Agenda item

This report updates Members on the development of a single strategic commissioner across the eight NHS clinical commissioning groups (CCGs) in Kent and Medway and the appointment of a single accountable officer across the eight CCGs. It is for information only.

Discussion

The Committee was advised of the new shared senior management structure  of the nine Clinical Commissioning Groups in Kent and Medway. Glen Douglas was now the Accountable Officer for all these CCGs. Medway had been grouped with West Kent, Dartford, Gravesham and Swanley in this structure. Ian Ayres had been appointed Managing Director for this group with Simon Perks as his deputy. Caroline Selkirk, previously the Accountable Officer for Medway CCG, was now the Managing Director for the separate group of CCGs in east Kent, while Patricia Davies had been appointed Director for Acute Strategy.

The Clinical Chairs of each CCG were leading the work to develop a Strategic Commissioner and it was confirmed that local authorities and their health scrutiny committees would be kept fully informed and engaged in relation to development of the Strategic Commissioner and of the wider Sustainability and Transformation Plan. Significant work would be undertaken during Autumn 2018 to develop the structure of the Strategic Commissioner. However, it was important to note that individual CCGs retained their sovereignty and their legal entity as commissioners of health services. The Strategic Commissioner was currently being developed on the basis that there would be no changes to legislation with this regard.

A Committee Member was very concerned that Medway CCG could be at risk of losing its status and felt that Medway CCG should remain as a separate entity in order for local people to be provided with the best possible health services. The Member was concerned that a larger organisation would struggle to meet local needs effectively. She also stressed the need for the Committee to be provided with regular updates on the development of the Strategic Commissioner.

Another Member said she had not previously been aware of the development of the Strategic Commissioner, which was concerning, and questioned what the implications would be for the development of local care of the Medway Model. The Member was also disappointed that the report did not emphasise the scale of the changes to commissioning arrangements that might take place.

In response, the Deputy Managing Director of Medway North and West Kent informed the Committee that the Strategic Commissioner would look to address urgent needs across Kent and Medway. He apologised that the Committee had not been informed of developments sooner but noted that the Council was represented on the Programme Board of the STP , which had previously discussed the developments. He also advised that information in relation to the proposed developments had been in the public domain since Autumn 2017. However, the concerns of the Committee were noted with the Deputy Managing Director undertaking to provide further updates to the Committee as and when required. He would also ensure that health scrutiny was fully engaged in the developments.

The Deputy Managing Director recognised that there was a need to maintain and strengthen existing arrangements. He emphasised that no changes to the Medway model were being proposed and that there was not currently a clear view on whether Kent and Medway should move to having a single CCG. In response to a Member concern that Medway could be forced to join a single Kent and Medway CCG, it was confirmed that any final decision would be a matter for individual CCGs

A Committee Member asked what the role of the Strategic Commissioner would be if Local Care and the Medway Model would still be delivered locally. They were also concerned with regards to funding for development of the commissioner. The Committee was informed that the Strategic Commissioner would be responsible for wider commissioning across Kent and Medway, for services where it was considered that individual CCGs were too small to enable them to commission these as efficiently as possible. Possible areas for the Commissioner to become involved in included cancer services, mental health provision and some children’s services. It was emphasised that commissioning of primary care and local care would still take place locally and that even where services were commissioned across Kent and Medway, there would still be flexibility to enable services to be commissioned to meet specific local needs. The Commissioner was being established from within existing resources, with the Deputy Managing Director having been seconded into his current role and having his salary being paid by Canterbury CCG.

Decision

The Committee:

i)     Noted the report.

ii)    Expressed its concern in relation to the development of a single strategic commissioner for Kent and Medway and requested that regular engagement be undertaken with the Committee.

iii)  Requested that a letter be sent to NHS Medway Clinical Commissioning Group to express the Committee’s concerns that the development of the strategic commissioner had not been presented to the Committee sooner.

iv)   Requested that an update report on the development of the Strategic Commissioner be added to the Work Programme for the August 2018 meeting.