Agenda item

Simon Perks (Director of System Transformation, Kent and Medway STP) and Dr Bob Bowes (Chair, NHS West Kent Clinical Commissioning Group Governing Body) were in attendance for this item.

(1)  Mr Perks explained to the Committee that much had happened since the update to HOSC in November 2018, and that the current meeting was timely to update Members on the progress as well as future arrangements around commissioning health services across Kent and Medway.

(2)  Dr Bowes explained several of the drivers behind the proposal for eight CCGs to dissolve and a new single CCG to be created:

                      i.        The current structure made it difficult to make large scale strategic decisions.

                    ii.        There was a national mandate for CCGs to reduce their management costs by 20%.

                   iii.        A single, larger, CCG would allow for a wider pool of expertise.

(3)  Giving additional context to the second point in (2), Members were informed that only 3% of the NHS budget was spent on management.

(4)  Responding to the third point in (2), a Member commented that CCG responses to planning applications were not always robust. Dr Bowes explained that this was in part due to individual CCGs not having the required expertise due to their smaller size.

(5)  NHS representatives continued to explain the broader context behind the proposal. The creation of internal markets in the 1990s had led to a lack of integration across the sector and its partners. It had created an environment where, in some cases, individual patients had to deal with many professionals as there was no single point of oversight of a patient’s care. This led to duplication and inefficiencies.

(6)  The Long Term Plan set out the push for collaboration, though this would not be without difficulties due to the cultures embedded in each organisation, along with multiple, legitimate, views of what was best for individual patients. Integration presented an opportunity for a more patient centric view.

(7)  Mr Bowes acknowledged that there were mixed views around GPs leading commissioning of services, but he considered this clinical input very important as it gave decisions clinical authenticity.

(8)  Members were concerned that high level decision making would fail to meet the needs of individual districts and people, and that the changes echoed structures from the past. Dr Bowes acknowledged that arrangements for the health service had oscillated between strategic and localised structures. He explained that the new system would see a high-level partnership (the single CCG) set the desired outcomes, as informed by the Population Needs Assessment (and Kent Integrated Dataset), and then the four Integrated Care Partnerships (ICPs) would decide how best to deliver those outcomes based on available resources and needs.

(9)  The future arrangements would see each ICP held collectively responsible for its population’s health outcomes, whereas at that time they were only responsible for delivering the activity.

(10)               Members questioned where Social Care and Public Health, services delivered by the local authority, fitted into the future arrangements. Dr Bowes said there was a growing awareness that health and care services at all levels needed to work better together. Examples of good practice at practitioner level had been seen within Multi-Disciplinary Teams. Integration of health and social care at managerial and commissioning level was more challenging because of cultural differences, but he felt it was very important to explore the ambition, otherwise there was a risk of missing the opportunities integration could bring.

(11)               With regard to the integration of Public Health, Dr Bowes explained there were two aspects: i) understanding the populations needs and ii) preventative care. This work would largely take place within the Primary Care Networks (PCNs) and what would in the future be called Local Care. There had been significant work carried out within the Local Care workstream to ensure a better offer of preventative care was delivered.

(12)               Dr Allison Duggall, Deputy Director of Public Health at KCC, added that there was a workstream underway around prevention within the future commissioning arrangements and evolution of Integrated Care Systems (ICSs). She reiterated the need to work with other parts of the system, and consider prevention at primary, secondary and tertiary levels.

(13)               Members asked about the process for the 8 CCGs to become a single organisation. Dr Bowes clarified that there was no requirement for a change in legislation in dissolving the 8 CCGs and creating a new, single CCG. Members of the current 8 CCGs would be asked to vote on the proposals in late summer of 2019. An application would then be made to NHS England and if successful, it would then be approved by the Secretary of State for Health. The intention was for a single CCG to be in place by April 2020.

(14)               Members questioned the ability of PCNs to operate from fit-for-purpose premises considering the constraints on capital finance. Mr Perks confirmed that NHS capital budgets were severely constrained, and this would need to be addressed by Government. However, he also explained that PCNs were not synonymous with GP surgeries and they would be carrying out new functions. Their premises would be an enabler but were not system critical.

(15)               RESOLVED that the report be noted, and the Kent and Medway STP provide an update at the appropriate time, which would likely be once the single Strategic Commissioner in shadow form had been established.