Across England there are plans to merge Clinical Commissioning Groups: according to the HSJ, 86 of the remaining 191 CCGs are planning to merge into much larger bodies covering up to 2 million at a time. This threatens to marginalise any local voice or accountability for patients and the public in dozens of areas.
In South East London the six CCGs are to be merged into one covering a population of 1.8 million people; in North West London eight CCGs have been planning to form a single, monster CCG which campaigners fear will be largely impervious to the needs or demands of 2.2 million people.
Many if not most of these mergers are going ahead without any public consultation. This is important because the scrapping of locally based CCGs would remove the already limited level of public democratic accountability. At present each CCG must meet in public, publish board papers, and consult on changes.
211 CCGs were set up in 2012, when the Health and Social Care Act amended the previous 2006 Act. Their task was said to be to commission the majority of health services for their population.
“Local” and accountable
Indeed CCGs were initially portrayed as local organisations: when they were first proposed in the ridiculously-named Liberating the NHS White Paper in 2010 the promises of local democracy were extravagant:
“The Government’s reforms will empower professionals and providers, giving them more autonomy and, in return, making them more accountable for the results they achieve, accountable to patients through choice and accountable to the public at local level”.
Subsequent guidance insisted that, contrary to current plans: “CCGs’ vision and plans will be accessible to a diverse range of communities and groups … to enable CCGs to be leaders in sustainable healthcare and accountable to the population they serve. … CCGs will have a strong sense of place.”
Of course the real reason for establishing CCGs was to promote the marketisation of the NHS by compelling CCGs to put services out to competitive tender: the promise of a greater local say over services was only window dressing to make CCGs palatable. In practice most CCGs have failed to live up to this expectation and have generally ignored the views of the public and failed to engage front line clinicians.
But there have been some important exceptions, most notably Lewisham CCG which joined with the public and Lewisham Council in successfully opposing plans to close Lewisham Hospital.
Any such potential will be lost when the CCGs are merged into giant, remote organisations: that’s why this merger process is being driven from the top.
Now Lewisham Hospital campaigners are demanding that there be full public consultation on CCG merger plans – and they believe they have the law on their side.
The campaigners have gone back to the amended NHS Act 2006 which (14G) stipulates that CCG mergers involve both the dissolution of the pre-existing CCGs and the formation of a new CCG.
And they have found that according to the Regulations governing the implementation of the Act, dissolution of a CCG requires the CCG to seek the views of all the people in the CCG area. Indeed, whether the CCGs are being dissolved, varying their constitution or changing their areas and memberships, the Board authorising the change is supposed to assess:
“The extent to which the CCG has sought the views of individuals to whom any relevant health services are being or may be provided, what those views are, and how the CCG has taken them into account” (Schedules 2 and 3).
This means a public consultation is required and not the partial “engagement with stakeholders” that is currently taking place.
More of the legal details are available to assist campaigners, councils and scrutiny committees wanting to defend the last vestiges of local accountability in the NHS: see the information posted by the Save Lewisham Hospital Campaign.
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