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Nicholson awards NHS England 'five out of ten' for first-year performance

The chief executive of NHS England has admitted that its direct commissioning duties - which include holding the GP contract - has been a ‘weakness’, awarding it ‘five out of ten’ for its first-year performance.

Sir David Nicholson also said that the competition environment was the ‘worst of all worlds’ is his keynote address at the Commissioning Live conference in London – his last appearance before stepping down on March 29.

He explained that competition had been intended as a tool for commissioners to improve services for patients but that ‘between the regulation and legislation, we’ve lost it’.

Sir David said that CCGs had deserved ‘eight out of ten’ for their start, but warned that his own organisation had failed to focus on ‘direct commissioning’, which includes primary care services.

He said: ‘NHS England’s weakness has been our own direct commissioning. We spent quite a lot of time thinking about setting up CCGs and organising that, I don’t think we quite put the same amount of discipline in organising our own direct commissioning.

‘Part of the downside of how commissioning is organised at the moment is the split between primary care and other services commissioned at the local level.’

‘[So I’d give NHS England] about five out of ten I think, they’ve made a decent start but the potential is all there.’

Sir David also said NHS England needed to support commissioners in understanding the competition rules - which were the ‘worst of all worlds’.

He said: ‘NHS England as an organisation, needs to stand behind you to make it happen. I’m hopeful that we can do that, because I think the place that we’re in at the moment, is the worst of all worlds and it is stymieing our ability to improve some of our services for patients.’

‘That’s what I think - but I’m finishing on Thursday.’

Sir David revealed that NHS England was working with Monitor to address the lack of guidance for CCGs on when services - including current local enhanced services - should be put out to tender.

He said: ‘Competition wasn’t invented by the 2012 [Health and Social Care Act], it was there before. The attempt in the HSCA was to give us a local health based competition regulator, to avoid being sucked into a big national and European debate around competition.’

‘The intent behind it always was that competition is a tool available to commissioners to improve services for their patients. That was the absolute intent behind it. But somehow between that intent, the regulation and the legislation, we’ve lost it.’

Sir David stressed that competition should only be used to for improving care, and not because of fears of the external regulator or legal advice which invariably says ‘to be safe you have to compete’.

He said: ‘We’ve been struggling manfully – womanfully – with Monitor to get a simple set of rules that everyone can understand.’


Readers' comments (10)

  • How ironic - i was going to score Nicholson minus 5 out of 10. How bizarre!

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  • For a simple set of rules everyone can understand we need to reinstate the old pre- internal market National Health Service.

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  • "Competition is a sin " - John D. Rockefeller.

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  • NHS England=0/10.
    David Nicholson=0/10
    Daily Mail=0/10

    Bad, Sad and Mad in that order.

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  • Sir David Nicholson - Take your place in history with Blair, Cameron, Langsley and Hunt in the Hall of Shame responsible for the privatisation of the NHS through the back door.

    If you thought competition was so bad why didn't you do something to stop the policy when you were in a position to influence things.

    Why get involved in Top down reorganisation and the shameful waste of money that is the PFI projects bankrupting the NHS.

    The NHS is not a profit making business so a market can never work when you have such thoughtless policies like PBR - which force equal payments for all stopping the market forces working!

    Retire in shame and failure.

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  • Vinci Ho

    How many roads must a man walk down
    Before you call him a man?
    How many seas must a white dove sail
    Before she sleeps in the sand?
    Yes, how many times must the cannon balls fly
    Before they're forever banned?
    The answer my friend is blowin' in the wind
    The answer is blowin' in the wind.

    Yes, how many years can a mountain exist
    Before it's washed to the sea?
    Yes, how many years can some people exist
    Before they're allowed to be free?
    Yes, how many times can a man turn his head
    Pretending he just doesn't see?
    The answer my friend is blowin' in the wind
    The answer is blowin' in the wind.

    Yes, how many times must a man look up
    Before he can really see the sky?
    Yes, how many ears must one man have
    Before he can hear people cry?
    Yes, how many deaths will it take till he knows
    That too many people have died?
    The answer my friend is blowin' in the wind
    The answer is blowin' in the wind.

    Song dedicated to a bureaucrat .............

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  • Wish I was finishing on Thursday.............

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  • Bet he always 'worked from home'on Fridays like a lot of beurocrats seem to!

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  • Yet again this man earned a huge amount out of an organisation that he and it influenced nothing for the good of the patients and at best could score half of its objectives - a truly low benchmark for the person the government trusted with this and for the next man to come in and live up to (at best)! If you can do no better than halway decent why are you allowed to leave on a massive pension - wouldn't front line service and staff that fail half their patients be ostracised, or an organisation in charge of NHS delivery condemned and the leader dismissed? WEAK GOVERNMENT AND EVEN WEAKER ACCOUNTABILITY AT THE 'TOP' OF THE NHS! Everything this man stood for and this government cowers behind!

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  • A man who allowed patients to die under his management ... a bit rich don't you think?
    To add insult to injury, the promoted him bumping up his final salary ready fro a nice retirement ... he has no right to rate anyone!

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