Agenda item

Glenn Douglas (Accountable Officer, Kent and Medway Clinical Commissioning Group) and Michael Ridgwell (Programme Director, Kent and Medway STP) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. Mr Douglas began by stating that all eight CCGs had now committed to establishing a strategic commissioner and sharing a single senior management team with one accountable officer for Kent and Medway. A sub-committee, comprising of the Chairs from the 8 CCGs had been created to oversee the governance of the strategic commissioner; Dr Bowes (Chair, NHS West Kent CCG) had been appointed as Chair of the Sub-Group. Mr Douglas noted that Hazel Smith had secured a new role with Health Education England; Patricia Davies would now be responsible for partnership working in addition to acute strategy as part of the new shared management team.

(2)       Members enquired how the establishment of the strategic commissioner would affect the individual responsibilities and priorities of each CCG. Mr Douglas explained that all eight CCGs were committed to working together on strategic areas in order to provide consistency and reduce duplication with providers. The overall aim of the strategic commissioner function was to simplify the process of contracting and make savings.

(3)       In response to a question about stroke services in Thanet, Mr Douglas confirmed that the public consultation had closed and that the responses would be independently analysed. He noted that in Thanet, a degree of support for the proposed model had been expressed however there was a desire for a Hyper Acute Stroke Unit to be sited at the QEQM. He explained that the next stage of the process would involve Tony Rudd (National Clinical Director for Stroke) working with the clinical chairs to establish a clear evaluation process around the options, taking into account public consultation responses, which would lead to the options being re-evaluated and mitigations put in place prior to a decision being taken by the Joint CCG Committee in autumn 2018. Mr Douglas reported that there had been a change in leadership within Thanet CCG and a candidate had been put forward to the Thanet CCG governing body for approval.

(4)       Members sought clarity about the commissioning of primary care and the future of the strategic commissioner. Mr Douglas confirmed that primary care would remain locally, and that each individual CCG would retain responsibilities for primary care commissioning. He stated that the only change had been the creation of a shared Accountable Officer for the Kent & Medway CCGs. He informed the Committee that over the next 9 - 12 months there would be further discussions about whether the strategic commissioner would continue to act as a subsidiary to each of the CCGs or if there would be a move towards a single CCG, forming a statutory body; if that was to happen, plans would need to be put in place to determine what services would be provided locally. He stated that all CCGs were working together to map out what a future structure may look like. He reported that whilst legislative change, in terms of structure, by 2019/20 was unlikely; the local system was able to do things, such as running in shadow form, to move forward. He noted that GPs were supportive of strategic commissioning and recognised the need to work together to support services in Kent & Medway going forward. 

(5)       Members enquired about financial balance in Kent & Medway and the governance of strategic commissioner. Mr Douglas noted that each CCG was currently responsible for its own budget however there was a national move towards a single control total which would cover both CCGs and providers.  Mr Douglas stated that each CCG had an existing governance structure which would remain in place. A new governance structure to incorporate the strategic commissioner was being developed. He noted that workshops for independent CCG members were taking place about holding the strategic commissioner to account.

(6)       Members asked about joint commissioning, the cost of the restructure and overall deficit in Kent & Medway. Mr Douglas noted that he was actively engaged with KCC with regards to joint commissioning; he stated the importance of maintaining relationships with borough councils too particularly for engaging with local people and acting as a gateway into the voluntary sector. Mr Douglas explained that he anticipated that the new structure would result in savings. Mr Douglas committed to sending the Committee the total 2017/18 financial deficit for Kent & Medway when available.

(7)       Mr Inett enquired about the East and West Kent commissioning split. Mr Douglas explained that commissioning took place at two levels, strategically and locally. The middle tier split was an administrative convenience and focused on the major providers in East and West Kent. He reported that there was very little overlap between the two communities in terms of NHS services. He noted that there may be greater collaboration between providers in the future as part of accountable care systems.

(8)       The Chair enquired if Mr Douglas was confident in having the support to make changes to the structure going forward; he confirmed that he was. He noted his confidence in the leadership of the CCGs and their shared objective to move forward.

(9)       RESOLVED that the report on the Kent and Medway Strategic Commissioner be noted and that the Kent & Medway STP provide an update to the Health Overview and Scrutiny Committee in six months’ time.