Grant outlines vision of NHS ‘local autonomy’

The NHS Commissioning Board exists to facilitate NHS changes that will be driven by CCGs, according to Malcolm Grant.

The Board Authority Chair said the new NHS depended on collaboration between local and national organisations: “The top-down approach is dead.”

Speaking to the NHS Confederation conference, Grant described a future NHS whose national character is the sum of new services devised at local level.

All healthcare systems faced the same challenges, Grant argued: the growing prevalence of long-term conditions, the rising costs of drugs and medical technologies, and the limitations of “stagnant economies”.

He described the leadership of the new Commissioning Board as resembling a company’s board of directors, with an executive core and a non-executive team representing more diverse experience and talents.

The role of the Board, he said, is “enabling, facilitating and supporting those with whom it works”. It will define outcomes for the CCGs, but not processes.

He urged clinicians responding to the Board’s draft mandate, which will be published in July, to focus on its message of “local autonomy” and not try to dilute it with clauses representing narrow sectional interests.

The challenges facing the NHS would be met through new and locally-driven service models that shifted care into the community, Grant predicted.

Finally, he described the Board as being “obsessed” with outcomes, cost-effectiveness, innovation and pragmatism.

Grant’s speech offered significant clarification of the role of the Board and the business model of the new, decentralised NHS.