16 September 2014

The NHS has many components. In this post I am writing about the funding of the clinical commissioning groups of the NHS.

The National Audit Office (NAO) has published the allocation of funding to clinical commissioning groups (CCGs) and local healthcare groups for 2014/15. You can read the NAO full report and allocations here.

Broadly, the CCGs are GP-led replacements for the primary care trusts. There are 211 CCGs in England who from April 2013 commission services for the patients in their area from other parts of the NHS such as hospitals and mental health services – and indeed from any competent health provider outside the NHS.

Off target
As I have explained in earlier posts, the finite NHS funding is allocated to the various component geography-based NHS organisations in England based on their different healthcare needs and the size of their populations. Each primary care trust/CCG has a target funding, that is, what it should receive to deliver a standard level of healthcare for its population in their particular circumstances. The allocation of the funding is cursed by historical anomalies. By and large the health authorities do not receive their target funding: some get more; and some less, including in the past Cornwall. In the jargon, measuring the distance from target, some are above target, others below. This was so for the primary care trusts and is now so for the CCGs. The moves to bring all up to their target are slow in order that no overfunded component suffers instability from sudden financial loss.

I looked at the make up of the allocation system and why some healthcare groups did not receive their target funding in the 2010 post Funding health in Cornwall.

Cornwall health funding in the past
There have been repeated complaints in the near past that Cornwall has not received its fair NHS funding, that is, its target funding. In 2011-2012, for example, Cornwall and Isles of Scilly primary care trust was funded 2.2 percent under target. However, 45 trusts were further below their targets in percentage terms than Cornwall. Cornwall was not singled out for below-target funding, was not uniquely unfairly funded. It was not a victim, or at least not a singular victim, though nationalism seldom acknowledges and campaigns for the many others funded below their target or below average in health or any other public field.

2014/15 funding
In 2014/15 Kernow CCG, which covers Cornwall, is to receive more than its target funding. Its allocation of funds is 6.2 percent above target and in these terms it is better funded than 179 of the 211 CCGs.

109 CCGs receive funding below their target funding in 2014/15, 101 receive more than their target, and one is on target.

And nationalism says …
Anyway, Cornwall is now above target, over funded. What will nationalism say about the 109 underfunded CCGs? Does fair funding in public spending apply only to Cornwall? I think a weakness of nationalism is that it deals only with the parochial and does not lift up its eyes beyond its tribe: it works to parochial not universal principles.

Presenting Cornwall as a victim, short changed, picked on, singled out for unfair treatment by central government, on the wrong side of comparisons with others – the whole train of the piranist grievance agenda – is unconvincing though a staple of Cornish nationalism. The evidence tells against it, life beyond the Tamar shows it to be nonsense, and I shall go on explaining this as long as the nonsense is expressed.

The NAO figures cover not only CCGs but also funding to local area teams for primary care and to local authorities for public health. The CCGs take about 4/5 of the budget for these three local commissioner components.

The Devon, Cornwall, and Isles of Scilly local team is funded above target and the Cornwall local authority for public health is funded below the target.

In part 3 of the NAO full report you can read how the allocations are made.

Previous primary care trust allocations
Recurrent revenue allocations for 151 England primary care trusts 2011/12
Recurrent revenue allocations for 151 England primary care trusts 2012/13