Should local GPs or a county-wide committee make Lancashire's key healthcare decisions?

At what level should health decisions be taken in Lancashire?
At what level should health decisions be taken in Lancashire?

Plans to create a single organisation to commission healthcare services across the whole of Lancashire and South Cumbria have been criticised by a powerful committee of councillors.

The region currently has eight clinical commissioning groups (CCGs), made up of GP representatives who decide which hospital and community services should be purchased on behalf of patients in their areas.

Lancashire and South Cumbria NHS commissioning boss Andrew Bennett

Lancashire and South Cumbria NHS commissioning boss Andrew Bennett

But the long-term plan for the NHS, published earlier this year, suggested that those decisions should be taken at a broader level – with just one CCG by April 2021 for each of the 44 regions charged with better integrating health and social care within their borders.

However, the proposals drew derision from members of Lancashire’s health scrutiny committee.

Preston city councillor and former South Ribble MP David Borrow, said that the current structure of the NHS “cuts out elected politicians” – and that the proposed changes would make matters worse.

“There is a democratic deficit already – and this model makes it even more difficult to get in touch with the people who make decisions [within the NHS]…to raise their constituents’ concerns,” Coun Borrow said.

County Cllr David Whipp

County Cllr David Whipp

Chorley councillor Margaret France, who spent 20 years as a GP, said that the NHS had gone through decades of reform and was now reverting to the type of commissioning system which had been in place in the early 1980s – and she condemned a culture of continual change.

“We see the same people with a different title, in a different office and with a different uniform – and they’re doing the same job. Money is being wasted every time these reorganisations take place,” Coun France said.

Meanwhile, Liberal Democrat county councillor David Whipp blasted what he likened to Soviet Union-style “centralised planning”.

But Andrew Bennett, executive director of commissioning at the Lancashire and South Cumbria integrated care system (ICS), said any changes were about “doing the right work at the right level” – and a more collaborative approach.

“The [previous] reforms of 2012 were chaotic and led to a fragmented service of commissioners and competitive providers that were expected to dance together in a market approach.

“It’s really unfortunate that [the current plans] become toxified in the rhetoric – [they are] about partnership working, not centralisation. This is a system which is reaching a place of maturity.

“The vast majority of staff who work [in the CCG areas] would continue to work in those places,” said Mr Bennett, who added that it would be possible to “design in” the involvement of councillors in any new arrangements.

The meeting heard that the memberships of each CCG would have to agree to any merger. Earlier this summer, the Greater Preston and Chorley and South Ribble CCGs – which already share almost all of their staff – rejected a merger plan in Central Lancashire and voted to remain separate entities. However, from later this year, the governing bodies will hold joint meetings, but take separate votes - ending the current arrangement which sees the two organisations meet separately to.discuss usually identical agendas, at different venues, on consecutive days every two months.

Three years ago, a joint committee of all eight Lancashire and South Cumbria CCGs was created with the aim of reducing variation in the range of services available to patients in different parts of Lancashire - and to bring the healthcare system into financial balance. The committee has made decisions on standardising access to services such as diabetic testing devices and treatments for back pain. However, its powers are derived solely from the individual CCGs which sit as part of the joint group.

Scrutiny committee members were told that any money saved by having a single CCG could be made available to the new ‘neighbourhood’ areas recently created across the region to join up NHS, council, community and voluntary services in local areas.

That new way of working forms part of a five-year strategy which the ICS has to draw up by mid-November to indicate how Lancashire and South Cumbria will respond to the challenges laid out in the NHS long-term plan. As well as moving to just one CCG, that document is likely to include detail on a single “group model” for hospital co-operation across the region, work to improve mental health and plans to create new partnerships with other parts of the public sector.

The committee was asked to provide feedback on a draft document, but concluded by a majority that there was not yet enough detail to conclude whether they supported the ideas or not – and invited representatives of the ICS back to County Hall in two months’ time.

A call from committee member and county councillor John Fillis for the committee to state overtly that concerns over accountability meant that the plan could not be supported “at this time” was voted down.

County Coun Eddie Pope said that broader public involvement was also needed.

“[You have surveyed] 1,000 people out of 1.7million – that’s not consultation,” County Coun Pope said.