Competitive edge in the NHS - Commissioning Support Unit CIO interview

When film director Danny Boyle wowed the world with a glorious opening ceremony at the London 2012 Olympics, England's NHS was thrust centre stage. Enshrined by the 1946 National Health Service Act and described by Boyle in the official programme notes as "the institution which more than any other unites our nation", some 600 NHS staff danced around hospital beds to Mike Oldfield's Tubular Bells to revere the history of Great Ormond Street and our National Health Service.

The cruel irony of the evening was that the creeping privatisation of the NHS has been happening for two decades and is continuing under the Conservative-led coalition. While Great Ormond Street itself receives significant funding from owning the rights to JM Barrie's Peter Pan, Boyle's NHS celebration was brought to you by McDonald's, Atos, Samsung, Visa, Coca-Cola, BP and G4S.

As such the NHS has become a political pawn, CIO for the NHS Yorkshire and Humber Commissioning Support Unit Mark Dundon told CIO UK recently.

"It's a very difficult area to operate in," Dundon says. "The market context is one of an ever increasing population size, which is older, living longer, with more conditions - and the budget has to go even further.

"Funding the NHS is a highly sensitive political topic in times of austerity."

Indeed, while Chancellor George Osborne was announcing a fund of £2 billion a year to the frontline of the NHS in last week's Autumn Statement, US arms dealer and defence giant Lockheed Martin was one of a number of private companies weighing up a bid of £1 billion for an NHS contract to run GP services in England - one of the biggest put out to tender - and one described by chair of the British Medical Association Dr Mark Porter as "another worrying example of creeping privatisation of the NHS".

The Commissioning Support Units are themselves operating in a competitive space. Set up in April 2013 as part of the government's plans to devolve healthcare planning and commissioning to local GPs, Primary Care Trusts are being replaced by Clinical Commissioning Groups (CCG) - that consist of GPs and healthcare professionals - who procure their commissioning support from CSUs.

"In April 2013 there were 23 CSUs across England; that's now condensed to nine," Dundon says.

"I was recruited into West and South Yorkshire and Bassetlaw CSU. We merged with North Yorkshire and Humber to become Yorkshire and Humber CSU - we are now responsible for six million patients across 23 CCGs.

"It's an example of consolidation across the marketplace of CSUs. Some weren't strong enough.

"If a CSU does its job and services its customers and patients right, the customers will stay and the CSU will be financially sustainable and win business from other CSUs which aren't doing that. It's a competitive landscape," Dundon explains.

NHS competition

A CSU thus has a natural habitat in commissioning to its local area, but there's nothing to stop a CCG procuring services - whether that's IT, a laptop, WiFi, business intelligence, mobile devices or medicine management tools - from wherever it can get the best service.

"A CSU is an arm's length body from the NHS on a roadmap to privatisation at the start of 2016," Dundon explains.

"We need to make sure we are in a position to become competitive and sustainable financially.

"It is a very competitive, very commercially-focused area. The CCGs are learning to become very demanding customers - they do not accept below-par, sub-standard delivery timescales because of the pressure they are under in managing a budget to deliver patient services or manage patient outcomes. They need the best bang for their buck and expect a lot from a CSU.

"It puts a lot of pressure on the staff at a CSU to get it right, and where they don't it exposes them very quickly which leads to merger, acquisition and consolidation," Dundon says.

The IT, technology and intelligence landscape in the NHS is one which really excites the former Plusnet CIO who believes the greenfield landscape of the NHS has "so much untapped potential".

"There are lots of basic, simple opportunities to take advantage of, and our board is a strong mix of NHS leadership who know the service inside-out with great commercial acumen, and three of us who came out of the private sector.

"Ultimately we want to become a private business. We need to become profitable so we can invest that money back into services and improvements which go back to benefitting patients.

"I suspect when CSUs become private in 2016 it will be a social enterprise model. It will need to make a profit which will in turn be invested back into patient care and services which benefit the community."

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