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between the cracks

The perils and pitfalls of the new commissioning arrangements for children

A fringe session of the NHS Confederation conference saw Dr Nicholas Hicks, Dr Vimal Tiwari, Andrew Webb and Katrina Percy discuss how to make the new commissioning arrangements work for children and young people. PSE’s Kate Ashley reports.


ragmentation in children’s services has long been a problem – but the new commissioning environment is set to make it much worse.

That was the verdict of public health and medical professionals speaking at an event held at the recent NHS Confederation conference in Manchester, attended by PSE. They said the risks are rising, and there is still widespread confusion amidst the restructuring of the NHS and the new commissioning arrangement.

But where there are challenges, opportunities can also be found. And the speakers in the fringe session on commissioning for children’s services had the necessary ideas and passion to kick-start a conversation exploring these issues to build a better service for the future.

The session was chaired by Dr Nicholas Hicks, programme director for public health on the NHS Commissioning Board, and the director of public health for the past decade for NHS Milton Keynes and Milton Keynes Council, who outlined the potential pitfalls.

Simply because the majority of the population are adults, he said, children can often be overlooked in major reorganisations – a concern shared by the other speakers.

Dr Hicks said: “Particularly when there are large-scale changes, those changes tend to be designed around the needs of adults.

“Children are not just young adults, they have very particular needs and wants that need to be met and addressed by the system.

“It’s very easy for children to fall down between the cracks of an adult-orientated system so I hope today is a real opportunity for us to meet those needs and how we can work to reduce the risks that I think we all recognise are being built into the system.”

Making the most of it

He emphasised the need to focus on the future, rather than remain in protest mode over the reforms.

“The Act has now received Royal Assent so it’s 26 | public sector executive Jul/Aug 12

not a question of debating whether or not; it’s a question of how we make the most of it and how we use that to improve outcomes and experiences for children and their families.”

He described the

new environment:

with the NHS Commissioning Board responsible for primary care services including general practice, children 0-5, screening and immunisation programmes and specialised services; local government with public health for children 5-19, school nursing, children’s social services and social housing; and CCGs responsible for commissioning many of the community services and hospital paediatric services.

Dr Hicks was blunt in his assessment of the risks, saying: “There’s no doubt that commissioning for children will be fragmented in this new world.”

Another major concern he reported, especially for parents, was the transition to adult services, which can often be “very disjointed”.

While this could be dismissed as a nice-to- have bonus to the patient experience, Dr Hicks warned that it could be more important than this, signifi cantly affecting the quality of care.

“Coordination makes a real difference to the outcomes that people experience.”

Andrew Webb, vice president of the Association of Directors of Children’s Services (ADCS), spoke about the interface between the NHS and children, and warned that commissioning and community must work together.

“We currently waste a lot of money,” he declared and emphasised that evidence shows early intervention is the best way forward.

“We are engaged in service commissioning too late for children whose needs could have been met more effectively earlier on, in the early stages of their development or as their problems start to emerge.”

Competition vs coordination

Current progress on the road to a new approach to commissioning is still “a very mixed picture”, Webb admitted, and gave a few reasons why this was the case: “It’s hard, it’s complicated and there are lots of vested interests.”

He highlighted the extent of confusion in the NHS, with staff unsure about where they will be in the next six months and added: “We haven’t really got a grip on the impact of the change and transition.”

As for future progress, he voiced concerns over competition harming coordination and urged medical professionals to break out of the absolute here and now to commission in a different way.

Webb continued: “The fragmentation of individual institutions at community level – that we’re working through at the moment; the tensions that get put into the system aren’t designed necessarily to make us work together. It might drive up quality, it might drive down costs, it might do a lot of things but we don’t know that yet.

“One thing that, inherently, the new structures won’t do – because they create competition at many levels – is deliver coordination.”

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