Agenda item

HASC has previously received reports on the proposed establishment of:

• A single CCG operating at a Kent and Medway level from April 2020 (formed through the merger of the existing eight CCGs)
• Integrated Care Partnerships, operating across local geographies of circa 250,000 to 750,000 resident population
• GP-led Primary Care Networks (PCNs), serving a registered population of circa 30,000 to 50,000, acting as the provider and delivery vehicle for local care.

This report provides an update summary of the work to date in establishing these arrangements, and in particular the development of the single CCG.

Discussion

Ahead of the report being introduced a comment was made highlighting dissatisfaction with it. It was highlighted that there were references to engagement with voluntary and community organisations and to letters from MPs, who had not supported the proposals, but that details had not been provided. It was also suggested that the consultation that had been undertaken in relation to the Kent and Medway Stroke Review could not be considered to have been successful in the context of ongoing Judicial Reviews and Medway’s referral of the decision to the Secretary of State for Health.

The Director of System Transformation at the Kent and Medway STP introduced the report. It was explained that stakeholder engagement, including with the voluntary and community sector, had been undertaken and would continue during the process of establishing the single Clinical Commissioning Group (CCG). The lack of information on this in the report was an omission. NHS England had approved, subject to a number of conditions, establishment of a single CCG. These included a requirement to appoint an Accountable Officer and a Chief Financial Officer. The process of appointing clinical members of the governing body was underway with a Clinical Chair having been appointed. The key purpose of establishing a single CCG was to support development of Integrated Care Providers and the development of Primary Care Networks to enable care to be delivered as close to home as possible. The Council was a key stakeholder of the Integrated Care Partnership in Medway with the Chief Executive being Chair of one of its committees. The single CCG was due to go live on 1 April.

Members of the Committee made comments and asked questions as follows:

Engagement, collaboration and savings – It was suggested that levels of engagement were low because the proposals were not meaningful for patients and that the need for financial savings required more joint working. It was considered that the papers presented did not adequately set out the impact of the changes and that improvement plans were being motivated by a need to make savings rather than by a need to improve services. The savings  figure of £190million quoted was significant. It was questioned whether the savings already made in the last few years were considered to have had an impact. The Director said that the purpose of the report was to highlight the proposals and that that it was not intended as a public facing engagement document. In 2016, there had been a deficit of £450 million. The fact that it had now reduced to £190million was significant. There was no evidence available to suggest that savings made so far had led to reduced service quality although it was not clear whether the changes proposed would completely eliminate the deficit. It was anticipated that a single CCG would be able to more effectively support primary care providers and the Primary Care Networks that would be fundamental to improving local care and reducing the pressure on hospitals. It was acknowledged that engagement activity needed to be strengthened and the new CCG would consider how to achieve this.

Existing CCG Deficits – With reference to six out of eight Kent and Medway CCGs currently being in deficit, it was asked what the impact of this would be on the single CCG. Assurance was given that the current deficits of other CCGs would not have a detrimental impact on Medway post-merger. Medway was one of the CCGs not in deficit. There was a commitment to ensuring that all areas received a fair share of resources. Commissioning would in future focus more on outcomes and there may be a need to reallocate resources in the longer term.

GP Support for proposals and future reporting – It was asked whether the 75% of GPs who had supported the proposals broadly came from areas that faced similar issues, such as being in areas of deprivation. The Committee was advised that the figure was the average across the existing eight CCG areas. Support within each CCG area had been relatively high. Specific reasons that GPs voted against the proposals were not available but in general, there had been concerns about loss of localism and a loss of connection with primary care commissioning. Assurance had been given that local support would remain. No pattern had been seen in relation to deprivation. In response to a question about how the Committee would receive reports in the future, the new CCG would have the same reporting responsibilities as the outgoing CCG. As service provision would involve more commissioner and provider collaboration it could be that a greater range of organisations would attend the Committee in relation to a specific issue e.g. mental health.

Timescales for Improvements – In response to a question about how long it was likely to take before improvements were realised, the Committee was advised that progress was already being made but that it was hard to indicate when the new arrangements could lead to improvements. The Medway and Swale Integrated Care Partnership was developing key work strands and building relationships with the Council and providers. Work was taking place to ensure that outcomes were compatible with the Joint Strategic Needs Assessment. The seven Primary Care Networks that comprised groups of GP practices in Medway would collaborate on improving the health of the local population and to share resources, knowledge and support.

Public engagement, Stroke Review and Inequalities – Concerns were expressed about the proposals and consultation previously undertaken in relation to the Kent and Medway Stroke Review, with it being suggested that this had been flawed. The manner in which the consultation had been undertaken and that parameters appeared to have changed meant that there was a lack of confidence in other public engagement and consultation activity. Concerns were also expressed that a single CCG might not be able to focus effectively on reducing inequalities in Medway.

The Director considered that reasonably good stakeholder engagement had been undertaken as part of the process supporting the establishment of the single CCG but it was acknowledged that it would always be possible to do more. There was a need to find different and more effective ways of working together and it was considered that without this, even the availability of unlimited resource would not facilitate significant improvement. It was noted that health inequalities persisted after several years of the current system and it was considered that a single CCG could be better placed to address these.

There was a need to use data more effectively and to focus on design of services that focused on improving health outcomes of the population as a whole. The whole health system would share responsibility for improving health outcomes compared to the current situation where only the CCG had this responsibility. It was hoped that greater confidence could be built with the Committee in relation to what the establishment of a single CCG was trying to achieve.

Further reservations were expressed about the development of a single CCG.

Decision

The Committee noted and commented on the report and looked forward to working with and holding the single CCG to account in the future, whilst expressing reservations about the development of a single CCG.