Agenda item

The Committee is invited to review the report on ‘Developing further collaborative working across NW London CCGs’ presented to the Hammersmith and Fulham CCG Governing Body on 26 September and to consider its implications for local democratic accountability.  The report is attached as Appendix 1.

Councillor Vaughan welcomed Vanessa Andreae and Janet Cree to the meeting.  The paper provided an overview of collaboration and governance arrangements, about democratic accountability and how commissioning arrangements will operate across the eight North West London CCGs. 

Janet Cree outlined on the collaborative working.  The paper produced for the Committee was based on a paper submitted to the September meeting of the CCG Governing Body.  The intention was to work better with the other CCGs, to ensure the best healthcare for residents in Hammersmith & Fulham, and remain accountable to the local community.  It was important to note that the Borough boundaries and CCG boundary did not align and that approximately 50,000 H&F residents were registered outside the borough.

The CCG explained that easier and quicker decision making would benefit residents and help improve patient flows and commissioning.  Working on out of hospital services, with GP practices and collaborative with other CCGs would facilitate this.  Decisions being determined by clinicians in the borough across 8 CCGs was difficult so the aim was to create greater efficiencies and avoid duplication. This was an in initial paper to formulate what shape and form the joint committee would take and how decisions would be made.  This would be further developed, to be considered at a governing body meeting in January 2018.   The joint committee will meet in public, rotate in terms of its location in different boroughs; and may also be streamed. 

Councillor Brown sought assurance that different channels of communications and use of technology were seamless across different NHS bodies.  Vanessa Andreae confirmed that they were some way from this.  Consent was needed to allow a patient records to be uploaded but this was increasing. Care plans were prepared but not always communicated or accessible, either as paper copies or digitally.   All practices used SystemOne so that all patients, under community cardiology and respiratory care, had benefitted from improved patient record access during treatment.

Councillor Carlebach commented that the collaborative working arrangement was excellent and encouraging.  He referred to a paper by Dr Ingrid Wolf highlighting significant gaps in the paediatric training of GPs.   In response, Janet Cree reiterated that the paper’s focus was the organisation of CCGs so that level of detail was not provided. One of the aims was to reduce unwarranted variation, and differential offers and provision across North West London.  One of the key drivers was to have common standards and outcomes that could be expected for patients, for example, locally working to ensure training for specialist paediatric GPs, with cascaded training.

Co-optee Patrick McVeigh concurred that the combined CCGs would be better placed to collectively commission more efficiently but sought clarification regarding Accountable Care Partnerships (ACPs) and Accountable Care Organisations (ACOs), in relation to the Health and Social Care Act 2012 funding restrictions.  Janet Cree clarified that ACOs were different organisations which merged to form one entity.  In Hammersmith & Fulham, there was an Accountable Care Partnership, where partners worked together collaboratively.

Councillor Vaughan referred to joint commissioning arrangements and one data set and enquired how this would take place across 8 CCGs.  Vanessa Andreae explained that existing data sets would form the basis of information used in different clinical systems.  That information was already available, gathered from different systems and collated.  Sector wide implementation would allow shared sets of information so that clinical activity can be identified. This was being considered at STP level through a collaborative working arrangement with providers.  They needed to work together on the same set of data, to allow the CCG to make effective joint commissions.  This was an on-going area of work.   

Jim Grealy commended Clare Parker on pulling together 8 CCGs but commented that the new system was two-tier and engendered a crucial loss of accountability.  In terms of representation, no councillors were involved, few clinicians, or Healthwatch.  Highlighting concerns about the resolution of potential conflict between a patient and their GP, it was also pointed out that there was no assurance that agendas will be published in advance, public involvement or that councillors will be involved.  Suggesting that the CCG should reconsider, he continued that only involving people post decision making was a concern.  In response, Vanessa Andreae confirmed that councillors had never have been part of CCG and that while Healthwatch had been, they had no vote.  It was reiterated that the September paper had not yet been finalised and that the proposed joint committee, will be a sub-committee.

Olivia Clymer (Healthwatch CEO) confirmed that they had submitted questions to CCGs.   It was clarified that the 2012 Act required the CCG to submit commissioning intentions and while she acknowledged potential the efficiencies, Healthwatch would have one seat across 8 CCGs.  There were also concerns that related to scrutiny and accountability; and timeframes for engagement.  Vanessa Andreae explained that the currently, the Accountable Officer was required to go to five different meetings.  The proposals were yet to be further developed and refined. There would be no change in the relationship between LBHF and the CCG, there will be some decisions will be delegated to the sub-committee but the H&F CCG governing body will remain the same statutory decision-making body. 

Councillor Vaughan enquired that when a decision was being taken, who was subject to scrutiny.  Clare Parker was the Accountable Officer for 5 CCGs, so that the relationship will remain the same but the collaboration will be extended to include 3 more CCGs.  In response to a query from Councillor Coleman, Vanessa Andreae explained that they preferred a consensual approach to decision making.

Councillor Coleman referred to section 1.3a and commented that decisions for acute services meant decisions for acute providers should only be made once.  Using Imperial as an example, Vanessa Andreae clarified that the CCG was much stronger working with the other CCGs, to get a larger portion of the Imperial budget.  Greater leverage was possible working collaboratively but it was not possible to comment on decision making mechanisms in relation to the other CCGs at this stage. 

In response to a question from Merril Hammer (SOH) regarding whether there would be further opportunities for the proposals to be scrutinised, Vanessa Andreae responded that there was no change to the CCG’s accountability.  It was pointed out that there was no mechanism to feed into the governing body process and that the accountability required greater clarity. Merril Hammer commented that ACOs created structures for long term contracts and who may sub-contract services, imposed without any legislative framework.

Noting a question from a member of the public regarding the specialist commissioning of services for high functioning adults with autism and the need for clear patient pathways agreed to provide a detailed response outside of the meeting.

Councillor Vaughan thanked the presenters, observing that the 8 CCGs, needed to clearly formulate the governance arrangements so that it was possible to understand who will be subject to scrutiny.

RESOLVED

That the report be noted.