoming an FT and is the commitment against which the health economy,
and particularly the Trust, will be measured. All aspirant Foundation Trusts
have a signed TFA which is available on the Trust’s website.
NHS Foundation Trusts
The Benefits to commissioners of becoming a Foundation Trust
NHS Foundation Trusts:
•
Are free from central government control – the board has the authority to run its Foundation Trust as it
judges best, but is accountable for the success or failure of the organisation. This is a cultural shift which
fosters improved leadership and innovation;
•
Have greater financial freedoms – they can borrow commercially and generate surpluses to expand,
improve quality or develop new services; and
•
Are accountable to:
•
Their local communities, through their members and governors
•
Commissioners, for delivery of services specified in their contracts with PCTs, CCGs and other specialist
commissioners;
•
Monitor as their regulator and
•
Parliament, by laying their annual reports and accounts before the House of Commons and House of
Lords.
Monitor as the regulator of FTs has said it is keen to develop closer and more effective relationships with
commissioners.
Health economy issues
Potential acute sector re-design
Public services are facing unprecedented financial and other challenges. The NHS is increasingly
under pressure to improve quality, productivity, respond to public demand and make significant
efficiency savings. The NHS works as a series of organisations that are inextricably linked and
works as a whole system. Clinical Commissioning Groups may wish to change clinical pathways to
improve services to local patients. Changing patterns of care can, in some circumstances, impact
on the viability of other related services. Therefore the whole system needs to work together to
determine priorities and solutions, ensuring that clinicians, managers and local communities are
engaged effectively in the process of change.
System reform presents a number of challenges to local health systems and creates/exposes
system management risks between the Strategic Health Authorities, Primary Care Trusts and
newly formed CCGs.
Many health organisations on the Foundation Trust pipeline are struggling to attain legitimacy in
their current organisational form having been challenged organisations for many years. In many
cases, reconfiguration and efficiency saving will be required to deliver on the demographic and
economic changes for the NHS over the medium term.
System connectivity
The relationship between Commissioners,
Providers and Consumers
The current pressure on public sector accounts, and the structural transition in the NHS present a
number of significant challenges to local health systems. For many organisations, traditional methods of
cost improvement are not enough to ensure sustainability and therefore achieving or maintaining
Foundation Trust status is a significant challenge.
Provider configuration has many challenges:
•Cost of transition
•Achieving viable/safe clinical models
•Public and patient expectations and reactions
•Politics
•Loyalties and alliances
Structural transition exposes the risks that whilst SHAs and PCTs have mandated system management
responsibilities and also have experience of strategic change over many years; newly formed CCGs have
neither responsibilities or experience in many cases.
Nevertheless, systems configuration may be needed, alongside the QIPP challenge and the requirement
for all Trusts to be FT by 2014
An aspirant Trust’s FT application is a health economy issue
Aspirant
Foundation
Trusts need to
demonstrate
clinical and
business
viability
Tactical Cost
Improvement is
not enough
Clinical &
Business
Viability
Increased
competition and
plurality
CCGs have
ambitions to
minimise
hospital based
activity
Providers have
already made
significant
internal efficiency
gains
Sustainability and
critical mass
ensure quality
and continuity
Many health organisations on the FT
pipeline are struggling to attain legitimacy
in their current organisational model and
form. Critical mass and activity based
income are influential factors in
determining whether an organisation is
sustainable and can achieve FT status.
Conurbations of health organisations need
a programme approach to re-configuration
that is aligned and transparent, and that
uses clinical and economic evidence
and objectivity.
Providers have
fixed costs that
need to be
funded
An innovative and whole systems based approach to a Trust’s FT applicaiton is required to develop and
agree a mutually sustainable position
Foundation Trust application - building consensus on a target
operating model
Programme Launch
Case for Change
2. Organisation Baseline
Stakeholder profile
Communications
Plan
Stakeholder Map
Virtual Network
Established
Governance & Project
Membership
Risk Mitigation
Portfolio
Current Operating Model:
Access, Quality & Financial
Baseline
Environment & Transport
Mapping
Programme
Established
Identify Quick Wins
5. Stakeholder Engagement & Account Management
Clinical Expertise & Objectivity
Programme Management Office Established
CCG Learning Development & Support
Target Operating
Model
Patient and Activity Flow
Analysis
Workforce Data & Analysis
Key Risks Identified
3. 4. Target Operating Model
Options Criteria &
Long Listing
SWOT
1. Alignment
Short List Options
Option Evaluation
Target Operating
Model Baseline
TOM Baseline
Review
Transformation
Objectives
Stakeholder
Alignment
Programme
Mandate & Outline
Business Case
1. Alignment - the importance to the programme path
Stakeholders brought together on the programme path to achieve a
route to FT status
2. Organisation baseline - market assessment
Provider landscape
review
Market Configuration/
Provider Structure
Analysis
•
What is capacity for different services and what is needed?
• What are the current and potential alternative suppliers and
how do they relate?
•
Provider analysis, using contracts data, commissioner
interviews, geographical/service line capability and capacity
mapping
What are the current market structure characteristics that
impact on current utilisation?
• What are the incentives faced by providers?
•
Review available expenditure, activity, and utilisation data
sources
Contracts analysis and incentive implications
•
•
These work streams also inform an assessment of the sustainability of the current market configuration and
development of the case for change
Care pathway patient
flow analysis
•
How joined up are patient care pathways?
• Are there patient or information bottlenecks?
•
Identify care pathway flows for key service lines, including
points of referral, bottlenecks and ease of patient and
information flow
To what extent does willingness to travel influence service
utilisation now and in the future?
• Where are patients at specialist units being referred from?
•
Map service-specific patient movements across relevant
geography
Assess current patient flows against current capability and
capacity
Is choice available for services where attributes are
appropriate?
• Are patients effectively exercising choice where it is available
to them?
•
•
Geographical patient
flow analysis
Choice and contestability
review
•
•
•
Consider implications of underlying service attributes for
choice and contestability.
Map these implications against areas where choice and
contestability currently exists.
2. Organisation baseline - patient flow & market assessment
Example of patient and activity flows
Type
Total
Cases
STHK
Cases
A
B
C
Volume
1,003
22
583
235
163
Cost
(£000)
3,324
73
1,932
779
540
2. Organisation baseline - business unit performance
There are a number of tried and tested tools which have proved to be very powerful and engaging with clinicians. They help to understand that whilst cost
will vary from patient to patient the ‘portfolio’ of cases must balance in order to maintain a viable service. The following examples have been utilised to
engage effective change.
Case Study: Profitability Trees
Case Study: Breakeven analysis
Profitability trees which breakdown the income and cost components of an HRG.
This clearly shows cost and volume drivers and illustrates how the deficit or
surplus at HRG level is derived
Breakeven and margins analysis, which illustrates the required patient throughput
per theatre session or outpatient clinic in order to breakeven
2. Organisation baseline - financial position
Typical Issues
Approach
Key benefits
• Organisation is in significant financial
distress , including a need to generate
substantial cost improvement
• Detailed scrutiny of the organisation’s
financial position
•
Independent and experienced
perspective provided based on sector
experience
•
Cross organisational approach to
verifying/ cross check findings, and
examining controls
• Lack of clarity around underlying
financial and recurrent / non-recurrent
positions
• Strains on cash availability and
potential for income generation
• Existence of historic debt obligations
requiring prompt payment
• Competing financial challenges from
sector partners / providers
• Poor income and expenditure
forecasting and results
• Operational control issues , e.g
• poor credit control; and
• inappropriate levels of pay and
non-pay spend
• Rigorous and fast-paced review and
assessment of financial forecasts and
trends
• Bottom up and top down review of
organisational and operational
processes, including risk review
• Challenge to current and future
financial assumptions based on sector
experience
• Application of sensitivity analysis to
financial forecasting
• Clarity provided on underlying
financial position and current and
future plans
• Short, medium and long term view
taken with recommendation on
financial and operational
requirements and improvements
• Stress testing reasonableness of
activity, income and expenditure
assumptions
• Readily implementable
recommendations made on cost
improvement governance, and
development of programme
• Review of cost improvement
programme, governance and
programme management
methodology
• Organisational knowledge gap
bridged through comprehensive
findings and graphical analysis
3. SWOT Analysis
SWOT and TOWS frameworks:
A SWOT exercise can be undertaken across the
health economy to help to shape the evaluation of
options:
Strengths
Weaknesses
Opportunities
Threats
Strengths
Weaknesses
Opportunities
SO Strategies
for
ADVANCEMENT
WO Strategies
to
OVERCOME
WEAKNESSES
Threats
ST Strategies
to
OVERCOME
THREATS
WT Strategies
to
AVOID AND
OVERCOME
In developing a robust strategy it is important to scan both
the internal and external environment to understand the
organisation and the market within which it operates.
The process of determining these strategies is commonly
referred to as a SWOT analysis. A detailed SWOT analysis
by an organisation and its key stakeholders can provide
useful information to help to shape future strategy and
determine how resources might be best deployed in order
to maximise organisational potential.
In a SWOT analysis, internal factors (e.g. clinical ratings
of services, local reputation, strategic partnerships) are
classified either as strengths (S) or weaknesses (W).
External factors (e.g. local health needs, new technologies,
regulation, or competitor activity) are classified either as
opportunities (O) or threats (T). This can then be mapped
on to a strategic framework (often referred to as a TOWS
framework).
4. Target operating model - option evaluation
Understand
Local Context
Four key stages of work, as outlined below and detailed
in the project plan
Stage 1: Local Context and Long List of Options, will focus on
understanding the local issues impacting on the Trust as well as
the full range of options available for its future use. In this stage
we will also develop generic selection criteria for the high level
assessment of these options.
Stage 2: Ranking of Options, will focus on applying selection
criteria to rank – qualitatively - each option in order to identify
the “preferred” or highest ranking options for more detailed
review – the “short list.
Stage 3: Detailed Appraisal, will focus on appraising each of
these short listed options in terms of likely costs, outputs, risks
and impacts - in quantitative terms - in order to identify the
option most likely to generate the greatest net benefits for the
local health economy.
Generic Approaches
(‘Long List’)
Generic Selection
Criteria
Stage One
Qualitative Ranking
Selection Criteria
Selection of ‘Short
Listed’ Options
Stage Two
Key Features
Detailed Costs
Cost Benefit
Appraisal
Stage 4: Business Case Finalisation. In this phase we will finalise
the business evaluation and present to the Trust Board.
Stage Three
Stage Four
Detailed
Benefits
Risk Appraisal
Selection of Best
Case ‘Preferred
Option’
Finalisation of
Business Evaluation
Baseline Status
Quo
Additionality/
Displacement
4. Target operating model - option evaluation & criteria
Process:
• In order to identify the leading options for the future of a Trust, a six stage process based on Multi-Criteria Decision Analysis
(MCDA) to narrow the current range of options can be used.
• MCDA is a useful approach when considering a range of solutions against a set of criteria containing a mix of considerations.
MCDA is based on the standard Treasury Green Book evaluation approach, but supplements this to take full account of
qualitative factors which can be important for decision making.
• The approach has been recognised in government. For example, it was used by the Department of Work and Pensions (DWP) to
evaluate the delivery model for personal accounts in the impact assessment for the December 2006 White Paper. It has been
used recently in other strategic prioritisation processes across NHS North West.
• The process involves a number of key steps that will be undertaken in order to arrive at a short list of options that will be worked
up in more detail. Indeed the purpose of the evaluation process is to rule out options – as opposed to identifying the precise way
forwards.
• The process is summarised in the diagram below. It includes the establishment of the Trust’s strategic priorities and evaluation
criteria and builds on the evidence established in the baselining exercise and SWOT analysis.
1. Identify strategic
priorities
2. Define
evaluation
criteria
3. Construct
scoring
system
4. Develop
option set
5. Appraise
options
6. Sensitivity
testing
Target Operating Model –
4. system designs – organisational models for FTs
NHS
Trust
Community FT
Acute
Sector FT
NHS
Trust
Specialist
Tertiary FT
FT
combined
entity
Existing
FT
NHS
Trust
New FT
This slide shows some of the organisational models being adopted to achieve FT
status from the simple acute focussed FT to the sort of organisational franchising
model now beginning to emerge in some areas.
Outsourced
management/franchising
FT
4. Target operating model – option evaluation, some system
designs for integrating care
Potential market configurations to consider may include care integration or networked care models. This slide sets out stylised examples of
options for configuration of models of networked care. We would map the challenges and benefits inherent within each model, as well as the
clinical, patient experience and economic attributes suited to each system, to the options being appraised – in which option is the most
appropriate system (given service attributes) being implemented?
Total vertical integration
Community
Primary
Primary care led
Primary
Commissioner
Hospital
Hospital
Community
Fully merged organisation
Primary/Commissioner
Integrated health & social
Social Care
Community
Primary
Primary
Community
Hospital
Commissioner
Hospital
Hospital
Community
Primary
Commissioner
Community
Virtual ICO
Commissioner
Hospital
Commissioner
Provider arm acquisition
5. Stakeholder engagement – importance of involvement
As groups of emerging commissioners, Clinical Commissioning Groups will have an opportunity to improve the health of
patients and wider communities but they will face a challenging commissioning environment and there will invariably be
difficult choices and decisions. The public, patients and local representatives including MPs and local councillors are
inevitably interested in and feel closely involved with their local hospital and for aspirant foundation trusts, often wish to see
it succeed in its current organisational form.
Good responsive commissioning can be achieved when patients, the public and key stakeholders including Members of
Parliament and Local Councillors are at the heart of what the NHS does.
Improving health and health services requires Clinical Commissioning Groups to understand and act on what really matters
to people and ensure they are active partners in co-designing and co commissioning health services. This is especially
important in the case of local politicians (MPs and local councillors). Everyone has a stake in the health of their community.
Get the engagement right, and Clinical Commissioning Groups can improve services and bring people with them through
change. This is especially so for local politicians. Clinical Commissioning Groups will need to balance engagement and any
proactive relationship with the ability to understand the political environment in which MPs and local councillors operate.
Good engagement is based on in the quality of relationships that clinicians have with their
stakeholders (patients and the public) and clinical commissioning groups create with local
people, communities and their representatives. See time spent building relationships with
local politicians as a worthwhile investment. They have insight and understanding about
local intelligence and the local communities needs, wants and priorities of local people and
will be keen to share it and work with the Clinical Commissioning Groups to fill in the
gaps.
5. Stakeholder engagement
Increasingly approaches to involvement that rely heavily on ‘formal’ consultation alone will struggle to be
good enough: now more than ever Clinical Commissioning Groups will need to work with local politicians
as well as patients and public as partners if better health outcomes are to be secured.
Ensuring that local politicians are actively involved in decisions about commissioning can be a means of
delivering powerful messages of reassurance to local communities but this has to be balanced with their
ability to do the opposite which can include delaying changes which the NHS need to deliver to improve
quality and outcomes for patients.
Clinical Commissioning Groups face many challenges as they journey toward authorisation and what is at
the heart of much of their success will be the ability to engage actively with their local communities. This is
equally so of local politicians where Clinical Commissioning Groups will have to balance the role of local
politicians as the democratically elected members of local communities.