Agenda item

(a)  To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health, Adult Social Care and Social Inclusion PAC held on 17 June 2019; and

(b)  To note the outstanding actions.

RESOLVED

The minutes of the previous meeting held on 25 June 2019 were noted as an accurate record and agreed.

Actions and Matters Arising - Clinical Commissioning Groups: Merger and the Case for Change

Janet Cree reported that the Governing Body of H&F CCG had considered a report which set out details about the potential merger and case for change. Unfortunately, H&F Save Our NHS had been omitted from the list of organisations which had provided feedback and that this would be amended.

The Governor Body of the CCG had discussed and considered a recommendation to merge in April 2021. This contrasted with prevailing views regarding an earlier merger and considered feedback and changes to the current financial situation of the North West London CCGs.  A more realistic timeline for the merger had been agreed. The CCG would remain a statutory body, be reviewed and strengthened financially.  The schemes of delegation would also be reviewed, and the CCG would continue to work with the local authority.  It was explained that this was the direction of travel, not a decision to merge but one step in the process of moving towards a merger. Further and regular reports would offer further details and assurance at future governing body meeting to ensure local accountability, focus and transparency.

Councillor Richardson said that the Council welcomed this news and the opportunity to contribute towards a process that would shape the future of the CCG of North West London.  In response to a question from Victoria Brignell regarding consultation and engagement, Janet Cree confirmed the CCG would ensure transparency throughout the engagement process. Councillor Richardson enquired about specific dates and timelines for consultation.  Lesley Watts responded that the decision to postpone the vote had considered the current financial difficulties for CCGs in North West London and that these would need to be prioritised ahead of reorganisation. A sensible timeframe would be discussed with the governing bodies and that a finalised timetable would be provided as soon as this was determined.

ACTION: CCG to provide the Council with a timetable for the proposed merger

Councillor Caleb-Landy enquired about the potential impact of the merger on residents in terms of local accountability.  Janet Cree responded that a move towards a single CCG would benefit residents through collective work to achieve economies of scale and deliver a more sustainable financial position over a greater primary care footprint.  In a follow up question, Councillor Caleb-Landy asked if any modelling work had been undertaken with a comparative sized organisation.  Lesley Watts explained that in her previous experience as a Chief Executive of a large, primary care trust (PCT), it was necessary to undertake local analysis to understand how patient pathways operated. Multiple care pathways hindered the ability to provide health care for patients and this would be balanced with the need to drive forward efficiencies. 

Jim Grealy commented that the proposed changes had been previously been presented as administrative and not patient-facing.  He felt that this was no longer the case and that there was fewer opportunities for the patient voice to be heard or engaged with.  It was important that residents formed part of the decision-making process.  Lesley Watts agreed and confirmed that the type of consultation or engagement would depend upon the nature of proposed patient service changes, in line with the requirement to follow protocols. 

Lesley Watts concurred with Jen Nightingale’s analogy of undervalued and skilled secretarial services being lost and projected cost efficiencies being valued more highly than experience and local knowledge, removing quality of care.  Janet Cree added that there would be a local focus and that feedback highlighting concerns would be monitored.

Councillor Richardson agreed to allow Councillor Coleman to present a brief statement to the Committee regarding the CCG merger and case for change. Councillor Coleman recounted how the Council had held grave concerns about the approach taken by the Collaboration of CCGs. The West London Alliance (WLA) had met to discuss and share concerns about this, and the financial and democratic deficits. Mark Easton (Accountable Officer, Collaborative of North West London CCGs) had also attended the meetings. It was felt that proposals for the merger had been flawed and inadequate, and that consultation and engagement had been equally insufficient. 

Councillor Coleman explained that legal advice had been sought, and a letter setting out concerns had been sent. The subsequent delay of the merger to April 2021 was therefore welcomed as it did not comply with NHS guidance.  The case for change was flawed and did not address or justify claims that savings would be achieved. This was confirmed by Mark Easton to be about £1 million.  It was acknowledged that the CCGs were under considerable pressure to reform but that there were many issues left unaddressed.  The case for change lacked critical details such as what the reconfiguration of CCGs could look like and therefore could engender a proper response.

In response to a query by Councillor Lloyd-Harris who welcomed the CCGs news of the delayed merger, Councillor Coleman explained that administrative savings formed a small part of the overall financial savings and that more information was required. Lesley Watts agreed that initial savings could be £1 million but that this would increase going forward, with the aim of spending less on administrative services and more on patient care. An assurance was given that if there were significant changes to patient services consultation would be undertaken.