Agenda item

This report provides the Committee with an update as to the H&F CCG plans for financial recovery.  This also includes an update from Healthwatch.

Councillor Richardson welcomed the CCG to the meeting.  This item would contribute to the currently on-going discussion regarding the CCG financial position and help facilitate further dialogue.  Councillor Richardson assured NHS colleagues that it was not the Committees intention to revisit points but to ensure that members clearly understood the CCGs rationale for resolving their current situation.  A letter from the CCG in response to the chair’s letter dated 15 January 2019 had been received but further clarity was sought around some of the issues raised. 

The pre-consultation business case had a specific action on patient transfer but any changes could only be implemented following consultation, as part of the implementation plan.   An assurance meeting with NSH England, Clinical Senate had reviewed the business case and was awaiting final sign off. A date for the consultation was expected and the CCG would return to the Committee as part of the Consultation.  An engagement event had been held at the Irish Centre, facilitated by the CCG on 29 January 2019.  There was a challenging target for savings to achieve, with £9 million identified to date.  The intention was to continue with engagement and the financial recovery plan would need to be ratified by the governing body.

Anne Drinkell (Save Our Hospitals) asked a question about the proportions of people who died in hospital and in hospices. H&F did relatively well at enabling people to die at home and this was not reflected in the terms of reference.  At the same time, statistics from the CCG indicated that there was a significant gap between how many people would like to die in a hospice and how many people do so.  The inference was that there would be a reduction in the provision of palliative care.

Sue Roostan explained that a full strategic review of palliative care would be undertaken. They were still in the process of gathering evidence, and it was not yet envisaged what the shape of the provision would be for residents. She concurred that many residents wanted to die at home.  The 2016 JSNA (Joint Strategic Needs Assessment) for H&F recognised that percentage of people dying at home was high, which indicated that the Borough was doing better compared to the national average (5.9% of H&F residents died in a hospice).  Comments for the palliative care review were required by 13 February, and would be sought from members of the public, those directly affected, hospice staff and other stakeholders. 

With reference to the planned savings figure of £17 million, Bryan Naylor pointed out that £9 million of this figure had been identified, with the remainder being rolled into the following financial year.  He raised very strong concerns about organisational under performance.  He had observed that increasingly, the concept of a local provider had become diluted with a corresponding increase in management. The retention of senior management throughout this situation was questionable and open to challenge, given the need to identify savings. Further evidence was needed to provide assurance that the CCG was doing all that it could. 

Mark Easton responded that across the NW London collaborative, a 20% reduction in management costs had been identified, as per NHS England planned guidance.  He was confident that overall, a saving of £2 million was possible.  The scale of the current savings required was significant. He recognised the importance of sound, financial structures and a balanced budget.  The CCG still sought to maintain mental health standards, protect primary care budgets and achieve management changes within the NHS constitutional framework.  Bryan Naylor expressed concern about the plans lacking credibility.  In his view, services had been ill-managed and wasted resources. 

Jim Grealy reported that information provided at the CCG facilitated events, offered little variation in the figures presented.  Whilst he accepted the significant scale of the challenges presented, the Committees role was to scrutinise the delivery of local services.  Over a period of seven months, no details about the changes to public services or information had been given, although financial headlines had been provided at the workshop on 29 January. There was no indication as to how cuts to services would be achieved without being damaged.  There was little transparency and whilst the consultation would help provide this at the end of March, he asked when a comprehensive list of service reductions would be provided. Sue Roostan explained that CCG presentation at the 29 January workshop (circulated) provided details of the savings scheme, but a range of additional information would be required, which included an inequalities impact assessment.  Work on this was on going and would be considered by the governing body.  Responding to a follow up comment, it was accepted that substantive changes would require formal consultation and it was also recognised that residents felt frustrated with the information given.

Mark Easton assured the Committee that there was no intention to remove services without undertaking serious consultation.  The CCG would continue to engage in dialogue, which would inform the ongoing development of the plans. He accepted that the process was frustrating and that it was difficult to see what reduced services would look like locally but that there was an obligation to comply with NHS requirements. The process was about finding opportunities within the budget to shape local services.  The budget would increase in the next financial year.  The current focus was a small sub-set of the wider CCG budget picture, and which would be increased in some areas.

Councillor Caleb-Landy commented that many residents were concerned about the level of savings required and struggled to understand the figures.  The Committee needed assurance about the information provided and its wider context. Transparency of the figures was required, with clearer explanations for non-medical people. Mark Easton responded that the long-term plan signalled the direction of the NHS and accepted the need for greater clarity.

Councillor Coleman expressed concern about the lack of local democratic accountability and the impact of having the CCG collaborative but thanked Mark Easton for coming to the Committee.  Additional funding may be going into acute services but primary care was a concern. The temporary closure of the Pembroke had progressed to form part of a review of palliative care.  There was a concern that everything that the CCG did now, would be viewed as cuts.  Councillor Coleman asserted that CCG had tried to be strategic but needed to more overarching.  It was essential to identify the impact of changes in one part of the primary care system on other areas and build a whole system, strategic case.

Mark Easton responded that the Long-Term NHS Plan was strategic. It considered partnerships and integrated care systems (ICS), with one CCG working in alignment with one ICS.  A relationship with the Borough was essential, as was a borough based, NHS body.  The plan required that the CCG collaborative formulated a response, with the intention to submit this in autumn 2019.

Councillor Coleman commented that the Council was not currently part of the current partnership arrangement because of the Shaping a Healthier Future (SaHF) consultation, and, the Sustainability and Transformation Plan (now known as the North-West London Health and Care Partnership).  Councillor Coleman suggested that this should not prevent the Council from being able to continue to engage in dialogue, provided that the fundamental disagreement around changes to acute services could be removed from the discussion.  The Council was not currently represented at the strategic transformation board and the SaHF was being remodelled and refreshed, the scope of which was currently being drafted.  Councillor Coleman asked if it was possible to have early access to the remodelling and whether it was possible to meet to further discuss this.

Mark Easton confirmed that the Council could be involved in the formation of the response to the Plan, as part of local engagement.  However, the specification for the SaHF remodelling was currently being drafted and would be finished within the coming two weeks, to be commissioned in April.

Merrill Hammer (Save Our Hospitals) commented that the engagement events had facilitated helpful discussion but that the reduction of management costs, with a target of 20% had not been factored into the financial recovery plan.  She added that there had been very little information made available to the public and she asked if the figures had been compared like for like, given the higher inner London salary figures. The piecemeal approach in providing information was not sufficiently strategic to coordinate healthcare provision for residents in North-West London. Mark Easton clarified that management costs for NW London represented 2-3% of the overall cost and the reduction would not have a significant impact, although it would be helpful.  It was explained that they had begun to streamline management structures in advance of the Long-term NHS Plan recommendations and that the North-West London target recommendation was bigger than the national target.  He continued that to devise a strategic plan at the same time as a financial plan would be problematic, as one would inform the other.  The CCG was not alone in being financially challenged and in risking financial deficit.

Sue Roostan explained that the targeted savings not achieved for 2018/19 would be rolled forward to the 2019/20 savings plan.  There were plans to decommission community services, for example, dermatology, which was ‘double-running’, with both community based and hospital provision operating at the same time.  The CCG was committed to being open and transparent in sharing information, and to maintaining on-going dialogue and engagement and looked forward to bringing this back to the Committee. Councillor Coleman expressed support for CCG and was sympathetic to the situation that that CCG now found themselves in, particularly in respect of the financial burden of GP at Hand.  He offered the Council’s support in helping the CCG to resolve this with NHS England.  Mark Easton confirmed that NHS England had provided an assurance that a solution will be found but admitted that their concern was increasing and had been flagged as a significant risk in the CCG’s budget.  They would soon have to reach a decision as to whether to indicate this as a deficit at the end of the year. Advice to date had been that the issue was being considered at a national level but he was not optimistic that there would be a quick resolution. 

Councillor Richardson concluded the discussion and welcomed confirmation that the CCG would return to the Committee in March with the formal consultation document on the proposals for service change.