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Going cold

The story so far

Dr Peter Weaving, a self-confessed commissioning enthusiast, is vice chair of Cumbria CCG with a population of 500,000. Keen to pursue what clinical commissioning can achieve, he is also a realist about the scale of the challenges ahead and the support needed to allow CCGs to succeed…

‘The A66 is closed, emergency services have been called to 97 crashes in the last six hours and the ambulance trust is about to declare a major incident,' our CCG managing director informs us.

I look up from the notes, if they could be honoured with such a title, that I am scribbling before a presentation to the board of NHS Cumbria to reassure them we are prepared for authorisation as a CCG. Much as I would like to see this moment as ‘the eagle has landed', I suspect some envisage a sickly chick falling from the nest.

The managing director continues: ‘The infirmary has orthopaedic consultants triaging in A&E, has drafted in extra plaster-room technicians and is putting on emergency fracture clinics. People are going down like ninepins.'

After a bitterly cold night, even gravel paths were like skating rinks. My car looked like a Glacier mint and I had to hold the door handle while scraping lest I slide away like a spaceman. Then the message came through. The CCG chair himself couldn't get up his drive, let alone get the car out, so could I do his presentation too?

I looked round the room at the assembled executive and non-executive directors of the trust, members of HealthWatch and someone very senior from social services.

‘Sure, why not?' I agreed, and flicked through his slides on an iPad.

Today was a mark on the map and I was unsure how it would go or how to play it.

Let me explain. Eighteen months ago we were a functioning CCG – we monitored and set contracts, and engaged with secondary care, community colleagues, social services and the third sector. Our localities were borough council areas – small enough to engage with individual practices, but big enough to lever change in services.

Then we implemented the structural organisational changes that were needed to precede a CCG flying the nest. Clear blue water emerged between the CCG and our parent cluster PCT – it is to become the local office of the NHS Commissioning Board. This slimming of the CCG back office was reinforced by ‘recommended' staffing levels of 10 staff for 200,000 population – a staffing complement of one twelfth of our parent PCT.

Now forgive a diatribe here – we embarked on commissioning because health economies are facing the combined onslaught of demographic change, technological advance and falling finances. We knew the bulk of healthcare spend is in the hands of primary care and empowering them was going to save our bacon. It was not going to work by stripping out our thin management resource.

The next loss is the departure of public health to work alongside local authorities in a health and wellbeing board. I have spent the past three years sharing an office with an associate director of public health. It's been an itinerant relationship through three offices, but it did introduce me to the world of the local authority, their officers and the daunting reality of decision makers elected by the public. Today one of her public health colleagues was bemoaning the loss of the good working relationship with primary care.

Finally to our dear support staff – unsung heroes of the health service – the sort of people who can do anything with Excel pivot tables and lay them so that the cancer rates in that ward of the city are correct. Their future lies in a commissioning support service, which is planned to cover the whole of Cumbria and Lancashire and anybody else who wishes to subscribe to its services. The previous day I asked for, and received – pretty much by return of email – the A&E attendance rates by practice subsequent to the introduction of a minor injury local enhanced service. I struggle to believe I will receive that standard of service when it is situated 100 miles away.

My time has come. I stand before the board and their colleagues, my colleagues, and tell them that what I want to see clear the hurdle of CCG authorisation is not a committee-devised camel but a thoroughbred.

And, more importantly, with all of us in the saddle.