Agenda item

To consider any requests received for deputations, petitions, presentations, or questions.

The Chair noted that a deputation had been received from NCL NHS Watch on the Integrated Care Systems (ICS) White Paper, integration and innovation and primary care post-Centene.

Brenda Allan, NCL NHS Watch, explained that NCL NHS Watch had addressed the Committee in March 2021 and that, since then, further information had been provided in a White Paper. It was noted that the written deputation set out a number of concerns and the Joint Health Overview and Scrutiny Committee (JHOSC) was urged to raise these concerns.

It was stated that the core NHS ICS Board was expected to have three additional partners from primary care from the local NHS, from general practice, and from social care. Brenda Allan noted that there was no local authority or public representation and that there was no mention of any documents being open to the public. It was stated that private providers could be on this Board and that they were not subject to Freedom of Information requests. The JHOSC was urged to argue for parity of representation, or at least increased representation, for primary care and local authorities to ensure accountability. Brenda Allan added that NCL NHS Watch believed that independent providers should be excluded from resource allocation boards.

There were concerns that the proposals set out in the White Paper would result in the increased allocation of contracts to private providers. NCL NHS Watch asked the JHOSC to argue to make NHS organisations ‘preferred providers’.

Brenda Allan noted that the social care proposals had been further deferred which was concerning and that the plans for public health were brief. She asked the JHOSC to argue for more investment in social care and public health and for comprehensive reform of social care.

NCL NHS Watch noted that there had been a significant shift to virtual services, particularly as a result of the Covid-19 pandemic, but considered that face-to-face consultations should be made a right for patients. The JHOSC was also asked to urge the reconsideration of capped budgets which may have a significant impact on health services, particularly following recent reductions in funding and spending required to react to or recover from Covid-19.

It was stated that there was significant pressure in primary care which provided 90% of patient contacts but received 10% of NHS funding. Brenda Allan noted that primary care was generally much cheaper than emergency care but that pressures had resulted in staff leaving. It was added that, in relation to contracts, there was an uneven playing field for GP providers as large, multinational companies could use substantial teams to respond to tenders. The JHOSC was asked to raise the issues noted by NCL NHS Watch to support and ensure the preservation of primary care.

Jo Sauvage, NCL CCG Chair and Primary Care Lead, stated that the primary focus of the CCG was to ensure that residents were satisfied and able to access GP practices. It was highlighted that the ICS framework had been published recently and that the CCG was still considering the detail. It was added that some things were mandated by central government and that other things could be influenced locally.

Sarah Mansuralli, Executive Director of Strategic Commissioning, noted that national discussions were ongoing but that the CCG was starting to discuss possible structures with partners. It was explained that the CCG was due to present a paper to the JHOSC in September 2021 which would set out the initial response to the requirements set out in the ICS design framework. The Chair added that the ICS design framework and the current selection regime for providers had been included in the agenda pack, under the work programme item, so that JHOSC members could familiarise themselves with some introductory information before the September meeting.

Paul Sinden, CCG Chief Operating Officer, explained that there would be some changes in commissioning in the move to ICS. It was noted that the ICS was likely to take on direct commissioning of primary care providers, including community pharmacy, optometry, and dentistry and that there would be opportunities to further integrate services locally. Paul Sinden stated that, to support the local and primary care voice within ICS, the system would be talking with the five councils about the role of integrated borough partnerships which would inform ICS planning and commissioning. It was added that the borough partnerships may be asked to provide services or support, such as the Covid-19 vaccination delivery programme. It was explained that the CCG was also supporting GPs to form a GP provider alliance to ensure that their voices were represented clearly within the ICS. It was noted that these representatives would be selected locally and that private providers, such as AT Medics, would only be on ICS groups if they were selected locally.

Paul Sinden noted that the CCG had created an inequalities fund and would be working with borough partnerships to respond to inequalities. It was explained that the fund was £2.5 million this year and that this would increase to £5 million next year. It was noted that the White Paper had set out a greater focus on inequalities.

It was commented that the CCG had committed to look at its procurement processes which was linked to the item on AT Medics. It was noted that there would be consideration of different ideas, such as a greater weighting for social value in the procurement process. It was added that the process was governed by a procurement framework but that there was some flexibility within this. It was also commented that AT Medics had started as a small, local practice before the recent change of ownership.

The Chair noted that concerns relating to ICS and AT Medics had been discussed over the last few meetings and she wanted the Committee to focus on its recommendations. The Committee generally supported the recommendations set out in the deputation.

Cllr Tricia Clarke suggested that there should be greater protection for patient data. She noted that the deadline for patients to opt out of data sharing should be extended and that the process should be simplified. The Chair noted that data sharing was referenced in the item on GP Services.

Cllr Paul Tomlinson stated that the highest decision making body in the ICS should be public. He added that the ICS framework document did not refer to the Community Partnership Forum; he enquired what had happened to this forum and what role the public would be able to have. Brenda Allan, NCL NHS Watch, stated that the ICS Board would need patient, public, local authority, and primary care representation to ensure good decision making. She acknowledged that there was a GP Alliance but highlighted that the NHS ICS Board would have decision making powers and expressed concerns that the representation and proposals were not robust enough. In relation to increased weight for social value in procurement, Brenda Allan noted that this would have to be a significant increase to have a meaningful impact.

Cllr Derek Levy expressed concern about local authority representation within the ICS. He stated that local authority representation was important in presenting the voices of residents. Jo Sauvage noted that there was some scope for manoeuvre in the guidance and that this could be helpful in providing opportunities for partners to be included; she added that there were strong local relationships in North Central London and that opportunities in the guidance could be used advantageously to embed democracy.

The Chair noted that the CCG had agreed to meet with the key local authority representatives in advance of primary care commissioning and was looking to include a greater weighting for social value within the procurement process. The Chair stated that there were a number of health providers throughout London who were owned by partner or parent companies and that there should be safeguards to ensure that referrals were based on health, rather than commercial, reasons. The Chair suggested that the ICS should have an identified committee that was aware of any business relationships between primary, secondary, and tertiary providers to ensure openness and transparency.

RESOLVED

The Committee made the following recommendations:

1.    The Integrated Care System (ICS) and its committees should be as open to the public as possible.

2.    The NHS ICS Board should include local authority representation, local authority voting rights, and the ability to discuss and challenge decisions. It should also ensure that all agendas, minutes, and relevant documents are open to the public. It was considered that this would ensure transparency and accountability.

3.    The role of the Joint Health Overview and Scrutiny Committee (JHOSC) should be maintained, including the ability to scrutinise all decisions made by the ICS. It was also considered that the JHOSC should retain the right of refer matters to the Secretary of State.

4.    The ICS should consider how patient and resident voices would be included in its processes. The JHOSC felt that patient and resident voices should be included at all levels, including the top level.

5.    The JHOSC also requested further detail on the arrangements for the NHS ICS Board, the governance and committee structure within the ICS, and the relationship between the different committees, and how the voices of patients and residents would be included.

6.    The ICS should have an identified committee that was aware of any business relationships between primary, secondary, and tertiary providers to ensure openness and transparency.

7.    To support the NCL NHS Watch recommendations.