Guidance Developing Commissioning Support: Towards Service Excellence was published by the NHS Commissioning Board Authority in February 2012.

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1 Commissioning support: Key facts Introduction The setting up of the new clinical commissioning system has given the NHS the opportunity to think about what support clinical commissioners need to more efficiently deliver better outcomes for patients. The aim is to design the most efficient and cost-effective way of providing excellent commissioning support activities, allowing CCGs to maximise their investment in frontline healthcare services for communities and improving health outcomes. For some support activities, CCGs may choose to appoint their own internal staff while for others they will have a choice of using new NHS commissioning support units (CSUs) or other sources of commissioning support, for instance from the independent or voluntary sectors. NHS CSUs are currently being designed to offer an efficient, locally-sensitive and customer-focused service to CCGs. CCGs are likely to need support in carrying out: Transformational commissioning functions, such as service redesign; and Transactional commissioning functions, such as market management, healthcare procurement, contract negotiation and monitoring, information analysis, and risk stratification. CCGs will always retain legal accountability and responsibility for meeting their statutory functions and their commissioning decisions cannot be delegated to other organisations. Guidance Developing Commissioning Support: Towards Service Excellence was published by the NHS Commissioning Board Authority in February Developing the new environment for commissioning support is a major undertaking and will require cultural change, both in developing sustainable and customer-focused NHS suppliers and in ensuring that the services they provide really deliver against their customers requirements. The NHS Commissioning Board (NHS CB) is working with and supporting CSUs to enable them to provide great commissioning support services to CCGs, to support CCGs through authorisation and to help CCGs to deliver their responsibilities from now onwards clinical commissioning, service transformation, partnership working and ensuring better health outcomes for their communities.

2 The overarching aim is that CSUs are as individually autonomous and self sufficient as possible whilst safely hosted by the NHS CB, that they become specialist suppliers of the work that underpins clinical commissioning, and that they help drive efficiencies in the NHS. Leadership CSU leadership teams will be a critical factor in the success of the new clinical commissioning system. CSU leadership teams need to develop attractive organisations capable of winning and retaining CCG business and of retaining the many highly skilled specialist staff who currently provide commissioning support functions in PCTs. Choice of commissioning support Choice is being introduced into commissioning support services to ensure that these services become more innovative and provide greater value for money to the NHS. Services need to be responsive to CCGs and support them in achieving their improvements to local outcomes. CCGs will be free to use their running costs allowance to seek support from wherever they wish, as set out in the White Paper and in the final version of Towards Service Excellence. Hosting The NHS CB will host all CSUs from April 2013 through to the point at which CCGs procure their choice of future commissioning support. Initially, the intention is that CCGs will identify a hosted CSU and this arrangement will operate under a standard contract. This will ensure: Stability in the system while CCGs go through a procurement process to secure ongoing commissioning support; The experience and expertise of staff in commissioning support roles in PCTs is retained for the benefit of the NHS; and CSUs, as new organisations, have the time to develop to become customer- driven businesses that are capable of being independently sustainable within a competitive marketplace. The host role is in effect a holding company which covers: Ownership of the NHS CSUs; Accountability and responsibility; A legitimate operating framework for CSUs in terms of statutory cover and a financial operating model; and An interim trading environment to support delivering contracted services to CCGs. NHS CSUs will legally be part of the NHS CB and have no independent legal status until they are externalised.

3 The NHS CB will require CSUs to pay a hosting charge for the period of hosting. The hosting charge will cover the costs of the CSU Transition Team at the NHS CB and its work to assure, develop and externalise CSUs. It will also cover costs which the NHS CB and NHS Business Services Authority (NHS BSA) will incur to act as host and employer respectively to the CSUs, such as HR, payroll, audit, IT, estates and legal services. The NHS CB is currently developing the hosting arrangements which will be put in place between the NHS CB and CSUs. CSUs will have governance arrangements equivalent to a board, including individuals who can act in a non-executive type role, but will not be able legally to call these arrangements a board. This is because CSUs are not yet organisations, but part of the NHS CB and consequently part of its governance arrangements. NHS Business Services Authority At its Board meeting in September the NHS Commissioning Board Authority agreed that it would host the emerging CSUs on the basis that the NHS BSA would act as employment partner. This sent a strong signal that these organisations are separate from the rest of the NHS CB and are en route to independence, but also allows the NHS CB to manage the potential conflicts that might arise when holding CCGs to account at the same time as providing their support. The Board will host - provide oversight and direction to CSUs, and CSUs will still need to comply with the Boards policies and processes. This arrangement ensures there is a degree of autonomy and independence for CSUs as they move along the path to externalisation by While hosted, CSUs will be managed in a way that maximises their ability to provide services which are sustainable in a competitive marketplace. They will be responsible as far as possible - for their own affairs, and increasingly act as separate organisations on an earned autonomy basis with their own quasi Boards and committees. The formal arrangements are governed by a memorandum of understanding which makes explicit the roles, responsibilities and accountabilities of the NHS CB, the CSUs, the NHS BSA and the Department of Health. The NHS BSA will be the legal employer of CSU staff. NHS BSA employment policies will apply to CSU staff, while all other policies will be those of the NHS CB. All HR and employment services will be provided by the CSUs for their own staff. This will not mean any changes to NHS staff terms and conditions. The national HR transition policy and process will apply to those NHS staff who

4 are transferring to CSUs and Agenda for Change terms and conditions and pay scales will be used by CSUs while hosted by the NHS CB. Procurement Once they are established in April 2013, CCGs will be public bodies and will be required to procure their commissioning support in the open market in line with the EU rules that govern the public sector. During this time, CCGs will need to ensure clarity about their requirements and, when ready, formalise their commissioning support arrangements using the appropriate procurement methodology. The trajectory for moving towards these formal arrangements needs to be worked through in light of CCG readiness and the relevant requirements for public procurements. The draft mandate for the NHS CB Our NHS Care Objectives outlines that the NHS CB will need to set up a new procurement framework to enable CCGs to procure from providers. The NHS CB is currently developing this work. The guidance Towards Service Excellence makes it clear that the CSUs are being established as self-sustainable entities so that they are prepared to compete alongside other potential providers as soon as CCGs are ready to procure. They will be run as break-even businesses from April 2013, providing chargeable services to CCGs and other customers, using any profit to reinvest in the development of their business. Service level agreements have been agreed between CSUs and CCGs specifying which CSUs that CCGs wish to use post-april Externalisation During the period of hosting there will be discussions with potential suppliers from all sectors to explore and assess innovative models for the externalisation of commissioning support. The NHS CB has commissioned a report to help it explore and appraise the potential externalisation options and provide insights into ways of creating a successful market for commissioning support services, prior to developing an externalisation strategy in This will be part of the work of the Commissioning Support Strategy and Market Development Team. The externalisation of CSUs must be completed by April 2016, and must be considered alongside CCG plans to formally procure their commissioning support. Business review and assurance process

5 The NHS CB will provide assurance to CCGs through a series of checkpoints that ensure the models of commissioning support are financially robust and that potential commissioning and financial risks are manageable. Checkpoint 1: December 2011-January 2012: This was a peer review process where SHAs assessed the preparedness of CSUs to be responsive to CCGs needs and develop an operating arrangement as a support service; Checkpoint 2: March-May 2012: The objective of Checkpoint 2 was to assess whether emerging CSUs were on a viable and secure path and had the ability to develop a full business plan by August Twenty five regional CSUs and the nationwide NHS Communications and Engagement Service submitted outline business plans for Checkpoint 2: 23 proceeded and two CSUs and the communications and engagement service were stopped. Following this, the NHS Commissioning Board Authority decided that all 23 CSUs would proceed to be hosted by the NHS CB from October 2012 onwards; a shift in emphasis brought about as a result of Checkpoint 2 and subsequent further evaluation which made it clear that each is viable in terms of scale. In addition, the Board Authority recognised the need for stability for CSUs and their customers to ensure a successful transition to the new clinical commissioning system. It also decided to develop a reconfigured communications and engagement service; Checkpoint 3: August-October 2012: This comprehensively tested the commercial viability of CSUs full business plans and strategies, and checked completion of their Checkpoint 2 development commitments. Further adjustments to management configurations were part of this process; and Checkpoints 4 and 5: Two additional checkpoints took place through to March 2013, to further assure CSUs business plans in terms of their scales, staffing and financial due diligence. Scale commissioning support services The scale commissioning support services include: Business intelligence; Healthcare (clinical) procurement; Business support services; and Communications and engagement services. The outcome of the business review and assurance process for the scale commissioning support services has been agreed and the NHS CB has named those CSUs which will be offering business intelligence, healthcare (clinical) procurement, business support services and communications and engagement services. CSUs which applied to provide scale services were assessed by the NHS CB for their ability to deliver against defined standards, the sustainability and

6 appropriateness of their cost structures, and their capacity and capability to deliver services. Working with local government The development of a joint health and wellbeing strategy at the local level through health and wellbeing boards is an opportunity to agree the commissioning decisions across the NHS/local authority interface. In putting new commissioning support arrangements in place, the NHS will need to strengthen this joint working, and not dilute it. It will be important for CCGs to work closely with local authorities to consider how to develop the best and most effective commissioning support arrangements. The NHS has agreed a joint statement with local government colleagues that reinforces the need for collaboration and integrated commissioning, and describes the way in which CCGs, local authorities and emerging CSUs should work together to develop the most effective and efficient commissioning support models. Some strong partnerships are emerging, with the majority of CSUs identifying local authorities as potential partners. Further information For further information on commissioning support, please go to the NHS CB s website at

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