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NW London Commissioning Reform Programme: Public Draft Case for Change

Report of the Accountable Officer, Harrow Clinical Commissioning Group (CCG)

Minutes:

The Board received a report which set out the case for change and considered the implications of moving towards a single North West London Clinical Commissioning Group (CCG).

 

Mark Easton, Chief Officer, NHS North West London Collaboration of CCGs, gave a detailed outline of the background to ‘The Case for Change’ document and the proposal that all sustainability and transformation partnerships (STP) develop into an integrated care system (ICS) which would act as a regulator of health in a geographical area.  In order to enable this change, it was proposed to change the organisation of CCGs to operate at ICS level and he advised that over the next couple of years the number of CCGs was likely to reduce from the current 196 to 44.  The Board could influence the timing of the changes and he was keen to see a substantial NHS presence retained in the boroughs.  As the document had been updated since the production of the agenda, Mr Easton undertook to circulate the latest version to Board members.

 

The Chief Officer outlined the core issues arising from the proposals in terms of continuity and change as follows:-

 

·                     the proposals built on the existing collaboration of CCGs.  It was proposed that 8 local borough based sub-committees of CCGs be established headed by a borough director with delegated budgets;

 

·                     work with local stakeholders would continue;

 

·                     public representation would continue;

 

·                     there were proposals in relation to memberships of North West London governing bodies.

 

He explained that the consultation would conclude on 24 August 2019 after which the necessary reports would be prepared for government.  He outlined the advantages of the new way of working which included:

 

·                     there was evidence to support that patient pathways across London could be standardised;

 

·                     prices and costs across London currently varied;

 

·                     NWL CCG would look to reduce health inequalities;

 

·                     a reduction in the number of times the same decision had to be made;

 

·                     collaboration in terms of payment.

 

In response to comments from the Board, the Chief Officer advised that:

 

·                     the changes were based on policy guidance and that he was reasonably confident that there would be a continuity of staff and experience. In terms of timing, in order to reduce the uncertainty for staff, sooner rather than later might be preferable to mitigate the risk of staff leaving;

 

·                     in terms of Harrow CCG’s financial deficit, it would be necessary to clarify the starting balance sheet of the new CCG.  Guidance on this was awaited from NHS England but it might be possible to clear the historic debt and start with a ‘clean sheet’;

 

·                     in terms of seats for Healthwatch, discussions on the membership were on?going but he noted the comment that this body did not have the capacity to gather evidence and that this should be factored in;

 

·                     his view was that local services were best commissioned locally;

 

·                     he was keen to have continued scrutiny of health services so he did not expect to see changes to statutory boards.  However, there was a North West London Joint Health Overview and Scrutiny Committee and there might be a need for a similar body for the Board;

 

·                     Equality Impact Assessments needed to improve in order to capture the needs of the diverse community and his expectation was that there would continue to be capacity to do this;

 

·                     in terms of the numbers of designated nurses, he did not envisage there being any changes in safeguarding arrangements;

 

·                     there were assurances in the consultation document about maintaining good joint commissioning such as CAHMS in Harrow.

 

In response to a question on timescales, the Board was advised that that the new CCG had to be established in either 2020 or 2021 with the former date reducing the uncertainty for staff and the latter providing more time to draft and finalise new governance documents/ constitutions.  In terms of the role of providers in the new arrangements, this was dependent on the integration agenda and the Chief Officer added that it might be possible, in a few years, to create a statutory health and care entity to provide both commissioning and services.

 

RESOLVED:  That the report be noted.

Supporting documents: