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Editorial Thursday 21 June 2012: Chairman Mal speaks: Malcolm Grant

Chairman Mal - Professor Malcolm Grant of the NHS Commissioning Board - opens with Cathy Newman joke about shaving his moustache off for £2000 for Comic Relief.


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I want to set out the NHS Commissioning Board's stall. And I want to start by setting out the global context: no developed economy in world has sustainable healthcare system: demand outstripping rate in GDP from changes in demography, growth of new conditions, type 2 diabetes, dementia. rising costs, stagnant economies. We are not alone. Even USA, spends twice percentage of GDP struggle with risk Supreme Curt strike down Obamacare Bill.

Issues endemic, go back 20+ years. How provide healthcare provides value to patients within limited resource.

Inspired by opportunities for innovation, improvement and delivery. Adapting to structures that are unfamiliar -opportunity to explore how to improve outcomes for patients

1 development of NHSCB
2. context in which operating
3 our vision of strategy to be built on local commissioning plans to drive all this forward

Board wholly new, a SpHA, curtain raiser to Board. Resume ENDP responsibilities form October, when start authorisation of CCGs, to 1 April 2013 go live.

As part of our preparation, we've taken a  number of strategic decisions. What is different about this structure from previous ones? The NHSCB was created by primary legislation, system of accountability quite different from that to which we are accustomed.

Culture, way on which we behave, respond to all interest in this room and delivery wholly new approach to commissioning of healthcare in England

Legislation: NHSCB shares responsibility with SOS. Not accountable

SOS retains accountability for promotion, we share responsibility for developing it, we are working closely with SOS to establish working relationship to allow transparency to dominate and permit culture to flourish.

Mix of NEDs and executive directors, ED team fully in place, contains some of best-known and most effective leaders of NHS, brings promise of stability and continuity.

In NEDs wanted group of individuals with strong values, but whose skills and experiences honed in different contexts. Not to represent vested interests. My job to blend with CSD and his team, don’t want Olympian detached challenge, want them to roll up sleeves, help us and understand role of teamwork in addressing huge challenges.

Working style, culture and behaviours. Try to do things differently. Webstream our meetings, tour country.

Top down is dead, the NHS Commissioning Board’s role is enabling and supporting those with whom it works. That means CCGs: it is not our job to tell them what to do, we will authorise, and support them, and enable a national exchange of innovation and improvement but above all, ensure they deliver for patients.

The new frameworking inverts the old. New relationship Board-Govt. Act gives us clear instructions:
1. high-level duties: reducing inequalities
2. innovation
3. commissioning and using research

Maintain the NHS Constitution. Third is new; the mandate, No longer does SOS have power to give operational day-to-day instructions. Commissioning assigned to NCB in way outcomes will be tightly defined but outcomes will not be. We want the new system to be tight and loose: tight on excellence defining, but loose to allow those with daily responsibility to get on and undertake improvements. it is about liberating the NHS.

Draft of mandate issued shortly, next moth, and I emphasise it is a draft. It's no secret that there is a strong preference on our part for the mandate to be brief, simple and clear, and we have encountered a little resistance form those who would stuff full of sectional interests. The mandate is not about history is about the future, Govt is spelling out its expectations for NHS in England for 1, 5 and 10 years ahead. If we make the most of it, the mandate can be the most inspiring and liberating part of whole legislation.

Please look at the mandate, don’t try to stuff with special interests. We need to devise through mandate strongest cascade of local autonomy.

The mandate will drive our relationship with CCGs, by ensuring that the mandate confers liberty.

On strategy - new landscape of the NHS in England transformed from the old. NICE and CQC but have new partner ALBs, PHE, HWE, collectively, have huge responsibility. Commissioning responsibility being devolved down. It will thrive, but it will have implications. The sum of local and regional decisions will spell out national implications for service improvement and change.

We believe can only think logically about system overall by preparing a set of principles in common with all actors. We need to identify strategic implications of significant local services, shifting services wholesale into community, new services, how to support and enable to happen

In conclusion, 4 points:
1. The new system will only work through partnership and co-operations. We're determined they will occur, but we need the understanding of all the people in this room to let us get on with an important job.
2. This is a hugely complex process of change. I promise that we will all make mistakes, but I want to deliver a culture where mistakes are opportunity to learn, not the occasion for blame. We need a culture shift: not to dwell on the past, but to focus on the future.
3. Be obsessed with outcomes, opportunity, spurring innovation - and we will choose pragmatism over ideology
4. Let one of most skilful workforces in world get on with improving outcomes for patients