Agenda item

Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) and Chris Greener, (Associate Director Commissioning Development, NHS Kent and Medway) were in attendance for this item.

(a)       The Chairman introduced the item and explained that this was a subject the Committee had considered in the past, and will return to in the future as the preparations for April 2013 continue. NHS representatives were then invited to provide an overview of the situation regarding transition locally and respond to questions.

(b)       A clear theme through the comments, questions and concerns of Members was the perceived complexity of the new system being established and the sense that this current reorganisation would not change anything and not be substantially different to the current arrangements.

(c)        The initial area of discussion was around the role of GPs in commissioning, which was stated as a goal of change. Reference to media reports around the secondary role of clinicians in Clinical Commissioning Groups (CCGs) was made. It was explained that increasing clinical leadership in the NHS was wider than just involving GPs. Kent and Medway was reported and having very good GP involvement. The Boards of CCGs appointed the Accountable Officer and the Chair and though the specifics varied, one of these top positions in each of the 8 CCGs in Kent and Medway was filled by a clinician. It was also explained that the CCG Boards were only in their interim iteration and were developing organisations and so the balance on the Boards would change. The Local Medical Committee was supporting the development process. It was recognised that there was a need to be transparent and publish details of the Board composition. In answer to a specific question, the proportion of Non-Executive Directors to Executive was a matter of local decision. There was a lengthy national assessment process for CCGs before they could be approved, led by the National Commissioning Board (NCB). Out of area independent assessors were used, with Ann Sutton, the Chief Executive of NHS Kent and Medway, carrying out this role outside the area and other Chief Executives doing so within Kent and Medway.

(d)       Commissioning Support Services (CSSs) were being established to provide back office functions such as finance. There was a capped budget of £25/head of population for CCGs to use on management which was a change from the past. Running costs locally were already at this level.

(e)       There was discussion about how far CCGs would differ from current Primary Care Trusts (PCTs). It was explained that CCGs would receive about 80% of the budget (proportionally) that PCTs currently received but that overall the PCT budget and responsibilities were being divided into four. Along with the CCGs, responsibilities would transfer to local authorities, Public Health England and the National Commissioning Board. On the subject of the latter, it was explained that the work of the NCB would be carried out by 27 Local Area Teams. Although the first wave of directors of these teams had been named, the one for the Kent and Medway Local Area Team had not. It was acknowledged this led to a measure of uncertainty and appointments to the national structures were a concern locally. However, other senior appointments had been made and in the interim, NHS Kent and Medway would continue to exist until April 2013.

(f)         Also at the national level, it was explained that the newly formed NHS Trust Development Authority (TDA) would take responsibility for working with NHS Trusts who were not Foundation Trusts to either ensure they achieved Foundation Trust status, or found an alternative solution. A local example of an alternative solution was the proposed merger between Dartford and Gravesham NHS Trust and Medway NHS Foundation Trust. Contracting and commissioning services at all Trusts would rest with the NCB and CCGs. Monitor was currently the FT regulator but would become the economic regulator for the whole health sector. The NCB, Care Quality Commission and Monitor were under a duty to work together.

(g)       It was stressed that in order to make the system work differently and in an improved manner, there was a need for everyone in the Kent and Medway health economy to make it work. A simulation event had been run to test out different situations. The key role of the Health and Wellbeing Board was highlighted with the CCGs and local authority producing a Joint Health and Wellbeing Strategy to help ensure commissioning plans did not work against each other. Work looking at how things could be done differently and jointly had been undertaken in Dover. There was also joint working more widely with 20 CCGs coming together to commission ambulance services.

(h)        A number of Members asked about the process in the NHS about rehiring people who had been made redundant, and whether this involved redundancy payments being returned. NHS representatives undertook to provide this information later.

(i)         In answer to a specific question, it was accepted that there was nothing new with the concept of patient choice but that it was taking in other areas beyond choice of hospital.

(j)         On patient and public engagement, the same duties around public and voluntary organisation engagement remained, but concerns were raised about communicating with the voluntary sector and NHS representatives undertook to take this back. The local authority and NHS were looking at patient Advisory and Liaison Services (PALS) at the moment as some aspects of the service may sit elsewhere in the future.

(k)        The Chairman reiterated that due to the comments and concerns raised by Members, the Committee would certainly return to the subject and proposed the following recommendation:

·        That the Committee consider and note the report along with the answers given to the numerous concerns raised by Members.

(l)         AGREED that the Committee consider and note the report along with the answers given to the numerous concerns raised by Members.