How do you scrutinise health services across a large area?

By Ketan Sheth

Many members of health overview and scrutiny committees will feel that their role is a complex one. In my experience, this area of scrutiny becomes even more demanding when there is a joint committee, involving a number of local authorities, to scrutinise health services across a large area.

I sit on the North West London Joint Health Overview and Scrutiny Committee (JHOSC) alongside seven other local authority representatives which was set up in 2013 to review Shaping a Healthier Future – the NHS transformation programme across north-west London. This year it was confirmed that Shaping a Healthier Future was no more, so you might be thinking that there would never be such a complex issue for a joint health committee to review. You’d be wrong.

A major change is afoot, but this time it’s more on the commissioning side of health services. On the back of the new NHS Long Term Plan, there’s now active consideration of a proposal to merge all eight of the clinical commissioning groups (CCGs) covering north-west London into one body. This would create a body commissioning health services for about 2.2 million people across eight boroughs. It’s linked to an intention in the Plan, for Integrated Care Systems linked to single commissioning bodies. Parts of the machinery for just one CCG have been around in north-west London for a while. The CCGs, a while ago, set up their ‘collaboration’, which has a joint finance committee, and there’s nothing new about co-commissioning among a number of CCGs. I don’t want to dwell here on the pros and cons of the proposal – we’ve had one JHOSC meeting to focus on it and shortly we’ll have another. But what interests me is reflecting on the challenges for members sitting on a joint committee who have to review such a large-scale project.

The first obvious point is that this is an enormous topic and the implications are profound. To my mind as a scrutiny member, the only way that you can start to understand the proposal and prepare for the all-important committee meeting is by breaking down the topic into smaller chunks. One way to do this is to look at the published NHS papers and ask some obvious questions based on: how, when and why.

The ‘how’ is key. According to NHS England guidelines for merging CCGs a “merger should not unduly distract the existing CCGs from business as usual, including delivering core performance standards and achieving financial balance.” So, straight away there’s one interesting line of enquiry here – how will the CCGs manage this process, if it goes ahead, and how will they be able to run existing services effectively?

The ‘when’ is interesting. The NHS Long Term Plan describes an intention that by April 2021 all of England will be covered by an Integrated Care System, involving a CCG or CCGs working together with partners. But in London, things are moving quite a bit faster and the intention at the moment is to have a single CCG for north-west London by April 2020. Again, this raises an interesting question: what are the risks of this pace of change?

Let’s look at the ‘why’. It would be unfair to say there was a single reason. But the NHS Long Term Plan says by “by 2020/21, individual CCG running cost allowances will be 20% lower in real terms than in 2017/18 and CCGs may therefore wish to explore the efficiency opportunities of merging with neighbouring CCGs.” This brings up more lines of enquiry such as will the cost-savings be achieved and what happens if they are not?

So, it will still be a big, demanding topic to look at in committee. But already, I think as a scrutineer I can feel more on top of it, and better prepared by working through it layer by layer.

ketanKetan Sheth is Councillor for Tokyngton Wembley and Chair of Brent Council’s Community and Wellbeing Scrutiny Committee.




All views in this blog are those of the author and do not represent those of INLOGOV or the University of Birmingham.









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