Lansley denies plan to create “super quango” to control the NHS

BMJ 2011; 343 doi: (Published 07 July 2011) Cite this as: BMJ 2011;343:d4320
  1. Adrian O’Dowd
  1. 1London

Health secretary Andrew Lansley has denied allegations that the NHS Commissioning Board could be reshaped as a new “super quango” with greater central power over local commissioners.

MPs on the parliamentary health select committee quizzing Mr Lansley on 5 July asked about an as yet unpublished Department of Health document leaked to the Health Service Journal about a proposal to rename the NHS Commissioning Board as NHS England, suggesting its power would encompass much more than commissioning and overseeing the new clinical commissioning groups.

The evidence session was held as part of an inquiry into the NHS Future Forum—the independent body set up by the government to review the planned reforms contained in the Health and Social Care Bill, which the government put on pause in April.

Chris Skidmore, Conservative MP for Kingswood, said: “This document seems to be making a power grab to making it a more centralised commissioning board. Are we not going down the route of creating a rather large super quango here?”

Mr Lansley said: “The leadership in terms of commissioning is clinical and local and that is a change from the current top down structure.

“We are strengthening both elements of what the public have a right to expect in the NHS—we are strengthening the transparent national leadership in terms of standards and services, and we are strengthening local clinical leadership.”

Andrew George, Liberal Democrat MP for St Ives, asked what had changed as a result of the pause in the health bill, to which Mr Lansley said: “Quite a lot of things have changed.”

Mr George said: “The changes you have described represent changes of emphasis, wanting to bolster issues and reassure the public. But as far as the broad direction of government policy in this area is concerned, those broad themes are still there, are they not?”

Mr Lansley replied: “Legislation by its very nature is precisely about ensuring one captures the intentions, sets out the safeguards, is clear about the accountabilities and, I agree, it wasn’t recommended to us by the NHS Future Forum that we depart from the fundamental principles of the bill. They said there was widespread support for the principles of the bill.”

These popular principles included giving patients a share and greater influence in decision making, a focus on outcomes, and for clinical leadership and devolved power.

MPs asked how the NHS was doing on the government’s drive for £20bn (€23bn; $32bn) of efficiency savings between 2011 and 2015—known as the quality, innovation, productivity, and prevention (QIPP) challenge—given the current changes in the health service.

David Nicholson, NHS chief executive, also giving evidence, said: “If you look at the QIPP challenge across the whole of the four years, about 40% comes from central things like tariff changes [and the current pay freeze] and 20% from service redesign.”

The pause in the progress of the health bill would not affect that effort, he said, adding: “The real danger for us is if you don’t do that redesign, you end up making the savings through the operational efficiencies and that’s where you get into problems with quality.”

Planning was already happening, he added, around service redesign which resulted in a flattening and then reduction of non-elective activity, and concentration and specialisation of sites.


Cite this as: BMJ 2011;343:d4320