NHS commissioning board that will take over £30bn of health spending next year makes admission in official ‘risk register’

The new independent quango at the heart of the coalition’s health reforms has warned that it is struggling to recruit enough people to make it operationally viable by next year.

The NHS commissioning board, which will take over £30bn of health spending for patients from next year, has made the admission in its official “risk register” – a document that flags up problems it is facing.

Sources at the board confirmed that the biggest problem was workforce, saying: “Basically the shake-up has meant there’s less of the expert workforce out there than we need.” The coalition health reforms have so far cut 18,000 senior NHS posts, including many of the most experienced in the health service.

When the English NHS commissioning board arrives formally next April, it will dwarf government departments such as the Home Office and will effectively regulate the 200 GP clinical commissioning groups and fund complex hospital specialities such as cancer. Even its incoming chief executive, Sir David Nicholson, warned that it could become the “greatest quango in the sky”.

However, there have been signs that the board cannot fill even well paid senior roles. In July a recruitment drive to appoint nine “local team directors” – each to be paid £140,000 – failed to attract suitable candidates.

Kieran Walshe, professor of health policy at Manchester Business School, said that one of the biggest problems was that “we have seen a real stampede for the exit. They are often older, run pretty big organisations and the fact is they don’t want to be three rungs down the ladder in some outpost answering to the commissioning board.”

The board is based in Leeds, a deliberate shift to emphasise its independence from Whitehall. However, job adverts this week for director posts say that there may be “flexibility” on location. There will also be preference for applicants at risk of redundancy as a result of the “abolition of primary care trusts and strategic health authorities” – a key plank of coalition’s NHS reforms.

This process is happening far faster than previously imagined. Last week the chief executives of primary care trusts, which buy care on patients’ behalf and were meant to be scrapped next April, were told they would be relieved of their duties in October – six months earlier than expected. “The timing of this letter has surprised people at all levels,” said Managers in Partnership, the trade union of 6,000 healthcare managers.

Andrew Gwynne, on Labour’s health team, said:

“Ministers have been busy thoughtlessly axing clinical and administrative jobs across the NHS at an alarming rate – now they’re faced with concerns at the very top of the service about the numbers of staff available.”

“As the new NHS bureaucracy takes shape it’s exposing the chaos at the heart of the government’s health service reorganisation”.

NHS managers said that they have been warning about the loss of expertise in the system because of the whirlwind of changes engulfing the health service.

David Stout, the NHS Confederation deputy chief executive said that: “We must do as much as possible to retain the knowledge and experience already in the system. Too much of this has already been lost. The NHS commissioning board has rightly recognised these risks. It needs to act quickly to ensure it has the right staff in place to plan high quality, safe and sustainable care for our patients.”

A spokesperson for the NHS commissioning board said: “Setting up a new organisation is a complex task and it is inevitable there will be risk in that. The critical thing is that we recognise and manage that risk. We are passionate about openness and transparency which is why we discuss and publish operational risks in our board papers. We regard this as key to the future operational culture of the NHS.”

The Department of Health said there was a “process to match staff in the current system to positions in the NHS commissioning board”. A spokesperson said that it would still not release its own risk register, despite rulings against the government by the information commissioner, because “officials need to be able to give ministers full and frank advice in private when developing highly sensitive policies and programmes”.

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