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Should there be consultation on CCG mergers?

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Having persuaded often-reluctant GPs to step up to run, and pay for local NHS services, it seems we now want to move in the opposite direction. The trouble is – there is no legislative basis for this – and much debate as to what is right in any particular area. This article is a classic example of the head-scratching now taking place. Of course, there should be consultation…!



The prospect of a health services merger across the entirety of North East London being done without formal consultation was slammed as “preposterous” at a Town Hall meeting last night. The debate followed concerns raised on the scheme earlier in the week by campaign group Hackney Keep Our NHS Public, with local doctors now warning that the plans would represent a “loss of control and accountability”. The merger, which would see City & Hackney clinical commissioning group (CCG) being bundled into a larger ‘integrated care system’ (ICS) across NE London, would see 85 per cent of the area’s health budget being devolved upwards. The scheme is expected as part of the NHS’ Long-Term Plan, with the restructure set to occur by 2021.

GP and osteopath Dr Nick Mann said: “There are an awful lot of concerns about this merger. For instance [about] mental health beds, if patients with schizophrenia have to travel ten miles to the nearest facility. The CCG will no longer be accountable to us, it will be the ICS, which ultimately within one to three years will be making all the decisions. You can’t have local design and have a centrally funded model. There are lots of people across NE London, for instance, let’s say they decided to employ Virgin to provide community mental health services. It’s happened across the country, why shouldn’t it happen here? We’ve lost accountability, and I believe we’ve lost control, but we will still maintain local people running the service who still have responsibility for whatever falls upon us from above.”

Dr Mann went on to join councillors calling for more information explaining the process of the merger and what it will mean legally, and in particular whether a formal consultation will take place on the plans. Debate over the merger became heated, with Cllr Patrick Spence (Lab, Haggerston) saying that the plans had the feel of a “frankly undemocratic closed-door decision…in the way that private corporations make strategic decisions.”

CCG chair Dr Mark Rickets pointed out that while doctors who make up the membership of the organisation can vote off its board, the commissioning body is “not democratic like a local authority, that’s not how it’s been set up.”

It is understood that a ‘case for change’ for the ICS plans is currently being worked up, for publication in October, after which a “process of engagement” will take place. However, health bosses were unable to give councillors any precise details on the plans, nor whether the planned “engagement” would amount to a formal consultation.

David Maher, managing director for City & Hackney CCG said: “Within the expectations of the Long-Term Plan there are aspirations for modernising our community services, primary care and mental health services. There’s also an expectation that the commissioning architecture itself will begin to modernise too, particularly to take into account new ways of partnership working with local authorities and our provider bodies. There is the added expectation that commissioning administration costs will reduce by about 20 per cent, which obviously requires us collectively to look across NE London at how we administer public resources differently.” On whether there would be a consultation, Dr Rickets added: “We’re sort of using the word “involvement”. We want to do something which we’ve always done with our local communities, which is involve them. We do want to do that.”

Councillors on the Health in Hackney scrutiny commission see the risks of the plans as losing local accountability, with money going to bail out other areas as a result of top-down management. In their face-off with the borough’s medics over the changes, politicians remained sceptical over the arguments presented for the changes, including Maher’s points that further transparency and accountability could be introduced through the changes as a result of councillors sitting on Hackney’s Integrated Commissioning Board (ICB).

Health in Hackney scrutiny chair Cllr Ben Hayhurst (Lab, Hackney Central) said: “It is the case that 85 per cent of our budget is going to get devolved upwards, and there are not going to be guarantees attached that that stays in City & Hackney. The idea that that doesn’t warrant formal consultation is preposterous. It will affect the GP Confederation, funding for the Homerton, it will affect everyone. At the moment, I don’t buy the argument that it will increase accountability because there will be politicians sitting on the ICB. We’ve got that already, so I don’t buy that as an argument. I understand there’s pressure from above, and I understand there’s possible scope for administrative savings. At the moment, I’m not persuaded that it’s for the benefit of Hackney, it may be for the benefit of the wider picture, but let’s see.”


Article originally appeared on Hackney Citizen

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