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Sir David: balance between local and national ‘not quite right’

The balance between the local and national priorities in the NHS needs a rethink, NHS chief executive Sir David Nicholson told the NAPC conference in Birmingham.

Outlining his vision for the relationship between CCGs and the NHS Commissioning Board, he said there was a balance between getting better consistency in care across the country while at the same time promoting innovation.

‘I am absolutely clear that the balance between the national and local is not quite right,’ he told delegates.

But he added that he was enthused that CCGs could be fast and responsive to the needs of their populations and said they would find an ‘ally’ in the Commissioning Board in pushing through service change.

He gave examples of CCGs who were scouring the country for examples of best practice and finding and implementing solutions to problems with increasing referrals or poor patient experience within weeks – a timescale previously unheard of.

‘We are genuinely trying to make a different type of relationship,’ he said.

‘CCGs will be accountable to the commissioning board but we will also be accountable to CCGs in terms of commissioning primary care and specialised services.

‘It is about two organisations that have important roles to play and hold each other to account and that is a very different model than we have had in the past and we are committed to making it happen,’ he said.

The conference also heard that the NHS mandate due later in November would hold ‘no surprises’ although he suggested it would spark a lot of discussion among CCGs.

He added the more detailed the mandate is the more responsive it will be.

‘It is in everyone’s interest that the mandate is high level and straightforward,’ he said.

Discussing the next round of budget allocations, which he expected to see in mid-December, Sir David said collating them had been a more complex task than in the past.

‘The allocations are very different per head in different areas of the country and some of that is fully expected and warranted and some less so,’ he told delegates.

‘It is about how we can move people as fast as we can to fair shares while at the same time not destabilising the NHS.’

He said the whole system needed to shift from incentivising providers by how much work they did to paying for good outcomes.

‘Most of provision has been built on the business model that says the more you do the more money you get.

‘We have for too long subsidised suboptimal care and we simply can’t afford to do that any more.’