Agenda item

Future arrangements for NHS commissioning



This paper aims to provide the Oxfordshire Joint Health and Overview Scrutiny Committee with an overview of future commissioning arrangements across Buckinghamshire, Oxfordshire and Berkshire West (BOB) and seeks feedback on the proposals.


Joan Stewart of Oxfordshire Keep Our NHS Public urged the Committee to insist on a formal public consultation on the proposed merger of Clinical Commissioning Groups.  She maintained that it was more than just streamlining.  It was being designed for key stakeholders.  There were concerns that a more remote CCG would be more difficult to hold to account.  The merger is not inevitable – GPs have stopped similar mergers elsewhere.  She circulated a letter from the NHSE to her local MP on the matter.


Charlotte Bird of Keep The Horton General stated that the proposed merger would make things more difficult for the ‘Banburyshire’ area.  Although Banbury is the second largest town in Oxfordshire its hospital services have been whittled away.  Thirty three percent of those attending live outside Oxfordshire – mostly in Northants and Warwickshire.  Her group has already found it very difficult to get early communication with OCCG and OUH on proposals and this will be even more difficult in the proposed BOB footprint.  Most BOB members will not have visited Banbury – it will be an afterthought.  The commuter areas in the south of the region will be prioritised.


Surveys about the next five years' services were put on the CCG's and OUH's websites but no information whatsoever was given to the Banbury local newspaper despite requests.  She asked that the Committee insist that these organisations keep the Banbury press fully informed and to ensure that Keep The Horton General is fully involved in BOB CCG planning and that the needs and geography of Banburyshire are fully considered in future strategy.


The Chairman noted that there was no mention of scrutiny in the report or the presentation.  This was one of the Committee’s main concerns.


Louise Patten, CEO OCCG, gave a presentation on the BOB CCG engagement.  She said that there was already joint commissioning on ambulance services, for example, because that was the most effective level.  The Integrated Care Partnership is the key part.  There are no plans to change services - it’s about managing commissioning.


The experience of the Horton HOSC involving a number of counties has been useful.  Banbury will be the next area for health and social care planning which will involve the Horton and stakeholders.  She would welcome the way it will broaden the discussion beyond acute services.


The CCGs are member organisations and GP practices will vote in each one.  The NHS could impose a decision, but they would be mindful of the size of majority in the CCGs.


Ansaf Azhar, Corporate Director of Public Health, added that there has been a lot of integration of services at a local level.  There is an emphasis on prevention across the spectrum which should have positive impact on demand for services.


The Chairman added that there was a meeting of HOSC Chairs in the BOB area, Councillor Mike Fox-Davies attended for him.  They have asked for guidance from the Secretary of State whether scrutiny of BOB will be at the BOB level or will continue at county level.  It is expected that BOB will account for about 20% of commissioning while 80% will still be local.


Councillor Laura Price asked, if it is not about service changes, why joint commissioning cannot happen anyway.  It’s not changing the people, they are all meeting together anyway.  She said she could not see how it is going to change anything.  There were no tangible examples given.  She asked how it would help with Delayed Transfers of Care or recruitment of care workers for example.  She noted that with the Mental Health budget delegated to providers there is no democratic oversight.  They are late coming to the committees with information and out of line with the Council’s budget system.  She asked how BOB will fit in with the Council system?


Louise Patten responded that it is just a management restructuring.  She has never seen this level of engagement for a restructuring before.   It tends to be more about service change.  In setting the ICP we will develop our local plan.  Most decisions will stay local.  With the Mental Health contract there will be a prime provider.  The next step will be to get the local accountability.


Barbara Shaw noted that when Primary Care Networks are given money it ends up with a scattering of providers.  She asked how that will be scrutinised to ensure patients get the best services.


Louise Patten responded that governance will be dealt with in the February report.  It will show how it looks in generic form and put that in the public domain.


Dr Alan Cohen asked about oversight of ICP by the Health and Wellbeing Board.  He noted that elected councillors were a minority on the HWB.  Mostly it would be the same people reviewing themselves.  Louise Patten responded that it has worked that way in Bucks for two and a half years and does not stop scrutiny.


The Chairman stated that he will write to the Health and Wellbeing Board on this matter.


District Councillor Paul Barrow asked if a 20% saving on administration is realistic given that there will still be two levels operating.  Louise Patten described how the merger would avoid the duplication of service design in each CCG for example.  They are already working together and are confident they can deliver on those savings.


City Councillor Nadine Bely-Summers expressed concern about the mental health budget being opened to private providers.  Louise Patten responded that there was one main provider with others subcontracted, including some third parties.  She felt that scrutiny of management and services were being mixed up.


Councillor Jane Hanna asked if meetings of a merged CCG will be in public.  Louise Patten confirmed that they will be in public either way.


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