I sit on the North West London Joint Health Overview and Scrutiny Committee (JHOSC), alongside seven other local authority representatives. It was set up in 2013 to review Shaping a Healthier Future – the NHS transformation programme for north-west London.
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. What interests me is reflecting on the challenges facing members sitting on a joint committee such as this 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 also 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 2020/21, individual CCG running cost allowances will be 20 per cent 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?
It will still be a big, demanding topic to look at in committee. But, as scrutineers, I think we can feel more on top of it, and better prepared, by working through it layer by layer.