Agenda item
Single CCG for NW London and Development of the Integrated Care System
This report sets out the plan to form a single CCG and the vision for establishing an Integrated Care System (ICS).
Minutes:
Lesley Watts (Senior Responsible Officer, North West London Health and Care Partnership) introduced the report which set out the background and context of how the NHS were operating and seeking to operate as an Integrated Care System (ICS) and the rationale for merging the 8 North West London CCGs into one. The belief behind the merge was that the provider / commissioner split needed to come to an end. Lesley Watts expressed that the essence of the ICS meant that together they would use all the resources available to drive up the quality of care, drive out duplication and variation, address inequalities and learn from each other to get the best outcomes for patients and provide the vast bulk of care together. Direction had been increased in Boroughs with senior directors from community care, mental health and primary care who would work with the Local Authority as a result of discussions with Local Authority Chief Executives at joint meetings with Local Authority providers and Chief Executives.
Dr MC Patel (Chair, Brent CCG) added that as a member of the CCG and Board he had supported the principle of a single North West London CCG as it offered significant opportunities such as improved efficiency and the ability to address the severe problems of deprivation and inequality of access to healthcare. The merge meant they could start to address the shifting of resources with emphasis on particular areas to ensure everyone across North West London had an equitable offer and break down barriers that had traditionally existed. There was a desire to build on the good history of working with the Local Authority, local acute trusts and community services. Dr MC Patel advised that they should be looking at the population of North West London and its diversity particularly in terms of inequalities.
Sheik Auladin (Managing Director, Brent CCG) echoed this, stating that over the previous year health and the Local Authority had started working together more closely and collaboratively due to the pandemic, which had helped to galvanise all the work going forward from an ICS and system perspective. He informed the Committee that Brent CCG members had now voted in favour of the merge to a single North West London CCG.
The Chair thanked health colleagues for their introduction and invited members to ask questions, with the following issues raised:
In response to queries about the consultation process with the community and service users, Rory Hegarty (Director of Communications and Engagement, North West London CCGs) explained that the recent consultation had shared the Case for Change with each Borough’s Scrutiny Committees, Local Authority Chief Executives and Leaders, Cabinet leads for health, and was presented at Joint Health Scrutiny Committees, to the local Healthwatch organisations, community groups, all patient participation groups and campaigning organisations such as Brent Patient Voice and Save Our NHS. The case for change had also been published online for public comment, with a press release and social media activity. The legal consultation with the Local Authority had lasted 6 weeks and the results of that were now being analysed.
Members were concerned that resident engagement would be lacking once the merge happened, noting that at the moment there were 8 CCGs that residents could engage with whereas at a single CCG level there may not be any representation from a particular Borough. Rory Hegarty acknowledged the risk of losing resident voice at Borough level and advised they were working on a project called the EPIC Programme to get the patient voice heard. This programme involved working with local Healthwatch organisations, voluntary sectors and Local Authorities to shape how they worked together with the public. The desire was to co-produce the programme with local residents, Councillors, Healthwatch and the voluntary sector, and an invitation to Committee members to attend the next networking meeting for the programme was extended. In response to queries on how the success of the programme would be measured, Lesley Watts advised that it would be measured with Public Health in Brent as to whether the outcomes for patients and inequality measures had improved. Health colleagues expressed that the reason they wanted to make the proposed changes was to tackle inequalities in deprived areas such as Brent as they wanted services to be equitable across all areas of North West London.
Further relating to communications with residents, Julie Pal (Chief Executive, Healthwatch) advised that, having spoken to around 500 different types of residents about the changes, a lot of residents did not understand what the impact of the merge would be for them as individuals and sought assurance that the local response would recognise local needs. There was a concern amongst residents on what difference the change would make to their lives. Rory Hegarty advised that this was a change to how the NHS was organised and not to patient care or services and that there had been no requirement to consult the general public. There was a desire to enhance patient engagement through this change to the single CCG through the EPIC Programme. Dr MC Patel added that he would not agree with a change that he did not feel was for the benefit of his patients and the intention was to see better services and access to services through a combination of targeted interventions and breaking down barriers such as easier referral pathways. He highlighted that they already had begun to improve referral pathways such as the new self-referral mechanism for physiotherapy. Julie Pal noted the response and advised that it was a matter of perception and suggested that the message of reassurance to residents that services would not change was not coming through. Julie Pal and Rory Hegarty agreed to meet to share the findings of the resident engagement Healtwatch had undertaken.
Regarding funding, members wanted reassurance that Brent would receive adequate funding for services. Concern was raised that Brent was one of the most deprived areas of North West London and members queried how funding between the 8 Boroughs would be divided. Lesley Watts advised that centrally funding would come down to the ICS and the intention was to work towards fair shares, with movement of money over time between the more over-capitated Boroughs to more deprived Boroughs such as Brent. It was not yet clear what the allocations over 6 months or a year’s time would be but a commitment had been made to move at a quick time scale to deliver fair shares. Sheik Auladin added that Brent CCG was one of the worst allocated Borough’s in London and that it would have taken ten years to level up with other Borough’s across North West London, whereas the merge to the single CCG would give Brent the opportunity to level up within four years.
Reassurance was sought that the new single CCG would be able to provide the sort of procurement services needed for each particular Borough and in Brent. Lesley Watts informed the Committee that her teams would work more locally with Local Authority teams regarding the procurement of services, and in response to requests from Brent Officers during the consultation a structure for integrated delivery of care had been established. Deciding how to spend budget and allocations would be done in an integrated way, and health, social care and the Local Authority would prioritise together and attempt to direct that money to deal with inequalities. An example given was the commitment of health monies to the placement of patients to bridge the funding gap where patients came out of hospital and into Local Authority care. It was noted that there was a large majority of patients who went out of Borough for health services and Lesley Watts felt that it would be easier to standardise care received in those acute units, but the intention was where work could be done in-Borough, particularly integrated work and the lettings of contracts to local people, those would be done through Borough partnerships
The Committee asked about decision making and governance, including who would award contracts and how they could be answerable to the public, as the ICS meetings were closed to the public unlike Borough Committees and CCG meetings. Lesley Watts agreed that there was a need to refine the way the ICS was grown and how it received the public voice. She highlighted that the vision for the ICS was built together with Local Authority Officers and patients at multiple engagement events where the strategy for the ICS was agreed and she offered to share those documents from individual care partnerships on their priorities with the Committee. At an ICS level the Committee was Chaired by an ICS Chair which had all leaders of Council’s and Chief Executives on, which fed into the ICS Board. When the STP was in place there was patient representation on the overarching body and they would look to do that again with the new partnership board.
Members of the Committee addressed the equality impact assessment submitted with the Case for Change in August as they felt it had not addressed the separate issues relating to each equality consideration including age and disability. Members also addressed what they felt was a lack of consideration for children’s health within the paper with regards to population health. Lesley Watts advised that there were multiple work streams which Local Authority Officers were helping to deliver including a work stream for the elderly, Mental Health and children. She offered to systematically bring those work streams back to Committee to discuss what was being done in each of those areas. Sheik Auladin added that the proposals would give the opportunity to conduct referral pathways at an ICS level together for a pathway for children.
Concerns regarding reference in the reports to demand management within a sustainable budget were raised, with members feeling that would mean no referrals. Dr MC Patel informed the Committee that referral to demand management within the papers did not mean no referrals would take place but rather was about referring the right people to the right places at the right time, and about what primary care colleagues could do before sending a patient to hospital so that the initial investigation made sure the referral was the most appropriate. Dr MC Patel gave the example of pathology services which over the years had changed dramatically by stopping some tests that were previously done as a matter of routine that were not useful and using that money for more informative tests. He expressed from a GP perspective he did not want to be told not to refer a patient and that Brent GPs would fight for what was right.
In relation to the involvement of Brent Council in the proposals and consultation period, Phil Porter (Strategic Director Community Wellbeing, Brent Council) advised that the Council had a range of inputs the Committee may not have been aware of. There had been meetings with the Chief Executive and Leader and those of other Local Authorities also. He met on a weekly basis with a regional group from ADASS. He expressed that the proposals were a significant change with a lot to be worked out and that it was being worked on together, with the sense from Officers that it was happening therefore they needed to work with it.
Reassurance was given to Committee members that the proposals were not related to privatisation and Sheik Auladin expressed that it was about breaking down barriers between providers and commissioners. He highlighted that the systems were coming together to improve services for patients and this was the direction of travel for the NHS.
As no questions were raised, the Chair invited the committee to make recommendations. The committee subsequently RESOLVED:
i) For Brent Senior Officers involved in the engagement process to host a briefing session for Community and Wellbeing Committee members regarding the input they had on the proposals and answer further questions about the impact of the move to a single CCG for North West London.
ii) That Committee members withheld support for the proposals pending further information at the members briefing session.
Supporting documents:
- 8. Single CCG for NW London, item 8. PDF 107 KB
- 8a. Appendix 1 - Timeline for establishment of the single CCG, item 8. PDF 30 KB
- 8b. Appendix 2 - Proposed Governance Structure for single CCG Governing Body, item 8. PDF 27 KB
- 8c. Appendix 3 - Transition Governance Structure during Covid-19, item 8. PDF 118 KB