The top-down drive to force through CCG mergers, as discussed on our front page, is at its most frenetic in London, where 32 CCGs could be reduced to just five if current plans are rubber stamped by NHS England.

In North East London Hackney Healthwatch has raised the question of whether City & Hackney CCG’s days are numbered, given the lack of any public discussion or consultation as plans progress to merge seven CCGs into one. City & Hackney CCG dodged a series of direct question on the plans for merger, and it’s clear there are no plans for public consultation.

In North West London, as previously highlighted in The Lowdown back in June, the same eight CCGs that tried and failed to force through their half-baked Shaping a Healthier Future plan to axe hospitals and beds, are now seeking a merger to form a mega-CCG covering 2.2 million people.

They hope it would clear the decks to push through controversial plans by closing down the individual CCGs, and thus making it easier to ignore community views and boroughs like Hammersmith and Fulham and Ealing that might speak up for the needs of local people.

In South East London, six CCGs could also be merged into one, again gagging the more responsive and progressive voice of Lewisham CCG by eliminating it from the scene. CCGs South West and North Central London are also set for merger, regardless of the opposition from local boroughs, which could only influence decisions if there were a formal consultation.

According to the HSJ a further 17 areas are planning to make applications for mergers – among them Kent and Medway, Durham and Teesside, Staffordshire and Stoke-on-Trent, and Herefordshire and Worcestershire.

September deadline

There is a September deadline for 2020 merger proposals, each of which will need approval from NHS England.  It’s claimed that mergers would offer cost-savings and the development of system working, but it’s clear any such savings would come at a cost of reduced accountability and local engagement.

The HSJ notes that, as with efforts to create “integrated care systems” a potential obstacle to the merger process is the financial impact on areas whose CCG is in a relatively healthy position, as they merge with others deep in the red.

But top-down pressure for merger, combined with an apparent determination to push the process through behind the scenes to avoid public debate and disclosure, seem likely to be the most decisive factors – unless campaigners can manage to force CCGs and NHS England to comply with the regulations they are currently ignoring.

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