One in 10 NHS commissioning groups 'failing or at risk' five years after Lansley reforms, NAO finds

More than one in 10 NHS clinical commissioning groups (CCGs) are failing or at risk, five years after they were established during Conservative health secretary Andrew Lansley’s overhaul of the health service, auditors have found.

CCGs were established to put GPs and those with clinical experience of their local health system in charge of funding decisions, but increasing numbers are over budget and struggling to recruit senior staff, the National Audit Office (NAO) found.

As of October 2018, 24 of 207 CCGs in England are subject to enforced recovery plans from NHS England because of issues with their financial management or performance.

“We should be concerned that too many CCGs are failing to function effectively and that increasing numbers are overspending against their budgets,” said Meg Hillier MP, chair of the Commons Public Accounts Committee.

“Like previous changes to NHS commissioning, CCGs are going through more change and the NHS is crying out for stability.”

Senior Tories dubbed the Health and Social Care Act 2012 reforms “toxic” with some saying – back in 2014 – that it had been their “biggest mistake” in government.

The reorganisation cost £3bn at a time of austerity and introduced legal requirements which forced CCGs to run costly procurement exercises that let private companies bid against NHS providers for major contacts.

This was intended to drive down costs by competition but was widely seen as a push to privatisation and has undermined subsequent efforts to get different NHS organisations to work together.

While a number of CCGs have since merged to offset performance or budget issues, the NAO warns this undermines their ability to respond to local issues which was a primary driver of their inception.

The NAO found that 42 per cent are rated as “require improvement” or “inadequate” – while 10 per cent are deemed “outstanding” – and more than a third (75) of CCGs overspent against their budget in 2017/18.

This is an increase on 57 CCGs in the year before and the total overspend last year stood at £213m with their budgets facing a further 20 per cent in cuts by 2021.

However the NAO also warned that NHS England has yet to conduct a review of whether CCGs are working as intended, and say there will be significant changes in future that they must adapt to.

Despite ministers pledging no more top-down reorganisations of the NHS, the health service has been introducing Sustainability and Transformation Partnerships over the past three years.

These umbrella organisation include CCGs, NHS trusts and local authorities – which look after public health and social care – and aim to join up parts of the NHS which were balkanised by the Lansley reforms.

The NHS also has a long-term plan, delayed to 2019 by ongoing Brexit uncertainty, which will set out how the health service will look in a decade and how it will spend a pledged £20.5bn budget uplift by 2023.

“It would be a huge waste if in five years’ time NHS commissioning is undergoing yet another cycle of reorganisation resulting in significant upheaval,” said the head of the NAO Sir Amyas Morse.

“The current restructuring of CCGs must deliver balanced and effective organisations that can support the long-term aims of the NHS and deliver a much-needed prolonged period of stability.”

The report comes as University of Manchester academics published a review on the devolution of health and social care powers to Greater Manchester – a flagship scheme under former chancellor George Osborne.

It found that despite ambitious plans when devolution began in 2015 three years in it is still too early to say if it is working as intended, and warns that changes “may improve care, but will probably not save money”.

Julie Wood, chair of NHS Clinical Commissioners said CCGs still have a “critical role” in the NHS which must not be undermined by more reorganisation.

“Although there is a mixed picture, today’s report highlights the good work that is happening in many parts of the country to deliver positive health outcomes, especially in these challenging financial times when clinical commissioning groups are having to do more with less,” she said.