CSUs face job cuts but not privatisation

Commissioning support unit staff numbers are being reduced by up to 5%, but the units will not be privatised under new plans released by NHS England.

England’s 17 CSUs provide a number of support functions to the country’s clinical commissioning groups including IT and business intelligence services.

A national consultation started this month on redundancy options at the units, which will run until 20 February. This affects around 9,000 CSU staff who are employed by the NHS Business Services Authority, which has delegated authority to NHS England to manage the process.

A consultation paper published by Central Southern Commissioning Support Unit says that a year after their creation: “CSUs are in a better position to price services, react to changing customer demands and structure themselves in the most efficient way possible."

The paper says that some units will have no redundancies and “we anticipate that the majority of these reductions will be met as a result of voluntary redundancy and the removal of vacant job roles."

Up to 5% of staff are expected to be affected. “NHS England is seeking approval for a voluntary redundancy scheme which will reduce the number of potential compulsory redundancies. CSUs will also be asked to identify and close unfilled roles in their structures,” the paper says.

CSUs will be hosted by the national commissioning board until 2016, but are preparing to become autonomous bodies, which have to compete for work both amongst themselves and against commercial or voluntary providers.

The privatisation of CSUs was being considered, but a report presented to NHS England’s board at its meeting last week reveals that the option of selling CSUs has been ruled out.

“Given the early stage in the development of the CSS market and the consequent uncertainty about the value of the CSUs, there would be a significant risk that the NHS would be giving away value to the private sector buyer,” it says.

“In addition engagement with CCGs, as the largest customers, has indicated that this would not win their support, and without the support of customers a CSU would not have a sustainable future.”

Instead, the CSU committee recommends four  options for CSUs to select from: social enterprise; staff mutual; customer controlled social enterprise; or joint venture.

“While CSUs are hosted by NHS England, they are legally obliged to observe rules common to the public sector, such as those relating to procurement, formal financial control, management of risk, and nationally set staffing policies.

"This regime significantly constrains their ability to respond to customers’ needs in an increasingly competitive environment,” the board report says.

It adds that NHS England should prepare guidance for CSUs on the "process to autonomy", including a locally led public consultation when each unit is ready to submit its application to NHS England. For most CSUs this is expected to be in late 2015 or early 2016.

“If NHS England assessed that an application from a CSU could not offer sustainability and value for money, then NHS England would work closely with the CSU in trying to improve their plan; if this were not feasible, NHS England would explore other alternatives for securing excellent and affordable CSS for its customers,” the report explains.

NHS England is also creating a lead provider framework for CCGs to buy support services. A number of CSUs are looking to merge or work in ‘alliance’ in order to secure a place on the framework.