Guest commentary by Nicola Redwood

David Cameron and George Osborne as part of the general election campaign in 2010 repeatedly pledged that there would be no more of the tiresome, meddlesome, top-down reorganisations that had dominated in the NHS in the previous decade.

Later that year, a white paper came out, Liberating the NHS, and it became clear this would become the biggest top-down reorganisation in the NHS had ever seen.  So much for that pledge

At the time, I was working in IT for Greenwich Teaching PCT and a Unite Workplace rep. Then came the provider split.  I was involved as Staff Side Chair in endless meetings whilst decisions were made on our future path.

I ended up in an IT role in NHS South East London PCT cluster after the biggest and most complex HR transition change management I’d ever been involved in as a rep.

It was a difficult time and we lost quite a few people in the process through redundancy or resignation.  I never wanted to go through anything like that again.

But on 1st April 2013 I found myself working for something called a Commissioning Support Unit (CSU) when the Health & Social Care Act came into law.

CSUs are a little-known part of the NHS.  19 CSUs were set up in 2013: there are now only five.

In 2013, CSUs employed over 9,000 staff: this has fallen to around 7,000.  They are “arm’s-length” bodies of NHS England. Our legal employer is NHS Business Services Authority.

CSUs offer little information to the outside world about how they operate, their purpose or their decision-making process.  Their purpose is to provide advice and back office functions including recruitment, HR, Finance and IT to Clinical Commissioning Groups (CCGs).

Core business

IT contracts for CCGs and GPs are core buiness for CSUs.  The more significant role of CSUs is the role they play as the door through which the private sector is brought in without public scrutiny: the 2013 NHS England document Mapping the Market listed 23 private companies that could be involved in the work, and noted:

“Although CSUs and independent sector providers are still finding their place in the market, at  present, there is an emerging trend of independent sector providers working through CSUs to provide commissioning support rather than working directly with CCGs.”

CSUs don’t produce annual reports or financial accounts like other statutory NHS organisations. Working for a CSU is completely different to working for any other part of the NHS, and there is almost no transparency.

As a union rep, my role certainly isn’t made easy.  I work in a small team providing IT support (servers) to CCGs and GP practices across South London. However with so many reorganisations, in-housings and TUPE transfers there are times when I’m doing my day job less than I’d like.

My part of the NHS has seen more top-down reorganisation than I ever want to see again in a lifetime.

Fast forward to today.  The mental health of staff and a blame culture are key issues every year in our NHS Staff Survey results.

We’re now seeing another big change in the NHS in England, part of the sustainability and transformation plans.  CCGs are merging in STP footprints right across England in 2020 and 2021 to pave the way for them to become Integrated Care Organisations (ICOs ).

The NW London STP has been discussing derecognising trade unions, and there is little partnership working with unions. Each reorganisation experience is getting more painful and many of the good people are going.

December 2019 saw yet another consultation on reorganisation, due to yet another round of 20% cost efficiency savings needing to be made by CCGs.

This has a knock-on effect on CSUs, which get most of their income from CCGs. My CSU has lost multiple contracts, mostly in IT, leading to a significant financial challenges.

239 staff out of a total headcount of 1,574 are potentially at risk of redundancy. This is in the context of a still too-high spend on interim and agency staff.

We won’t know for a few months how many jobs will be lost in total across the CCGs and the CSU: it is likely to be between 100 and 200, but could be lower.

For the CSU, this is a complex reorganisation with many transfers in and out to be consulted on separately. My own team is being cut by half, with a proposal to move us out of London as well

Evidence shows that constant change causes instability and poor performance, and morale is extremely low.

This is accompanied by a rise in the number of employment relations cases and sickness absence putting even more pressure on us union reps.

Enough is enough.  With an unprecedented number of disputes across the NHS in the last 12 months, and services being decimated by cuts, NHS workers need to stand together as a collective and fight back.

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