HEALTHIER TOGETHER
Healthwatch raises concerns about new ‘Super-CCGs’
Sam McCaffrey reports on concerns that far-reaching decisions affecting patient care for years to come are being made in private meetings with little transparency or accountability.
about patient care and the shape of health services in their region. In Greater Manchester, North Yorkshire and North West London, for example, CCGs have been forming committees and partnerships to make decisions about care at a regional level.
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Healthwatch England is concerned that these new ‘Super-CCGs’ are circumventing local scrutiny and accountability measures, as they fail to engage with the public, are not accountable to local democratic oversight and often hold meetings in private.
In North Yorkshire, four CCGs have combined to create the Partnership Commissioning Unit (PCU), responsible for commissioning mental health, children and family services, continuing care and adult safeguarding. But the local Healthwatch only became aware of the PCU by accident, when the local Healthwatch co-ordinator, David Ita, sat next to the PCU director, Janet Probert, at a health and wellbeing board meeting.
He told NHE that since then, he has had good engagement with the PCU – but the lack of formal engagement before that chance meeting is a worry.
Greater Manchester’s 12 CCGs have formed a ‘committee-in-common’ (CiC) to run Healthier Together, a major review of all healthcare services in the area (see pages 32-34).
The CiC has been operating since February 2012, in shadow form until April 2013. Healthwatch says it has already made decisions on 100 clinical standards for A&E, acute medicine and general surgery without public involvement.
The local Healthwatch groups have attempted to engage and attend meetings but have met resistance. Eventually, the CiC allowed some public engagement and split its meetings into two parts, public and private. But Healthwatch Bolton chair Jack Firth, having attended several
new trend has emerged among CCGs of banding together to make decisions
‘part twos’ of meetings, said the important decisions have already been made in ‘part one’.
“The CCGs and CiC in Greater Manchester just don’t understand what Healthwatch’s role is,” he said. “They invited us to some meetings that were public, where they said a lot of people could attend. We did attend but they were not about the strategy, as all that was done by the clinical senates, which we never got an invitation too. So the whole process has been made up by those doing it in secrecy.”
A Healthier Together spokesman told NHE that the 12 CCGs inherited Healthier Together from the 10 former PCTs in the area. Before continuing with it, the CCGs sought legal advice, recruited an independent chair, and set up an external reference group to represent patient groups.
“We do appreciate that some groups hold very strong views about the proposals in relation to their local hospital services,” the spokesperson continued. “It is clear, however, that there has been substantial engagement activity regarding the Healthier Together programme over the last 18 months or so.
“As well as each local Healthwatch being entitled to send a representative to the external reference group, which meets monthly, numerous individual meetings have been held with local groups, as well as a range of other stakeholder events and meetings that Healthwatch organisations have been invited to and attended. This is on top of any engagement each Healthwatch may have had with their local CCG.”
Healthwatch England remains concerned, especially as the Draft Legislative Reform CCG Order 2014, which will make it easier for CCGs to form joint committees, is making its way through Parliament.
The watchdog has written several letters to health secretary Jeremy Hunt to raise concerns. Anna Bradley, chair of Healthwatch England, wants a mandatory seat for local Healthwatch
on any joint committee; a duty on all lead CCGs to consider existing local priorities and plans; and to ensure all CCGs act within existing local accountability mechanisms, even if it means being held to account by a health and wellbeing board outside of their jurisdiction.
NHS Clinical Commissioners, which represents the CCGs, says the mechanisms already in place are enough to ensure transparency and accountability. Its director, Julie Wood, cited the CCGs’ five statutory responsibilities, the second of which states: “CCGs will have transparent arrangements in place to feed patient and public insights into CCG decision making, including evidence from local Healthwatch, patient feedback, complaints and concerns.”
Wood told NHE: “There is no need for any further legislation or top-down mandatory requirements of CCGs.”
Concerns were raised in Parliament on 9 September when MPs debated the Draft Legislative Reform.
Shadow health minister Liz Kendall MP quoted extensively from Healthwatch’s letters to Hunt.
In response, Norman Lamb MP, minister for care and support, said: “Concerns were raised that joint committees might not meet in public. Joint working does not need to mean that it will take place behind closed doors and exactly the same responsibilities will apply to CCGs when they work jointly as when they work on their own or through committees in common…I would always encourage accountable organisations to operate in public wherever possible.
“We take on board the concerns of Healthwatch England. We intend to work with that body to ensure maximum accountability for the decisions taken as part of these joint committees.”
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national health executive Sep/Oct 14 | 35
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