Agenda item

A message from the Save Lewisham Hospital Campaign had been circulated to all Members, and an article dated 20^th September 2019 was also tabled. Members allowed Dr Tony Anderson of the Save Lewisham Hospital Campaign to address the meeting.  Dr Anderson stated that the merger proposals would remove important elements of local cooperation between the NHS and local authorities, and that there was no mention of the role of scrutiny under the new arrangements. He referred to other areas where similar proposals had been challenged and delayed. He considered that the duty to consult with local people on merger proposals had not been carried out and that terms of reference for the borough based boards and future arrangements for public and local authority involvement needed to be set out. Dr Anderson concluded by calling for the Joint Committee to ask for the process to be halted.

Martin Wilkinson, Managing Director Lewisham CCG responded to Dr Sullivan. He considered that the role of overview and scrutiny was not changed by the proposals at borough or South East London level. There were some minimum expectations from the NHS around borough based boards, but there were no terms of reference because the intention was to work with local authorities to deepen work on commissioning and discussions were on-going on these matters within all the boroughs. Issues like terms of reference and membership would be worked through in the next phase - a governance pack, including terms of reference for borough based boards, was being put together, but this would be subject to agreement by all six CCGs in the next six months. Borough based boards would still have the resources to work with local authorities on public engagement. An amendment to the paperwork submitted was that a committee was being set up to ensure that public engagement activities were strengthened. He was certain that the national guidance made clear that this was a structural change for the NHS which required engagement with stakeholders, but not formal public consultation.

Andrew Eyres reported that Lambeth CCG had discussed the proposals at a meeting that day, but members had asked for more information before coming to a decision.  He was about to take up a new Director role employed jointly by the CCG and Lambeth Council with a role on the new governing body if the merger took place. The proposals offered an opportunity for the boroughs to work more closely with the NHS.

Councillor Mark James asked whether unanimity was required amongst the six CCGs for the merger to take place. If Lambeth did not support the proposals it would not be able to take part, and then there would be concerns about how it would be able to respond to some of the strategic issues in the Long Term Plan. The Chairman asked whether the further information requested in Lambeth could be made more widely available; this would be possible, but the information was largely about Lambeth place arrangements and other boroughs might want to make other arrangements. Applications had to be made in September, but final decisions by the Regulator were expected in mid-October.

Councillor Victoria Olisa stated that she was disappointed that there was not an outline of the proposals that members could comment on. The timing of the meeting in September was to give members the opportunity to feed into the proposals before the end of the month. There appeared to be several timelines running, but information on key areas that had been requested in July had not been provided.

Christina Windle, South East London Commissioning Alliance, confirmed that the document provided to the Committee was the outline application as considered by the governing body (there were some additional technical papers) and there was also information about the engagement that had been undertaken. She accepted that there were very complex timelines and there was a need for consultation with staff. It was not now expected that the shadow governing body would be in place until January. One change since July, made after comments received, was that there would be more GPs on the governing body.

Cllr James Hunt was disappointed that there the NHS had decided that there should be no consultation and commented that the plans were rushed - in other areas the process was being slowed down. Cllr Richard Diment agreed with this and stated that due diligence had not been completed. Dr Angela Bhan, MD Bromley CCG, commented that the proposals had been under consideration for up to a year and a half, and staff wanted to see some certainty about what was happening.

Cllr Mary Cooke accepted that there had been briefings, but stated that this was largely about saving money and if local authorities were expected be  more closely integrated with the NHS in joint commissioning then they needed to feel that they had been more fully consulted. 

The Chairman referred to the decision some years previously to set up co-terminus local health authorities, and stated that councillors now needed to ensure that if these arrangements were lost they would still be able to scrutinise and ensure that sufficient funds were available for local boards to ensure good quality local services, if necessary by challenging the merged CCG. Councillors also needed to scrutinise acute services, particularly in relation to access and transport. The Committee had asked on many occasions for spending figures by borough now and in future with local boards and a central CCG. Members also needed some definition on how commissioning could be sustainable and lead to savings, particularly as the aspirations in the Long Term Plan seemed to imply growth. Councils needed to know how the new structures would be scrutinised to ensure better outcomes for patients, value for money and good clinical leadership, and be reassured that when they asked for information it would be provided. However, there was no business case and budget analysis for the changes. 

Martin Wilkinson responded with assurances that scrutiny of local boards and the central CCG would continue to be supported by the NHS, and that there was a genuine desire to deepen commissioning arrangements with councils.  Current CCG budgets were public information; in future, allocations would be made to the central CCG but how this was allocated to borough based boards would be open to scrutiny. He confirmed that the conversations with each borough about local boards would continue.

Councillor David Noakes whether there was scope to delay the process - the application to NHS England had to be submitted by the end of the month, and if the timetable slipped then the proposals could not go live in April 2020.

Christina Windle confirmed that terms of reference for borough based boards could be flexible, beyond a core consistency around NHS membership, and agreed with each Council.  The chairman commented that the role of the joint overview and scrutiny committee would be strengthened. 

The chairman explained that there had been local agreement to proceed by the local CCG’s, apart from in Lambeth, and there had been no opposition from her own authority, so she could not therefore oppose the proposals. She also considered that there would be no legal grounds to challenge proposals which were about internal CCG organisation. 

Andrew Eyres stated that that they were working with individual boroughs and collaborating across boundaries in many different ways, but this was a step-change towards a merger of organisations. This was an administrative change and did not involve any service changes - these would still remain subject to scrutiny.  The proposals were about doing things better at a wider scale, but sometimes work would need to be done in neighbourhoods and localities. It was not possible to design this all in advance - some things would be designed along the way with partners and other organisations. It was about better decisions to get better outcomes for local people.

The Chairman stated that the Committee was often reassured by what was said by NHS staff in its meetings, but then commitments made were not followed through in the papers of the next meeting. Martin Wilkinson proposed an informal joint workshop session to consider arrangements for scrutiny, and put in place any protocols that would assist in future. Cllr John Muldoon suggested that the Stakeholder Reference Group, chaired by Peter Gluckman, should be asked to consider this. The Chairman suggested that, rather than attempt to find a separate date in the diary, this could be done as an extra session an hour before the next meeting. Cllr Victoria Olisa asked for this to include a written briefing for Members. 

Christina Windle emphasised that the change had been planned for a long time. Although this was only the second time that the matter had been brought to the Committee, there had been discussions with local authorities for some time. The Chairman explained that it was necessary for issues to be aired at scrutiny committees, not just in camera with executive members or senior officers.

Christina Windle explained that some information, for example about budgets, could not be known at this time of year, but she could make a commitment that information would be shared, even when answers could not be provided straight away.

Cllr James Hunt reminded the joint committee that their concerns should be set out in a letter to NHS England.

Agreed that

(1) the Committee expresses its concern at the late involvement of local authorities and lack of detail available that led us to feel excluded from this process and not allowed us to have the level of scrutiny that we expected. The Committee requests that the process is slowed down to enable proper scrutiny to be carried out.

(2) a letter be sent to NHS England to express the Committee’s concern.

(3) lessons be learnt from the lack of engagement with scrutiny, and an informal joint workshop be held before the Committee’s next meeting, with a written briefing circulated to Members in advance, to consider future scrutiny arrangements.