The largest teaching and specialist hospitals in England will be reshaped by the NHS Commissioning Board to promote quality and efficiency.
The board chief executive Sir David Nicholson – former CEO of the NHS – said the board will directly commission specialist care worth £12bn. Sir David highlighted that this meant the board would be providing “between a third and a half of the income “of the country’s largest trusts and would be “thinking about what the shape of those organisations should be”.
In an interview with Health Services Journal magazine, Sir David said direct control of specialist and primary care budgets would mean: “It’s hard to imagine a service change that’s going to take place over the next few years that the commissioning board is not directly involved in.”
He added: “You will see fewer units doing more things.”
He said: “Harold Wilson talked about the commanding heights of the economy [in relation to state control of important industry]. Well the commanding heights of the health economy are the tertiary and specialists, and we’re going to be directly commissioning that. That will feel different, and quite significant.”
In the past those trusts had not paid enough attention to their commissioners, he said, but the board would be “a commissioner you need to take notice off” and “a big powerful commissioner in the system”.
Sir David said the board would seek to standardise pricing across the providers, whereas in the past “different regional commissioners have had completely different deals with the same organisations”.
The board would also want to drive greater consistency in quality standards and ensure equitable access by clustering services around particular trusts.
He said: “We can start to have a much more strategic view about the pattern of services across the country in a way nobody’s really been able to do before.”
He said clinical commissioning groups would often be leading changes, where they focused on general hospital and community care.