Mike Farrar, the NHS Confederation’s chief executive, reiterated this in a speech to over 170 health leaders and parliamentarians at the Westminster Health Forum on 17 October.

NHS Confederation paper

Read our new paper on the creation of the NHS Commissioning Board, which includes an analysis of the main issues facing the Board and makes 20 recommendations for improving chances of success.

Board creation welcome

Mr Farrar says: "We strongly welcome the creation of the NHS Commissioning Board. We want and need it to be successful. If it isn't, the whole NHS is going to have a very big problem, especially with the current financial pressures building daily.

"Healthcare commissioners play a vital role in the NHS. They are responsible for deciding how best to manage the NHS's money in order to improve local services and health outcomes. 

“But they have often struggled to get out of the shadow of healthcare providers which are more visible to the public and to politicians. So the creation of a national body with a single-minded focus on making the system work for patients and tax-payers is a major opportunity.

Potential 'bear traps'

"The Board faces a number of potential bear traps. It must act to avoid the danger of being seen as unaccountable to the public, overbearing to the health service, or ineffective in delivering tangible benefits to patients.

"Through its early actions, it needs to show that is not where we are heading. That will mean setting an example by demonstrating public accountability and clinical leadership. It also means showing it will not hold on to power or drown commissioners in guidance and bureaucracy.

Empowering commissioners

"We need to empower our new local commissioners, not stifle their enthusiasm. They need guidance which is just that - guidance, not mandatory rules. They want the freedom to act and drive change where they need to for their patients. If power remains centralised with the Board, enthusiasm for commissioning among local clinicians and managers will wane.

Strength and vision

“The Board will also require the strength and vision to lead the system through the most significant financial challenges the NHS has ever faced. It will need to support new commissioners in managing complex, strategic change including the reconfiguration of many acute hospital services. And it will need to ensure the benefits of scale and standardisation in commissioning are not lost.”

Striking the right balance

The NHS Confederation says early and genuine engagement with local commissioners and providers will be crucial to help the Board strike the right balance between national oversight and local control.

Recommendations

Our recommendations - based on the experiences of its members and aimed at the Government as well as the shadow board - are intended help the new body avoid the risks it faces and maximise its chances of success. 

The recommendations include:

• setting out a clear plan detailing how the Board intends to be fully transparent. The Confederation says the Board should have a responsibility to meet in public and should have a duty to publish information about complaints it receives about its commissioning decisions and how it intends to deal with these
• ensuring the authorisation process for CCGs is managed effectively so they are supported to take on their new responsibilities as quickly as possible but not set up to fail by being given the green light too early. It says that the Board should be required to account for how it is supporting clinical commissioning groups' and building their capability as they take on their responsibilities
• engaging early with commissioners and providers on how to develop and apply commissioning guidance so that it maximises the benefits of standardisation and consistency while not interfering unhelpfully with local priority-setting
• establishing a clear performance framework for CCGs which includes rewards and incentives to drive the best possible outcomes from clinical commissioners
• clarifying about how the Government intends the Board to work with CCGs to improve quality in primary care and how the Board it will manage its own responsibilities for primary care commissioning
• prioritising early engagement with stakeholders from across the system to design the operating principles for clinical senates and networks.