COMMENT
Doug Forbes, director of the not-for-profi t Institute of Commissioning Professionals, explains his concerns at putting clinicians in charge. T
he new health reforms are being built around the concept of commissioning,
which is fundamentally about ‘what to acquire’. With the previous Parliamentary Health Committee severely criticising standards of commissioning, the NHS has now embarked upon a set of reforms which put ‘clinical commissioning’ at its heart.
Why not have qualifi ed clinicians taking expert decisions about ‘what to acquire’? They certainly understand the technical and human requirements, but are they as well versed in the business and legal necessities? Has this new term of ‘clinical commissioner’ been defi ned, and does that mean that the whole role, from user consultation to acquisition, delivery and satisfaction, is to be directly undertaken by a clinician?
Public money
The loose defi nition of commissioning has tended to focus upon procurement. This has allowed the debate to be turned into one of ‘Make or Buy’ with the inevitable
spectres of privatisation and divisiveness being raised. Related to the key skill of ‘what to acquire’ is the question of ‘how to acquire?’ There are a wide range of ways of how to acquire, from competitions to grant aid and forming partnerships, employee- owned organisations and mutuals. No matter what route is chosen, it is public money whose spending is subject to value for money provisions.
Some years ago, after assisting the then Department for Children, Schools and Families with its ‘fi ve year vision’ for commissioning, we identifi ed that there were massive workforce development requirements in order to upskill the new entrants.
Our analysis of commissioning at that stage identifi ed a need for increased professionalism helped by the formation of a professional institute. Key educationalists and social workers were being taken from the front line and expected to handle the complexities of commercial arrangements with little training, guidance, mentoring,
reference material and professional standards. At least accountants have Standard Statements of Accounting Practice, regulation and a standards board. Where is the equivalent for commissioners?
The IoCP
The Institute of Commissioning Professionals (IoCP) was established in 2007 after a market survey indicated that over 93% of commissioners felt they needed a professional body to improve standards. A member survey undertaken in 2008 revealed that 91% thought that they had less than three years to deliver the vision. During that period, the IoCP has established an accredited membership exam, is pursuing voluntary registration of commissioning professionals and developed the concept of ‘commissioning excellence’.
It was apparent during the period that, as one university director put it, the PCTs have ‘Taylorised’1
their commissioning activity, with tasks broken down into
20 | national health executive May/Jun 11
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