Strapped for Cash? Let’s implement the intent

  |   Thought Leadership

The first signs of overt and reported financial distress in CCGs emerged this week, with the front page of the HSJ revealing the CCGs that have significant deficits. The year of focusing on yet another structural re-design is almost at an end.


“Less blue sky and more brown mud” – Mark Britnell


What can be done by a CCG?


1. Do not waste time on repeating the diagnosis


Despite the need for more evidence and more certainty, analysis on health system performance, inequalities and high cost will have been completed in microscopic detail by your legacy PCT using significant investment and support from the Private Sector. QIPP plans will already be in place and most health systems will readily understand where their financial problems exist.


More aggregation is not needed.


2. Target barriers to implementation


QIPP has failed to deliver other than at the margins for very clear reasons. It is extremely difficult to de-commission health care services and transact new pathways quickly. Legacy contracts, capability, public interests, transition funding and risk aversion all contribute to a consistent dynamic.


“A wealth of ideas but very little evidence of implementation”


Implementation of a commissioning intention requires resilience.


3. A Programme Management Office is not your path to Implementation


A PMO is not an implementation tool. Don’t fall into the trap of centralising accountability.


“Too many financial turnaround programmes fail here because the improvement is seen as the responsibility of the finance director, or worse still, is sidelined by the set up of a programme management office and, therefore, immediately stops being everyone’s problem” – Bill Shields, CFO Imperial College Healthcare Trust


4. Partner


Your CSU is your implementation partner. If you are considering further displacement of commissioning support or pulling services back to you-please consider this. A year of further changes to systems and structure is time you may not have.


Work with your CSU to build teamwork and joint accountability for QIPP.


5. Skill Up


There are 4 key skills domains required to translate QIPP into reality for CCGs. They rest at the implementation end of the commissioning cycle.




“Ideas are easy – implementation is hard.”