Clinical commissioning groups merger to change decision making on how NHS money is spent

Private companies will be able to have a say in how NHS money is spent across north east London after a huge merger planned for next year.

Seven different clinical commissioning groups (CCGs), the organisations which decide how NHS funds should be spent in each area, will merge into one body in April next year.

CCGs are in charge of buying health services for their area from providers like hospitals, charities or private companies.

The law forbids these providers – or their employees, partners or shareholders – from sitting on the board of a CCG which buys from them.

However, the merged CCG created next year will be an “integrated care system”, meaning it is not bound by any such laws and could have private providers on its board.

Waltham Forest CCG managing director Selina Douglas told the committee the merger was a “real opportunity” to get “the right board with the right representation”.

She said: “That can be a little bit different if we are not a CCG because CCGs have statutory responsibilities and a statutory board.

“We have our providers on our board here in Waltham Forest, which is really positive and which we could not have done if we remained a statutory CCG.”

The merged CCG is already running as a “shadow” body, with the expectation of becoming fully operational in April.

Waltham Forest is also part of the NHS North East London Commissioning Alliance, another body that can make decisions for all seven boroughs.

Papers from a meeting in September show one of its voting “lay members” is a management consultant for Deloitte, a private firm heavily involved in the UK’s Test and Trace programme.

Earlier this month, Sky News reported there are 1,114 Deloitte consultants working on the Government’s Test and Trace scheme, each of whom may be paid thousands of pounds a day.

At the scrutiny meeting, Cllr Alan Siggers (Con, Valley) asked how the council can be sure “decisions will be made at a local level” after the merger, adding: “Do we even have that input?”

Regarding GP members of the Waltham Forest CCG voting for the merger, he said: “GPs… have decided that this thing will go forward so, to an extent, it’s going to happen anyway.”

Managing director Selina Douglas responded that the CCG has “always worked on a single contract” with Barts Health NHS Trust, which manages five hospitals in east London, and thus has always worked “across a big footprint”.

She said that it was estimated that “about 98 per cent of resources” will be decided at the borough level after the merger.

Regarding the GPs’ decision already being made, she added: “We would not want to do anything that would really jeopardise our relationship with the local council.

“We did ask for support from the local authority, which was given, and we intend to work hand in glove with the local authority”.

Last summer, the Government’s Health and Social Care Committee raised concerns that accountability in bodies like the merged CCG will be “complex, slow, risky and weak”.

A report published on June 24 states: “It is not clear how (they) will be held to account for poor performance and how they will involve and engage the public.

“It is vital to avoid creating a situation where everyone in the system is accountable, but no-one can be held responsible for important decisions.”

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Victoria Munro

Local Democracy Reporter