To consider any requests received in accordance with Part 4, Section B, Paragraph 29 of the Council’s Constitution.
Minutes:
The Chair informed the Board that a request had been received from Mr Alan Morton, Chair of the NCL NHS Watch, to put forward some issues in relation to item 10 of the agenda pack, proposed merger of CCG’s within North Central London. The Chair advised the Board that in accepting this request that it be noted that the CCG governing bodies within North Central London were considering these proposals and the Board was being asked to note and discuss this update in its role as partners in the community.
Mr Morton was invited by the Chair to put forward his representations to the Board. Mr Morton introduced the Board to his representations as set out in the document titled ‘NCL NHS Watch’, which was circulated to the Board at the meeting. Mr Morton highlighted concerns around governance and privatisation as a result of the proposed merger of CCG’s within North Central London.
Although Mr Morton welcomed the NLP plans around prevention work and new screening, he informed the Board that there was insufficient detail on how those plans were to be actioned, and that there had been a small amount of public consultation or engagement.
Mr Morton mentioned that the NLP’s budget deficit was about £200 million a year of a £2.1 billion a year budget, which amounted to about a 10% a year deficit. Mr Morton stressed that the deficit was not the fault of the North London Partners (NLP) because the main reason for the deficit was due to deliberate government underfunding. Mr Morton was concerned that the deficit would put pressure on the NLP and result in the NLP selling assets to fund its deficit. Additionally, Mr Morton raised concerns regarding cuts in services due to the deficit.
In relation to governance, Mr Morton wanted to know how residents, staff and councillors would be involved in decisions in health care. He pointed out that there would be inadequate representation of the local authority at the Governing Body of the NCL CCG as only one local Councillor from North Central London would be able to attend the Governing Body Committee that would meet four times a year and that Councillor would not have a vote. He further added that plans were unclear in relation to the Health and Wellbeing Board and Haringey’s CCG. Mr Morton informed the Board that despite the advice in the equality impact assessment of the Proposed Merger of NCL CCGs report; the rationale, process, timetable and expected outcomes for the merger was not clearly explained. Mr Morton further explained the long-term implications of the proposed merger, which included privatisation of services and a system of financial cost based on ability to pay. Mr Morton urged the Board to ask the NLP the difficult questions he had put forward in his representations.
The Chair invited officers to respond to the representations.
Tony Hoolaghan, Haringey CCG - Chief Operating Officer, thanked Mr Morton for his representations. In response to the representations, the Chief Operating Officer made the following points:
a. The Board was informed that it was agreed as part of the NCL CCG merger that all the investment in primary care, mental health, community health services would all be protected. It was further added that the funding would be allocated to where it would be needed rather than it being divided by five boroughs, which would be positive for Haringey as the historical levels of investment in primary care and community care was less in Haringey and Enfield in comparison to other Boroughs in North Central London.
b. In terms of engagement, the Board was advised that it was the statutory duty of a Clinical Commissioning Group to engage with the local population, and that would continue as a merged CCG. It was noted that there was a genuine commitment to engage with the local population and there would be many forms of engagement work that would be undertaken, such as patient public involvement, websites, newsletters, and meetings on specific topics.
c. Regarding local authority representation, the Board were informed that none of the Governing bodies in North Central London had a Councillor on them. The Board were advised that Governing bodies needed GPs in the majority. The rules on the configuration was nationally set. The Board were informed that a request had been made for a Councillor from NCL to be on the Governing body. However, it was explained that considering there were five boroughs involved, additional representation would potentially create an enormous Governing body committee, which already included the Director of Public Health of the Council and local authority representative.
d. The NCL CCG merger was part of the implementation of the NHS plan to create an integrated care system (ICS) by April 2021, which entailed collaborative partnership work among commissioners and providers, the NHS Trust, Councils, Health Watch, voluntary sector and local people. NCL would be delegating decisions and budget down to Borough level. It was noted that there was currently a process of setting up a Borough partnership, and it was explained that there was a lot of activity being carried out at Borough level.
e. Regarding primary care networks, the long-term plan would be around collaborative partnership work and moving away from competition to ensure there would be less procurements in the future.
The Chief Operating Officer advised Mr Morton that he would be happy to discuss any of his concerns further outside of the meeting.
The Chair thanked the Chief Operating Officer for his response, and thanked Mr Morton for his representations.
At this point in the meeting, the Chair noted, at the request of officers, the variation of the agenda to consider agenda item 9 ‘North Central London (NCL) Long Term Plan’ jointly with agenda item 10 ‘Proposed Merger of CCGs Within North Central London’ to allow for discussion and comment on the changes at the North Central London level. The order of the minutes reflects the order that the business was taken, rather than the order on the published agenda.