by Corinne Camilleri-Ferrante
Consultant in Public Health Medicine
The recently published Design of the NHS Commissioning Board (CB) “presents recommendations for the organisational design of the NHS CB”. This was followed by the Commissioning Intelligence Report, which contained the Commissioning Intelligence Model. The juxtaposition of these two documents highlights the lack of joined up thinking about NHS commissioning and, the involvement of Public Health (PH) in commissioning NHS services.
The Design paper lays out the constituent functions of the NHS CB. It explains that there will be corporate teams and that the approximately 3,500 strong workforce will be committed to matrix working. What it most spectacularly does not talk about is public health involvement. There are medical, nursing and operations directorates but none have identified PH posts within them.
The Commissioning Intelligence Model has been written largely to inform the intelligence needs of CCGs for commissioning. This report makes many valuable points about the need for timely, accurate data to enhance patient care and commissioning. When I got to the Commissioning Intelligence Model, the full impact of what I was reading struck home. It could be a diagrammatic representation of the Health Services Public Health parts of the FPH curriculum. This is what every PH consultant is trained to do, and what health services PH specialists have spent years perfecting, studying and improving. The Commissioning Intelligence Report says that discussions with PH in LA will be necessary. This totally misses the point.
There are two fatal flaws in the reasoning behind these documents.
1. CCGs will need this commissioning intelligence, but it is a fundamental part of the commissioning process, not a bolt-on extra.. This has to be embedded in the commissioning process, so that the conversion of data into useable information for clinicians and others involved in commissioning is seamless. This will not happen if it is seen as something separate from the main commissioning focus. Health services PH professionals need to be embedded with CCGs, not sitting in LAs offering ‘advice’.
2. If this is necessary for CCG commissioning, then surely it must also be necessary for the NHS CB. Yet nothing in that document mentions it. Why this resistance to PH at the level of the NHS CB? How will the NHS CB ensure it has commissioning intelligence if it has not got the expertise within it? To say that Public Health England will offer such advice as is necessary is, again, to miss the point of the reality of every day working, taking hearts and minds with you in managing difficult decisions.
Commissioning intelligence is going to be vital if the challenges facing the NHS are to be met. Commissioners have to be properly trained in all aspects of population health. The NHS already has a fully trained cadre of professionals ready to undertake the work. Some of us have been doing it for years. Importantly, we are the only group who can guarantee that we have maintained our skills and who can bring together all the skills demonstrated in the model.
If the jobs are not guaranteed by Faculty standards, where are the safeguards for the future when the current crop of PH professionals retires?