The public have their say at the Clinical Commissioning Group’s first full meeting

Written by Tony Millett.

The NHS Wiltshire Clinical Commissioning Group (CCG) is getting into its stride as the GP-led successor to the Primary Care Trust (PCT.)  But that stride was halted for some moments at the first full meeting on Tuesday (April 23) of the CCG’s governing body – by members of the public.

A local Seniors Forum had tabled a question about a recent inspection at Bath’s Royal United Hospital (RUH) which found faults with the care of some patients.  The questioner said he had ‘first hand and bitter experience’ of one of the wards highlighted in the Care Quality Commission’s report.

The CCG’s Registered Nurse Member, Mary Monnington, had read the CQC report.  And she agreed to go with the complainant to make sure care had improved in the RUH’s Day Surgery Centre.

A petition from Wiltshire members of the lobbying group 38 Degrees asked the CCG to stop the health service being broken up or taken over by ‘irresponsible private companies’.  And they wanted the CCG to rewrite its constitution to include a framework for ‘safeguarding the NHS’ – but still be within the government’s Health and Social Care Act.

CCG Chairman Dr Steve Rowlands said “We are not in a position to rewrite our constitution” – but that the petitioners did have ‘our goodwill’. When one of the 38 Degree petitioners asked what competition had to do with patient care, Dr Rowlands replied “Unfortunately our political leaders think…”

The question from another member of the public appeared to have got lost in the CCG’s system.  But her question put to the meeting was similar to points raised in the 38 Degrees petition and Dr Rowlands pointed out firmly that this was “Our meeting held in public - and not a public meeting.”

From these interventions it seems public interest is focusing in equal measure on the coalition government’s political agenda for the NHS and on deterioration in some NHS services.

It could also be that government promises to “strengthen the collective voice of patients” that were made in the White Paper on which the NHS reforms were based, have raised expectations. So far Wiltshire Healthwatch – the patients’ voice – has not appeared.  And its predecessor, Wiltshire Involvement Network – has gone.

Ministers often repeat the themes from the White Paper: “shared decision-making”, “no decision about me without me”, and, of course, the rights involved in “patient choice” when it comes to treatment.

Patient choice is making financial management more difficult for the CCG.  The limited contract with New Hall – a private hospital near Salisbury – was £1.6 million overspent last year with the amount spent each month over a third up on the previous year.

“Can the CCG get a handle on those costs?” Dr Toby Davies, GP Chair of the CCG’s Sarum Group: “I don’t think we’re allowed to have a handle on it. We cannot stop surgery going to New Hall.”

It was explained that New Hall “have been quite commercial” in attracting patients.  They were said to be “cherry picking” the simpler elective operations because they do not offer the appropriate intensive care for more complex cases.

This overspend was not unique in the 2012-2013 figures.  There were overspends on all three of the major acute hospital contracts.
Last year the shadow CCG was running £509.4 million of the PCT’s budget.  The CCG needed £8.19 million from the PCT’s reserves to break even at the end of the year.

Other headlines from the meeting:
Contracts: The contract with Great Western Hospitals Foundation Trust (GWH) for Wiltshire’s community care services will be extended for a year to 30 April 2015.  This will allow the CCG’s re-design of these services to be completed before it goes out to competitive tender.

Maternity services run by GWH are being overseen by Wiltshire Council and will go to tender so a provider can be in place by 1 May 2014. Under the government’s new regulations almost all services must go to competitive tender - these regulations face a vote in the House of Lords today (April 24.)

The CCG Budget for 2013-2014 is still not settled as specialised commissioning is being stripped out of contracts to be passed to NHS England.  It looks as though this will reduce the CCG’s money by over £20 million.

‘Big Brother’: the CCGs will have less autonomy than the PCTs had. A new financial monitoring system allows NHS England (which regulates CCGs) to see live data on how the CCG’s money is being spent.  Anyone who bumps into this ‘Big Brother’ (as it was described) should know it is called ISFE – for Integrated Single Financial Environment.

Locality decisions: Wiltshire CCG is divided into three area ‘localities’ each with its director, governing body and budget. The localities do not hold meetings in public.  And at this meeting of the full CCG Governing Body there were no reports or minutes presented from locality meetings.  
And while a Register of Interests for the CCG's Governing Body and those who attend its meetings was published, it is not clear whether a similar document covering GPs who make decisions in the localities will ever be published.

Delayed Transfer of Care (formerly known as ‘bed blocking’) is still causing problems for Wiltshire CCG – and across the England.  It costs the CCG a great deal of money each week. On 4 April 2013 there were sixty-three patients across Wiltshire who were ready to leave hospital but had nowhere appropriate to go.

If that level was held for a week the CCG would face unbudgeted costs of well over £100,000 in lost hospital bed spaces.