COMMISSIONING
nurses will be represented on local com- missioning boards. He explained: “People keep asking if we are hung up on the fact that it’s actually not prescribed on the face of it in the Bill; but it’s in the regulations, and it is clear what the expectation is.
“We now need to move on to implementa- tion; we need to move on to fi nding and identifying and supporting those people who we know have the skills to move into positions on commissioning consortia. It’s about co-ordination, navigation, joining up services, making sure quality benchmarks are set high within commissioning and contracts, considering and dealing with safeguarding issues as well – all of those issues, we need now to actually deliver in practice.”
Would the RCN act if any commissioning group sought to get around the regulations, or found a loophole and had no nurse on the board?
Catton said: “Our expectation is that the regulations will be very clear. If Pathfi nders or consortia are fi nding it diffi cult to iden- tify appropriate nurses, there could be some issues around confl icts of interest. We would always work with those commis- sioning consortia to help support them in fi nding appropriate people to undertake those roles.”
Decision time
He went on: “Having done the campaign and lobby work at Parliamentary policy level, it is now time for implementation and support to get those people in place. There are going to be some important and critical decisions taken from this point on- wards about what services are going to be commissioned, and, critically, about what the design of future services are going to be, which will throw up some really tough issues and challenges for the local commu- nities on what services they want and how they want them confi gured.
“Again, it’s absolutely crucial to have nurs- ing involved in that, because there are some tough issues for nursing in terms of future care models. We may want nurses to work in different ways, in different worlds and in different settings; to support people at home, or closer to home. That does not mean that I think we should be reducing the number of nurses we’ve got, but there might be some questions about supporting people to work in different ways.
To manage that process we need nursing leaders with that toolkit of skills I have talked about, who understand and appre-
ciate the planning, education and training issues: that is critical.”
Clearly nurses will have full roles on the boards and thus will have to make the same diffi cult decisions as other members, meaning they will not always be able to simply “argue their own case”, according to Catton.
He said: “As board members they will have to take full responsibility. There will be tough questions around fi nancing, con- tracting issues, the risk of failure – dealing with all of those are part of the skill set that person must have. But they will also under- stand and appreciate the contribution of nursing and bring added value to some of those big questions.”
Service quality
Catton explained: “Very simply, one of the trickiest problems is getting the balance right between cost and quality. There are plenty of examples where people feel that cost considerations have dominated at the expense of quality. We hope that nurses – and clinical commissioners more generally – can play a really critical role in raising the quality and safety considerations of various commissioning options.
“Having oversight and responsibility for commissioning is not about doing the job of the providers, but it is about having very clear expectations around quality require- ment benchmarks, within the way that the specifi cation or commission for services is set out. Services will be as good as the com- missioning process or the contract.”
The RCN will play its own role support- ing those nurses who will be stepping into a formal commissioning role for the fi rst time, Catton said, and will act as a reposi- tory of information on best practice, skills development and training. He said: “We would want to focus on how we can help people practically with the implementation that exists in the system.”
Cuts vs savings
As discussed in depth elsewhere this issue, for managers and clinicians, the issue of ef- fi ciency savings and the QIPP agenda are at least as important as the commissioning reforms, and Catton said that certainly ap- plies to nurses.
He pointed to the RCN’s long-running ‘Frontline First’ campaign, saying: “With that campaign, we haven’t just been trying to highlight cuts to jobs or services being planned – we have also looked at examples
of nursing innovation. But a lot of what we’re seeing frankly does feel like cuts to frontline staff.
“Staff may be being told, ‘we’re going to do things in a different way’, ‘there’s go- ing to be reorganisation’, ‘we can do things smarter’ and all the rest of it; but we hear those words and there’s a real paucity of hard evidence for that. Instead, to front- line staff, it feels like cuts: they say ‘we can see it, we can hear it, we can feel it, we can touch it’. That results in people saying they’re worried there’ll be some kind of transition gap, with services being closed before alternative arrangements and provi- sions are in place.
“There is an urgent need to bring much greater transparency to how the £15-20bn in effi ciency savings is being recycled and reinvested. At the beginning of the process, that’s what we were told and that’s what frontline staff were being told. That’s why the rationale for £15-20bn savings was ac- cepted, on the basis that the savings would be reinvested.
“But again, people are saying to us they’re not seeing it and I’m sympathetic to that: I’m struggling to see that as well. For ex- ample, it looks as though the number of nursing places which are going to be com- missioned for next year is going to be re- duced by somewhere in the region of 10%, on top of the jobs that are being taken out of the system. There is a very major risk that we will go back to what we historically have had with nursing workforces: boom and bust. People are asking why we have not learnt our lesson from all of that.
“That’s not about us denying the need for greater effi ciency; we accept that, but it’s how that’s working out.”
Visit
www.rcn.org.uk or frontlinefi
rst.rcn.org.uk Howard Catton
FOR MORE INFORMATION national health executive Jul/Aug 11 | 23
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