Home » Commissioning Support » A Debate between the Centre and CCGs on CSUs

Motion: ‘This house believes that promoting choice and competition between CSUs is the best way to secure effective commissioning support for CCGs’.

Opening statement for: The Centre

Based on the experience of PCTs we know that CCGs are too small to be able to provide the whole range of commissioning services in house at sufficient quality.  As a result CCGs should go through a process of deciding which services they will provide directly, which they will share with other CCGs and which they will buy from a CSU.

We (the centre) have spoken to CCGs and they have outlined three issues: concerns about the capability of CSUs; concerns about how the capability of CSUs is going to be raised; and that choice of commissioning support provider is important.  Fundamentally we believe that operational improvement will be accelerated by CCGs’ ability to manage an SLA effectively and to exercise choice.  As a result we are going to put on SLA workshops for CCGs, and create a procurement framework for CCGs to be able to exercise choice as easily as possible.

We want private companies to enter the commissioning support market.  We believe this will improve the quality of offering for CCGs.  So to do this we will ‘externalise’ CSUs from the NHS to create a level playing field and promote effective competition.

Opening statement against: CCGs

We (the CCGs) want capable, effective, responsive commissioning support.  We are frustrated where service delivery from CSUs is not at the level it needs to be.  We are concerned that it is not improving at the rate it needs to.  We want the option to change things if that is what is needed, but only as a last resort.  What we really want is high quality support.

We believe the centre is trying to solve the wrong problem.  We believe the problem is not how do we create an effective choice of CSU, but rather how do we make CSUs capable.  FESC (framework for external support for commissioning) did not work for PCTs, and we don’t think a similar framework for CCGs will work. 

Instead we want to focus on creating strong partnerships between CSUs and CCGs to make each individual service line effective.  We believe procurement frameworks and an over-emphasis on SLAs will make this harder not easier, by creating transactional rather than transformational relationships.  We believe the centre would have more impact by ensuring the leadership of CSUs is clearly focussed on partnering effectively with CCGs.

Closing Statement for: The Centre

We are concerned that CSUs are not developing quickly enough so we will limit the number of slots on the procurement framework to force CSUs to work together.  Whilst this might divert management time it will be worth it because it will ensure that CSUs focus on their strengths and ensure that only the best survive.

We are concerned that in practice CCGs are not exercising choice, but instead choosing to take services in house.  We believe this is a mistake.  We have therefore created guidance to make it more difficult for CCGs to do this, and we will reinforce the need for CCGs to follow a make, buy, share analysis to demonstrate the need for services to be provided by an external provider.

Closing Statement Against: the CCGs

We are concerned about the externalisation of CSUs.  We are worried that staff with whom we are beginning to develop relationships will leave.  We believe that operational stability is what is needed at this stage to enable CSUs to focus on the operational improvements that most are trying to put in place.  We don’t want CSUs distracted by developing mergers and alliances at the expense of making services on the ground effective.

We understand the benefits of delivering services at scale.  We weigh up regularly the potential of these benefits versus the disbenefits of services being provided by others who are not improving them at a rate we are comfortable with.  We want the option to say the risk of leaving it to others is too high and we need to manage these services ourselves.  We need this option because it is the performance of our organisations that is ultimately on the line.


The CCG challenge to the centre is to really listen to what CCGs are saying, rather than simply hearing the parts that fit with existing direction.  CCGs are on the whole committed to commissioning support.  But what CCGs want is a focus on CSU leadership, partnership with CCGs, and attention to operational improvement,  rather than choice, mergers and procurement.


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