The Government's plans to reform NHS commissioning need to be significantly changed, warn MPs in a report published today.

The MPs propose that representatives of nurses, hospital doctors, public health experts and local communities should all be involved as decision makers alongside GPs in NHS commissioning.

They believe it is vital to make these changes to enable the NHS to meet the unprecedented challenge it faces of finding 4% annual efficiency savings over the next four years.

In their latest review of NHS Commissioning, MPs on the cross-party Commons Health Committee recommend a number of significant changes to the Health and Social Care Bill, currently before Parliament.

The Committee's Chairman, former Health Secretary Stephen Dorrell MP, said: "We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces. Our report contains a set of practical proposals to strengthen the Health and Social Care Bill and make it better able to meet the Government’s objectives.

"Our proposals are designed to ensure that NHS Commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors, and representatives of social care and local communities. We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly coordinated healthcare".

The most significant proposals include:

Local Commissioning Boards
Local NHS commissioners are statutory bodies responsible for a large proportion of public expenditure; they should be required to comply with the highest standards of governance and accountability.

In order to satisfy this standard each commissioner should be required to establish a Board where GPs should form a majority of membership but other places should be reserved for:

A professional Social Care representative

An elected member (a councillor or directly-elected Mayor), nominated by the local authority

A nursing representative

A representative of hospital medicine

A public health expert nominated by the Director of Public Health

Scrutiny and the patient's voice
The Committee believes that local authority scrutiny of health services should continue and welcomes the extension of local authorities' health scrutiny powers.

MPs recommend that NHS commissioners should be given a legal obligation to consult Healthwatch, and that Healthwatch should have a legal obligation to consult with patients and patient representative bodies.

Accountable executives
The Committee recommends that all NHS commissioners should have a Chief Executive and a Finance Director, both of whom should be members of the Board.
Independent Chair

The Committee recommends that all NHS Commissioners should have an independent chair, appointed by the NHS National Commissioning Board.
Meetings and Papers

The Committee recommends that the Boards of NHS Commissioners should be required to meet in public, publish their papers and comply with the rules of the Committee on Standards in Public Life with regard to conflicts of interest amongst board members.

Accountability to the NHS Commissioning Board
The Committee recommends that NHS Commissioners should be held to account by the new NHS National Commissioning Board through a clear system of authorization and assurance.
A new name

The Committee concludes that the Government's plan to call local commissioning bodies "GP Consortia" is misleading. It proposes that these bodies should be referred to as "NHS Commissioning Authorities".

Health and Wellbeing Boards
The Committee believes that its own proposals would mean that there is no need to proceed with the establishment of Health and Wellbeing Boards.
Commissioning of Primary Care

The Committee also believes that its proposals would mean that there is no need to separate the commissioning of primary and secondary care – as currently proposed in the bill. The Committee proposes that NHS Commissioning Authorities should be responsible for commissioning primary, secondary and community healthcare, as well as for creating robust links with social care.

Commenting further Stephen Dorrell said: "Ever since 1948 the NHS has suffered from an artificial distinction between primary and secondary care. Instead of entrenching this distinction further, this is an opportunity to abolish it for good – and create a single, integrated health service which is able to provide properly coordinated health and social care to all patients.

"It is an opportunity to deliver greater efficiency and high quality at the same time. It is a 'win-win'; what is the argument against?"

Responding to the publication of the Committee’s report on commissioning, Chief Executive of The King’s Fund, Professor Chris Ham, said: "As the Health Select Committee has made clear, modifications to the Health and Social Care Bill are needed if the government’s health reforms are to succeed.

"Today’s report includes a number of recommendations that would improve the Bill especially around the membership and governance of GP consortia, a phased approach to implementing GP commissioning, and stronger mechanisms for promoting joint working between health and social care.

"The Committee’s report is also a helpful reminder that the key priority for the NHS is to deliver the £20 billion in productivity improvements needed to maintain quality and avoid significant cuts to services over the next few years.

"The stakes are high. A pause for reflection will serve the NHS, its staff and patients well by allowing a sensible discussion about how best to deliver the reforms the health system needs, while maintaining the focus on how to meet the financial challenge the NHS faces.

"The real choice is not between the status quo and change, but between the right reforms, executed well or poorly planned reforms that could undermine NHS performance.

"Reform is necessary, but it should be based on a staged approach to implementation, a clearer understanding of where and how far to extend competition, and clearer lines of accountability than those currently proposed in the Bill."

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