Agenda item

Southwark’s  NHS Clinical Commissioning Group (CCG) have been invited to update  the Commission on the integration of South East London CCGs, and the Southwark branch of Keep Our NHS Public (KNOP), have been invited to contribute to the discussion. KNOP have provided the attached papers.

David Cooper and Steve Lancashire from Keep Our NHS Public (KONP) provided a presentation with reference to the paper supplied. The chair then invited questions and the following points were made:

·  Councillors on the Joint Health Overview and Scrutiny Committee (JHOSC) working across South East London (SEL) said that Southwark Council did not support becoming a partner of the STPs (Sustainability and Transformation Plans) when they were first brought in by central government several years ago to work across the 6 local CCGs (Clinical Commissioning Groups) of South East London (Southwark, Lambeth, Lewisham, Bromley, Greenwich and Bexley). The situation has now moved on and the 6 CCGs are now merged into one and the Our Healthier South East London (OHSEL) programme established.

·  KNOP representatives said that NHS structures are a central government political decision and somewhat out of control. The changes brought in by the Coalition Government under the Health and Social Care Act 2012 was referred to, and the subsequent increase in commissioning outside of the NHS. A member said that the changes brought in at that time included the move of Public Health to local authorities, which has generally been welcomed; furthermore councils have in many ways been commissioning services for longer. The various structural and legal changes to promote integration with social care were referred to, with KNOP emphasising the importance of good relationships to actually effect change and closer working.

·  KONP said that the NHS is underfunded, with more money going to the private sector, and what recent investment there has been for Covid has been directed to the private sector, where they raised concerns about ineffective delivery and cronyism nationally.

·  KONP and members concurred that local scrutiny does offer an opportunity to influence local NHS delivery, integration and community engagement, both through local borough scrutiny, and the JHOSC working across South East London to deliver OHSEL. These are good fora to register concerns about transparency, accountability, and democracy. KONP said  that  most of the governance done by the CCG is by clinical experts , who do have  knowledge and skills , alongside bog accountancy firms like Mckinsey,  with little understanding of the local population , and there is a gap in local democratic representation and limited community engagement . Covid has been given as a reason by the NHS for more limited community engagement however in KNOPs view this was limited even before the pandemic.

·  A member agreed that local politicians ought to be involved in steering the work of the NHS, particularly given the health inequalities of the population of Southwark, and emphasised the importance of a diversity of local leadership. Other members and officers said that presently the clinical lead for the 6 CCGs is a longstanding Southwark local doctor, who trained locally, with a passion and expertise in health inequalities.

·  Members said the OHSEL JHOSC was not meeting as regularly as it once did, which is a concern.  When the JHOSC did last meet community engagement was raised by members as a key issue. There are local discussions with Lambeth scrutiny colleagues and a meeting of the OHSEL JHOSC is planned soon.

·  KNOP acknowledge the enormous challenge of conducting health scrutiny and said they were delighted to hear about Southwark scrutiny members connecting with Lambeth members .They suggested linking up with Lewisham and Greenwich and urged councillors to dig deeper as sometime the communication from NHS can be bland .They did however praise the Southwark NHS local responsiveness, particularly Sam Hepplewhite’s recent work addressing pensioners’ concerns over vaccines.

·  Members said that the 6 borough CCG is now very big and there is a risk it becomes distant from local populations. There are however local level partnership arrangements between the NHS, council, and the voluntary sector, Partnership Southwark,  which Sam Hepplewhite chairs. She was unable to attend for this item, and sent apologies, because of the pandemic and vaccine rollout pressures on the NHS but offered to attend for the March meeting.

·  KNOP highlighted the recent government consultation on Integrated Care Systems (ICS), which are the direction of travel for the merged SEL 6 CCGs. Integrated Care Systems primary legislation is due soon and they recommended councillors keep an eye on this and the governance options that will be pursued locally as the definitions can be quite woolly.

·  The good community engagement that took place at the Southwark and Lambeth Integrated Care (SLIC) was recommended by KNOP as a good model. The SLIC was set up in 2012 for four years and was a partnership of commissioners and providers, with citizens, working together to improve the value of care in Southwark and Lambeth to help local people live healthier and happier lives. The partnership comprised the local GP Federations, the three local NHS Foundation Hospital Trusts - Guy’s and St Thomas’s, South London & Maudsley and King’s College - Southwark and Lambeth Clinical Commissioning Groups, Southwark and Lambeth local authorities and local people, supported by the Guy’s and St Thomas’ (GST) Charity.

RESOLVED

This item will be returned to at the 23 March meeting which Southwark CCG will attend.