Agenda item

The Committee will receive an update from Phil Johns on the merger of the Clinical Commissioning Groups in Warwickshire.

The Committee received an update from Anna Hargrave on the merger of the clinical commissioning groups (CCGs) in Warwickshire. This updated on the previous reports to the committee and confirmed:

• The timeline of approvals leading to the single commissioning organisation across Coventry and Warwickshire commencing on 1 April 2021.
• Next steps for merger, comprising appointments of chief officers, governing body members and all staff would TUPE transfer into the new organisation.
• Future landscape for health and social care. A government whitepaper recommended that the NHS and local government come together legally as part of integrated care systems (ICS). A single merged CCG across the area would assist and ongoing development of Place allowed local decision making and accountability within an ICS.

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

·       The impact on procurement arrangements for the merged CCG. There would be no immediate changes, but with the government whitepaper, new procurement regulations would be introduced.

·       The reorganisation of staffing in the new CCG and potential for redundancies. No redundancies were anticipated at this stage. A management cost reduction had already taken place and a wider reorganisation would take place as part of the move to the ICS, although for most staff, there would be no significant changes.

·       A member spoke of the lengthy endeavours to secure a new GP surgery for their division. This had been delayed by continual structural reorganisations. There were frustrations as communities needed the infrastructure and the land and funding had been earmarked. One of the benefits of the merged CCG would be the bringing together of expertise to manage GP estate and infrastructure changes. Later in the debate, a request for the new organisation to meet with the councillor to progress provision of this surgery.

·       A member had attended two virtual CCG meetings recently and commented on the different approaches in terms of public engagement. With the new CCG covering a larger geography, meetings should continue to be held online, adopting best practice to encourage public involvement.  These points were noted. There was a commitment to ongoing engagement, hearing patient and public voice for example on commissioning intentions.

·       Councillor Longden voiced his concerns about the CCG merger, considering that the north of Warwickshire would receive poorer services and the area already had health inequalities. Anna Hargrave offered to speak with Councillor Longden, whilst acknowledging his view. She referred to the previous discussions at this committee to explain the benefits of the merged CCG and offered to provide a briefing. Councillor Longden acknowledged the offer but advised he would not be a councillor for much longer.

·       Councillor Caborn welcomed the move to a single CCG and that staff were being retained, speaking of the opportunity for joint working across health and social care.

·       Further information was sought about the new ICS. This would be a new statutory organisation taking on many of the functions of the CCG and other functions, although the detail was awaited. Preparatory work was underway to move to the ICS and complete a staffing review simultaneously, to avoid the need for staff to go through two separate reviews.

·       Clarification was sought on the benefits of having a single CCG in moving to the ICS. Other CCGs that were still to merge would have an additional process to complete in the same timescale. There were benefits of scale, reference also to the change management processes in place, strategic planning and the four ‘places’ established. This would enable resources to be aligned over the next year alongside work with local authority partners.

·       A view in support of the proposals, the need for the new arrangements to embed and for organisations to work together. 

·       A lot of time had been spent discussing the CCG merger. There were concerns regarding health inequalities especially in the north of Warwickshire, which should have been a key focus and priority for the committee. Anna Hargrave confirmed that a lot of work was taking place on health inequalities, referring to covid, health needs assessments and identifying priority groups. These could be communicated to the committee or to the planned task and finish group. The new CCG and subsequent ICS would need to focus on health inequalities in a more robust way. The member reiterated that health inequalities had been an issue for many years. A further view that results were needed to demonstrate that health inequalities were being tackled.

·       Via the chat dialogue, a comment that the Health and Wellbeing Board was addressing health inequalities through a clear strategy and implementation by all bodies involved in it.

·       A comment that Healthwatch would be seeking assurances that patient voice would be heard at ICS, Place, PCN and practice levels. The arrangements would need to be both robust and transparent if they were to be effective.

·       Later in the agenda was an item on the review of scrutiny. There should be consideration of how this committee works with organisations.

·       Health inequalities was a considerable issue. It was important for the committee’s work programme to be focussed on such key areas. In response, a point that tackling health inequalities required a partnership approach, rather than being an issue just for the NHS. For example, the focus could be on wider determinants of health. There was a scrutiny role to look at the partnership response.

·       There were many issues to address and it was important to focus on solutions.

·       Thanks were recorded to the CCGs and to all NHS staff for their response to the pandemic.

Resolved

That the Committee notes the update and thanks the CCG representatives for their attendance and for responding to the committee’s questions.