Decision Maker: Healthy Staffordshire Select Committee
Decision status: Recommendations Approved
Is Key decision?: No
Is subject to call in?: No
Sally Young, Director of Corporate Governance, Communications and Engagement and Anna Collins, Associate Director of Communication & Engagement attended the meeting to present the report and answer questions.
The Committee were being asked by the Staffordshire Clinical Commissioning Groups (CCG’s) to provide feedback on the proposal to become a single Strategic Commissioning Group. All stakeholder consultation feedback would be reported to the CCGs GP membership during their consideration. The GP recommendation would then be conveyed to the CCG’s governing body. Any application to merge would then have to be made to NHS England with a view for it to commence in April 2020.
The consultation had started in May and would conclude in July 2019. A number of public meetings had been held and the CCG website had links to the documents.
15 other groupings of CCG’s in the Country were also going through this process at the same time.
The potential benefits of merging were outlined as:
To the public
• Local delivery, through Divisions, working to keep patients at the centre of all they do.
• Help reduce variations in patient outcomes and improve patient experiences.
• Stronger patient engagement (e.g. focussing on services and improving outcomes).
• Reduced duplication - doing things once, not multiple times (as envisaged by the Long Term Plan).
• Help deliver care closer to home by strengthening community services.
• Strengthen providers and commissioners working together.
• Stronger primary care voice with providers within the Divisions.
• Enable GPs to do things once.
• Free up time for staff to deliver once rather six times.
• Clarity in decision making processes.
• A focus on Divisions deciding how they will implement a single strategy.
• Support GPs working together.
• Focus on outcomes by strengthening our Divisions and giving delegated responsibility for local decision making to Divisional Committees.
• Quicker and simpler decision making.
• Better relationships with providers.
• Higher quality strategy.
• More efficiencies which can reduce costs and our deficit.
• Better relationships and integrated working.
• Quicker and simpler decision making.
• More control over the design of services and also about working together as a system.
An overall advantage was that one single CCG would to align with the Sustainability and Transformation Partnership (STP).
Currently the options available were:
1. Keep the current arrangements of six separate CCGs under a single leadership team
2. Develop a new, single CCG
If NHS England were not in favour of option 2, the CCGs could relook at alternatives next year.
With regard to the recent NHS England’s CCG assessments, Members asked if five of the six CCG’s rated as “inadequate” would reduce the number of “inadequate” CCGs to one and was this a national motivator to encourage mergers. The Committee was informed that there were 5 different domains covered in the assessment process. However, if the financial domain is viewed as inadequate the overall rating would always reflect this, regardless of the findings in the other areas.
There was concern that the move was financially led and one consideration that hadn’t been mentioned was commissioning policies. A question was asked on if the merger took place, would all commissioning policies align, for example hearing aids or would the local areas have the ability to continue to commission based on local need. In response, it was confirmed that a single CCG would align policies, and this had already commenced and discussed at a previous Committee meeting.
The Committee were concerned that the North and South of the County had very different population needs, and it was felt that local differences should be recognised.
A Member of the Committee felt that the Staffordshire NHS system was challenging, and little transformational change had happened in recent years to make the patient pathways sustainably viable and clinically more effective. It was asked how one CCG was going to address this. An example of a benefit was given as commissioners and suppliers meeting weekly to work together and draw up plans for an intelligence fixed price system which would move towards a more block contract approach where an agreed amount is paid and anything above that is agreed.
It was acknowledged that one CCG would change the way services were financed but not necessarily change the system for the patients benefit. It was asked how this was going to make the system transformative. In response, the Committee were informed that bringing all parties together would help but local knowledge would still be needed for local decisions.
There was concern around hard to reach groups and how they would access the consultation. On a wider issue, the Committee asked how many consultations were taking place at the current time across the county and could this lead to consultation overload especially as the documents were quite long and sometimes complicated. In response, it was informed that there were quite a few significant consultations taking place, but the CCG had an obligation to consult and public feedback and comments were needed in order to inform service design and decision making. It was acknowledged that there were also a number of Local Authority and Police and Crime Commissioner consultations all competing for attention. Summary documents were available and social media was used whenever possible.
In response to a question on what the STP thought about the proposed merger, the Committee were informed that a response had not yet been received. University Hospital North Midlands (UHNM) had indicated their support and a summary of all responses would be available at the end of the consultation.
It was felt that cultural change was needed more than changing the structures.
RESOLVED: That the Committees concerns, as listed below be fed into the consultation:
a) There was concern that the move was financially led and that commissioning policies hadn’t been mentioned. The Committee were concerned that the North and South had a very different population need and local need should be recognised. There was a concern that commissioning policies would be changed to the detriment of the public.
b) It was felt that cultural change was needed more than changing the structures.
Publication date: 05/09/2019
Date of decision: 15/07/2019
Decided at meeting: 15/07/2019 - Healthy Staffordshire Select Committee