Agenda item

This report updates the Committee on the development of a single Strategic Commissioner across all eight Kent and Medway Clinical Commissioning Groups (CCGs).

Discussion

There was a need for a well governed strategic commissioner across Kent and Medway and it was recognised that a permanent arrangement was needed to reflect the scale of changes in Kent and Medway. There had been significant concern expressed at the June 2018 meeting of the Committee about an apparent lack of transparency in relation to the development of the strategic commissioner and lack of information previously made available to the Committee. It had been agreed that the Committee would receive updates as often as required. It was considered that the plans to develop the strategic commissioner were robust but that progress had slowed down in the previous six to eight months with other areas having made more progress than Kent and Medway. Three design workshops had taken place, made up of members of all the Kent and Medway CCG governing bodies with a resulting next steps discussion paper currently being considered by the CCGs. It was anticipated that much of the early work in the development would be delivered by existing staff of the CCGs with the steering group to oversee work made up of clinical chairs, the two managing directors for the Kent and Medway CCGss and Councillors from Medway and Kent County Council. A key challenge would be moving to strategic arrangements while retaining full transparency and accountability for services.

The Steering Group was due to meet to more clearly define what the future arrangements of commissioning should be with the pace of the work needing to increase to implement the plans, including the development of an Operating Framework. It was anticipated that the Strategic Commissioner would be in place in shadow form by summer 2019 for it to become fully operational from April 2020. Its development would be overseen by a joint committee with it being anticipated that this would meet in public.

A Member of the Committee welcomed the increased transparency and potential for improved efficiency and reduced duplication as long as the needs of the local population were fully taken into account, including the relatively high health inequalities in Medway. In relation to the legal duty under the Health and Social Care Act to recommission services worth more than £650,000 every five years, it was questioned whether there had been a calculation of the services that exceeded this value and whether existing providers were disadvantaged by the process and how fairness in tendering processes was being ensured.

The Director of System Transformation at the Kent and Medway Sustainability and Transformation Partnership said that the new arrangements would aim to ensure consistency of outcomes across Kent and Medway in view of the increasing health inequalities experienced over the last five years. It was considered that there needed to be a different approach to commissioning, moving away from the current quasi market system to one where providers are required to work together to meet the needs of communities under a contractual framework set by the Strategic Commissioner. The current commissioning system had resulted in problems as the level of activity required had often not being understood at the time of services being commissioned resulting in there being services delivery difficulties and costly additions to contracts. It was noted that a third of patients in an acute hospital at any one time did not need to be there. There was, therefore, a need for commissioners and providers to work together, pooling resources to address this.

The Chief Operating Officer of Medway NHS Clinical Commissioning Group said that the CCG had clear legal advice that it needed to recommission services within the current procurement framework and that it could be subject to legal challenge by potential providers if it did not do this. There was no evidence that existing providers were at a disadvantage.

The Director of System Transformation said that an ‘open book’ approach to finances had been trialled in West Kent by the local CCG and hospital trust. This involved all parties having an understanding of the contribution that each resource made to the local healthcare system and collectively working to provide better care outside an acute hospital setting.

A Committee Member questioned why the Committee should be confident in the ability of a Strategic Commissioner delivering meaningful changes in view of the previous contractual challenges. The Director of System Transformation said that the aim was to move away from the current contractual environment. It was anticipated that future arrangements would involve significantly less people than at present with management costs being reduced. Expectations of the outcomes that groups of providers would be expected to achieve would be clearly set out. Previous contract failures had been caused by poor data and demand being underestimated as a result. The new commissioning arrangements would aim to overcome this with providers sharing knowledge and working together to deliver services that meet the prescribed outcomes.

A Member said that the contract problems highlighted should not have happened given that CCGs had been established to commission the correct care for local communities at an affordable cost. The Member was very concerned that in some cases, the scope of a contract had not been clearly defined before being agreed. The Director of System Transformation said that engaging GPs in the commissioning of local services would be important and that the Strategic Commissioner would be looking to re-establish capability and capacity in the local system.

Decision

The Committee noted the report.