To note the NCL CCG merger verbal update.
Minutes:
The Chair outlined that the merger to become a single NCL CCG [ North Central London Clinical Commissioning Group] took effect from the 1st April 2020. Haringey Clinical Commissioning Group employees now worked for the NCL CCG. The Chair invited Tony Hoolaghan, Executive Managing Director, Haringey & IslingtonNorth Central London CCG to outline how, operationally the NCL CCG, were working with the Council and the infrastructure in place to respond to the pandemic.
The following was noted:
· Francis O’Callaghan was the new accountable officer for the North Central London Commissioning Group and had arrived in February 2020, just before the pandemic had started. Francis was aiming to attend the Health and Wellbeing board meetings as part of her induction but was at an annual management event for this meeting. She was keen to attend and speak about the work of the CCG services going forward.
· There was a modification to the CCG members attending the Health and Wellbeing Boards in the respective 5 boroughs due to the leaner governing body arrangements now in place. It was clarified that, going forward, Dr Peter Christian, the North Central London Governing body GP representative and the Executive Managing Director for the CCG would continue representing the Haringey and Islington, CCG at the Health and Wellbeing board meetings. On occasions when Dr Peter Christian could not attend the HWB meetings, Dr John Rohan would substitute as he was also a GP member of the North Central London Commissioning group.
· Rachel Lissauer would be attending the HWB meetings as Director for Transformation for Haringey and Islington North Central London CCG when the Executive Managing Director was unable to attend. The North Central London CCG would be writing to the Chair to confirm these attendance arrangements.
· A summary of the actions and events to enable the merger of the 5 borough CCG’s [Haringey, Barnet, Enfield, Camden and Islington] to become one North Central London CCG was provided This was a prescribed process which required meeting the requirements of the NHS England Regulator and demonstrating that the merged CCG can fulfil required statutory functions.
· Despite the pandemic, the merger had completed and single CCG status was achieved and went live on the 1st of April. This meant that all the staff employed by Haringey, Barnet, Islington, Enfield and Camden CCG’s transferred to the North Central London CCG.
· The Haringey CCG staff were called part of the Haringey Partner directorate of the North Central London CCG and remained in Haringey, located in River Park House. There would be staff located, centrally, in NCL CCG and working in the 4 other CCG boroughs.
· The entire NHS and CCG’s [ Clinical Commissioning Groups] continued to be working at level 4 of the national incident emergency operating mode because of Covid 19 pandemic. It was noted that the infrastructure was in place to respond to the pandemic in North Central London as a CCG.
· Partner organisations had set up a number of work streams to deal with the pandemic, focusing on key areas such as primary care, hospital services and were working closely with the Council and the voluntary sector at NCL level.
· There were transformational achievements of working together as partners, concerning care homes, stepping people out of care in hospitals and into their homes.
· To support the CCG merger and, due of national requirement to reduce their running costs by 20% but the end of this financial year, there was already a significant management restructure taking place in the North Central London to enable a move towards a single CCG management restructure. It was noted that the restructuring process had paused in March because it was not feasible to continue with this exercise and respond to the pandemic. However, the North Central London CCG would need to resume this exercise and were considering the appropriate time to do this.
· There were positive outcomes as a result of the broader partnership working together in the borough. The integrated system partnership allowed partners to work together to respond to the health and care needs of residents. The Integrated care system and borough partnership was a key piece of work and a central part of plans. Rob Hart who was the Chief Executive of the Royal National Orthopaedic Hospital had become the executive lead for the Integrated care system in North Central London. Mike Cooke, a previous CE of Camden Council was also the Chair of the Integrated Care System Board.
In response to questions from Sharon Grant, Chair of Healthwatch, Cllr Blake, Cabinet Member for communities and Equalities, the following information was noted:
· Concern on lack of representation, for Healthwatch and, in turn, residents in the new CCG governance arrangements. It was questioned who would be challenging partners and representing patients and the public. Currently, the position was unclear with only one Healthwatch representative on the new governing board, representing 5 boroughs. The Chair of Healthwatch underlined the importance of patient involvement in the policy process and this was also key issue in the response to Covid and transformation of the NHS. In response, Tony Hoolaghan referred to the previous meetings held with Healthwatch to discuss this issue, and advised that there was official public participation in the subcommittee of the governing body. The meetings of the North Central London CCG would take place in public and Healthwatch were welcome to participate in these meetings. The governance structure was approved by the NHS England regulator and the new merged NCL CCG would keep the governance arrangements under review. Healthwatch were welcome to put forward their views on what was working well in the new governance arrangements and what could be improved going forward.
· The Chair of Healthwatch underlined the statutory function of Healthwatch and how this could not be shifted. The organisation had an obligation to the public to be the voice of patients and would be making representations at the senior levels.
· Cllr Mark Blake was concerned about decision making processes of the NCL CCG and questioned how the Council would be involved in the commissioning process. He further sought understanding of how the Council can work effectively as a community partner in this structure. In response, it was noted that there would not be a lot of decisions made in the borough at the top level of the NCL .There would be a small thin layer at NCL level to allocate the funding, considering the outcomes that were expected at borough levels. This was not top down approach to governance. There was also in place the Borough Partnership board and the Chief Executive of Haringey was co- chair of this with Siobhan Harrington, CE of Whittington Health Trust with representative from Healthwatch and the voluntary sector and there will be decision making by this partnership on a range of issues such as primary care, mental health, community health services, section 75’s.
· It was noted that the CCG is a statutory organisation and they will make some decisions at a North Central London level. Tony Hoolaghan offered to provide a note setting out the decisions that are expected to be made at the borough level and those to be made at the NCL level. It was also important to note that the borough can have an influence on the NCL CCG but there would also be decision making at the borough level by the new Borough Partnership.
· In terms of the elected councillor involvement in the process and big decision taken by officials and input of elected officials, The Chief Executive of Haringey was talking to elected members about the role of the Borough Partnership and governance arrangements.
· The Chair of the Board, supporting the points made by Sharon Grant and Cllr Blake, understood the exceptional circumstances that partners had been operating under in the past few months and looked forward to considering future decisions on changes in health and social care being made jointly by partners. There was concern that councillors were not aware of the first meeting of the new merged meeting of the NCL CCG governing board and there were no published papers for this meeting. Although, the current circumstances were taken account of, the Chair of the Board, felt it was important, going forward, to build trust in the wider community and part of his was to ensure that the NCL CCG governing body meetings were accessible to the public and minutes were available on request. The Chair suggested that, in future, it would be useful to have a written update on the NCL CCG merger and implementation instead of the verbal update to support the transparency of working between the Council and NCL CCG.
· In response, it was noted that the change to the way meetings were facilitated was temporary and as part of the current pandemic response. Tony Hoolaghan agreed with the Chair about going back to the way the CCG worked previously with an open and transparent process with all documents available online. Tony Hoolaghan highlighted the good working partnership between the Council and CCG and wanted to maintain this.
· The Chair of Healthwatch responded further on the need to respond to the challenge of inequality as was expected by the BAME communities in the borough and was concerned that, in this context, it was more important than ever for the Healthwatch network, across North Central London, to be involved in policy making. Healthwatch was established in the community and had insights that should be taken forward to policy making to help solve the challenges.