Lost in the ‘too difficult’ zone


It’s unlikely that embryonic clinical commissioning groups are thinking about the needs of people with learning disabilities.

It’s a safe bet that other priorities are way ahead on the agenda: getting CCG members to talk to each other, working out where they are going to get commissioning support and how they can pay for it, casting spells to turn GPs into leaders, that sort of thing.

But commissioning care for people with learning disabilities is one of about a million things that could catch clinical leaders with their corduroys down if they’re not careful.

Remember Winterbourne View? You may have seen it on Panorama becoming another one of those things that must never happen again.

Minimising the chances of a repeat of these depressing events is not just a regulatory issue but a commissioning one.  Some of the people in the “care” home should never have been there in the first place and would not have been if adequate local services had been available.

The investment in more suitable local provision would be modest and the savings more than enough to pay for it.

It cost £3500 a week to keep an individual at Winterbourne. On the basis of that figure alone it would be hard not to make a business case for better accommodation.

But will business cases like this be made? The numbers of people involved are relatively small and viewed from the perspective of a local GP or commissioner may not appear terribly significant. One of the drawbacks of scaling down commissioning units is the loss of the bigger picture. A couple of people on the practice list, a few tens at CCG level maybe. That’s where the business case starts to fall apart.

Examples like this will test the ability of CCGs to scale up on their own account, and work together on a risk sharing basis to provide services it may be uneconomic or otherwise impractical to commission individually.

Given where most of them are today, it is difficult to believe that these thoughts will appear on the radar any time soon.

Of course, until the NHS Commissioning Board is running at full steam, we don’t even know where decisions like this will sit. Commissioning for people with learning disabilities falls into the too difficult zone between the CCGs, the board and the local authority along with children’s services and others.

So it may not turn out to be a problem for CCGs. But until the gap between the commissioning board and local commissioners is closed, it will be nobody’s job to consider these issues until another one of the things that must never happen again happens again.

Before angry commissioners write in to rail against the hopeless oversimplification of articles like this, there is another cost to consider. It is not just the damage to the reputations of the NHS, local authorities, regulators and the individual managers who find themselves in the firing line when things go wrong. Nor is it the much more serious damage to the individuals who find themselves, through no fault of their own, in the wrong kind of care.

Low level commissioning issues that turn into high profile news stories have an unpleasant effect on politicians, turning mild mannered ministers into bloodthirsty vigilantes.

They also result in endless rounds of reviews and enquiries and reports and recommendations, the cost of which runs into millions of pounds – money that could have been invested in avoiding the problem in the first place.

Thanks to Moley for their contribution LGF

About admin

admin, Dave, David, planetdave, le grande fromage (LGF) - it's all me. I was diagnosed with ADHD in 2006 and usually take medication. My path to diagnosis was so painful that I swore I'd do whatever I could to make things better for other ADHDers.
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One Response to Lost in the ‘too difficult’ zone

  1. admin says:

    This is goin g to be a huge problem – the postcode lottery that we already have with the PCTs can, in my view, only get worse with smaller organisations. It’s like reinventing both fire and the wheel and expecting amateur bureaucrats not to end up with round, blackened, cinders.
    It’s one of the things I’m intending to battle (help required) since ADHD is one of those cinderella services that could fall through the gaps very easily.
    I really don’t get the thinking – people don’t have regional illnesses so why isn’t there a ‘national curriculum’ with set %s for each division of healthcare? I know that national organisations tend to get fat and bloated quite quickly but the potential economy of scale is huge.
    Individual commissioning may be low profile but the relative number of idiots running it will be huge.
    It’s politics for the sake of it. We live in a ‘democracy’. But we don’t, it’s a cartel and they can’t be broken up by the competition commission.

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