Agenda item

To brief the committee on the future of health commissioning in Coventry and Warwickshire, the proposed changes to the structure of the clinical commissioning function and the future process.

A report was introduced by Sarah Raistrick to inform the Committee of the future of health commissioning in Coventry and Warwickshire, the proposed structural changes to the clinical commissioning function and the committee’s support was sought to the application to create a single, merged Clinical Commissioning Group (CCG) in Coventry and Warwickshire.

Background was provided on the NHS long term plan, which outlined a new service model and as part of this, the formation of integrated care systems (ICS). The CCGs had considered how to support the move to an ICS and following a period of engagement, a case for change was developed, outlining the options available, which were reported.

It was noted that options which involved the strategic direction of the CCGs were reserved to the member organisations, who were asked to vote on their preferred option. Detail was provided on the process undertaken. The outcome of the vote was decisive in all three CCG areas, with members choosing the option of full merger. The next steps in this process were reported and CCGs were preparing to apply to NHS England and Improvement for authorisation to become a single merged organisation. If the application was successful, the three CCGs aimed to become a merged organisation by April 2021. Ongoing engagement with stakeholders and the population was an essential part of this process.

Questions and comments were provided, with responses provided as indicated:

•        It was questioned if the deadline for the merger was realistic. There was confidence that it could be achieved.

•        How could a merged Coventry and Warwickshire CCG (C&WCCG) give more local support? Detail was needed to evidence this. The allocation of funding across the merged CCG also needed clarifying, as there were differing needs in each of the areas and a concern that funding might not be distributed equitably.

•        Dr Raistrick referred to health needs and inequalities for Coventry and Warwickshire as a whole, desired outcomes using an example of improving diabetes targets and the differing interventions that would be needed across each ‘place’ to achieve the target. 

•        Adrian Stokes added that funding allocations would remain for each of the places they were earmarked for, for the next five years, subject to any financial changes imposed by the Treasury post-covid.

•        This response gave reassurance, but conversely there was a need to address known inequalities and funding would be required to do this.

•        A comment that average data for Warwickshire was generally good, but it hid issues in specific areas and there was a need to examine granular data for local areas. As a health and social care partnership local data was used, such as that from the joint strategic needs’ assessments (JSNA) and primary care networks (PCNs). It was equally important to maintain good outcomes in areas doing well.

•        Adrian Stokes reminded that CCGs needed to reduce their running costs by 20%. The merger proposals would remove duplication and some overheads, avoiding the need to cut staffing in more vital areas.

•        Delays in making changes could have a financial implication. Examples were the lengthy processes for review of CCG estates and the stroke service reconfiguration.

•        A member submitted questions on the number of lay members that would be appointed to the C&WCCG, spoke about people moving into Warwickshire but staying registered with GP’s in Coventry and wanted to see how the new organisation would be more efficient before he could offer support to the proposal.

•        Sarah Raistrick stated the need to balance of good governance and decision making. Where reviews affected all the Coventry and Warwickshire area, such as the stroke service review, the decision needed to be considered at various levels by three CCGs currently. A single body would provide more streamlined decision making. The new CCG would be mindful of needs from a place-based approach in each of the local places. It was hoped to reduce both overheads and the speed of decision making, which was something the committee could hold the CCG to account on.

•        Chris Bain advised that HWW would remain neutral on the merger proposal and was mindful that most patients were unaware of what a CCG is or does. HWW would monitor inequalities in service provision and outcomes. It wanted to ensure these were addressed and that the patient voice was included at every level of the structure.

•        Sarah Raistrick spoke on lay membership. The new constitution was being prepared with an aim to increase lay membership above the statutory level. There were two strong lay members currently who championed addressing inequalities and ensuring the patient voice was heard. Links with Healthwatch, both in Warwickshire and Coventry were referenced and there was a wish to hear the patient voice at all levels.

•        The proposal was for three voting lay members and four voting GP representatives on the new C&WCCG. Reference was made to the statutory requirements and the template constitution which could have been used. Specialist advice was being taken in preparing the constitution for the proposed C&WCCG including for an extra lay member to that required. A councillor did not feel able to support the proposals without seeing the detail. Adrian Stokes added that there was the opportunity for wider engagement via the Health and Wellbeing Board (HWBB) and place boards. Other members shared the concerns about reductions in lay representation, especially when viewed across the whole area and the need to ensure that Warwickshire was adequately represented.  For the first term of office of the new governing body, there would be three Warwickshire GPs and one GP representing Coventry.

•        A view that the key driver for the review was financial, and whilst this would lead to efficiencies, there were concerns about the loss of local knowledge, due to the size of the organisation.

•        Comment that this change was being driven by NHS England and it would happen. It was different to a service review like that for stroke services. Reference to the importance of the place plans and that for Rugby was being progressed.  The HWBB had a key role in setting the strategy and would be the body to be held to account and scrutiny.

•        Comments about the potential for a reduction in front line staffing, that a larger CCG would not necessarily make decisions more quickly and concerns at the potential for service closures. A sense that more information was needed before offering support.

•        Adrian Stokes asked if a further session on place would be useful. He outlined the developing arrangements in Rugby and Warwickshire north, considering both were working well, with a local focus. He confirmed that the savings were targeted at back office rather than front line services. The Chair agreed this additional session would be useful to respond to the issues raised.

•        Reference to PCNs. There was a perceived lack of patient voice, due to clinical leads not having an effective dialogue with patients. This forum could enable discussion of very local service issues. Sarah Raistrick responded that PCNs had really taken off giving local ownership to address needs in each area.  She referred to her own local network meetings, which were well attended, also the attendance at councillor forums to pick up any health issues raised. PCNs were keen to work with HWW and local councillors. The councillor stated the same approach was not being taken in his locality. This would be pursued after the meeting and referred to the GP lead.

The Chair sought views on the report recommendation, providing a summation of member feedback. More information was required to enable the committee to offer its support to the proposals. The CCGs had offered to attend a further meeting to speak on the place aspects. He asked if members wished to take up this offer before making a decision on this matter. A range of views were submitted and it was concluded that a further meeting should be arranged in the near future.

Thanks were recorded to the CCG representatives.

Resolved

That the Committee arranges a further special meeting in the near future to give consideration this matter, especially to the place aspects and that the concerns and comments raised by the committee as outlined above are reported to the CCGs.