As we have discussed in previous issues of The Lowdown, the controversial process of merging Clinical Commissioning Groups is well under way. John Lister gives an update.
If NHS England gets its way the days of any local accountability of Clinical Commissioning Groups (CCGs) could be numbered: according to an HSJ report NHS England is stepping up the pressure for groups of CCGs to merge: the latest proposals could see the current 191 CCGs in England reduced to just 40.
However one planned merger – of the six CCGs in Staffordshire – has now been formally scrapped after a majority of GPs in five of the CCGs voted to reject the idea. The merger plan had already been criticised as a “cost-cutting exercise” which had no benefits for patients by the Alcott, leader of Cannock Chase Council.
The GPs were told the plans were “driven by NHS England”, by Dr Paul Scott, chair of the North Staffordshire Local Medical Committee, who advised his members to reject the merger. He wrote in an email, seen by HSJ:
“Much has been made of the potential benefits of having a single CCG in Staffordshire, yet few if any of these arguments hold true or are at best speculative.”
Minimise local voice
Campaigners have argued that one of the reasons behind this drive to merge CCGs into such large units is to minimise any local voice or dissent while controversial closures and downgrades of hospitals and services are pushed through.
Now there are explicit statements from senior NHS management that confirm this is the case.
In Lancashire and South Cumbria, where 8 CCGs are planning a giant merger alongside the formation of an “integrated care system”, the director of finance and investment has openly stated to the Health Service Journal that he wants to be able to push through “tricky” decisions: “The place we need to get to is where we can enforce decisions on a majority basis.”
Hospital “reconfiguration” is a key concern in Lancashire, with potential permanent loss of A&E and acute services in Chorley: eliminating any local voice will make that easier.
Councils of various political complexions in London and elsewhere have warned of the impending loss of accountability: in Essex, where there are plans to merge 5 CCGs, the Conservative Leader of Thurrock Council, Cllr Rob Gledhill said:
“We understand the need for the NHS and all public sector bodies to work as efficiently as possible, but that should not be to the detriment of residents who rely on the vital services our local CCGs are involved in providing.
“Creating a single CCG responsible for commissioning health services for 1.2milllion people across south and mid Essex would not only be a huge challenge because of the sheer size of the area, but would result in the loss of local accountability and would be a real waste of the excellent local partnerships that have been formed.
“By taking a more centralised approach, we also fear that the different needs of patients and local priorities in the 5 areas would not be fully taken into account. We would strongly urge NHS England to think again about these dreadful proposals to avoid irreparable damage to a health service we are all very proud of.”
Telford says No
In Shropshire, Shaun Davies the Labour leader of Telford & Wrekin council, which has been fighting against the ‘Future Fit’ plan to downgrade the local hospital and move services to Shrewsbury, has also come out firmly against a merger of CCGs: he warns that any merger between the two CCGs would see health funding and resources being diverted out of the borough to Shropshire.
Telford and Wrekin’s CCG has a balanced budget while Shropshire CCG has had a mounting budget deficit, currently at around £28 million. Cllr Davies said:
“This is simply Telford and Wrekin being fleeced to sort out Shropshire’s financial problems and years of poor management. This feels like the whole ‘Future Fit’ debacle again – Shropshire takes over, Telford and Wrekin loses out, robbed to pay off Shropshire’s debt.”
In North West London, where another 8 CCGs are set to merge into the biggest CCG covering 2.2 million people, NHS bosses are still smarting from the collapse of their 7-year effort to force through hospital closures affecting two boroughs, Hammersmith & Fulham and Ealing: a merged CCG would be even more remote from local campaigners.
That’s no doubt why, despite regulations requiring them to do so, few if any of the planned mergers involving 86 CCGs have involved any genuine public consultation, or taken any real notice of the views of local councils which in theory should be regarded as partners.
The mergers are another top-down bureaucratic reorganisation.
If NHS England brazens it out and pushes through these mergers, council health and scrutiny committees, which still retain powers which date back to the 1970s to delay and challenge changes in services, may become the last vestige of local accountability in an increasingly centralised and monolithic “integrated” NHS.
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