The health secretary has been urged to rethink legal reforms that would ease the creation of allegedly unaccountable “super clinical commissioning groups”.

In a letter dispatched to Jeremy Hunt last week, Healthwatch England chair Anna Bradley said local Healthwatch organisations had become concerned about CCGs “clubbing together” in closed groups to discuss reshaping health services across wide areas.

Such set ups circumvented local scrutiny and accountability measures, undermining Healthwatch’s statutory role, the letter stated.

“Local Healthwatch have escalated concerns to us about the transparency and accountability of decision making and the effect it is having on their ability to carry out their statutory functions,” it added.

The letter urged Mr Hunt to amend a legal instrument currently passing through Parliament that will make it easier for CCGs to form joint committees and delegate a single CCG to make decisions on behalf of all the member groups.

Ms Bradley said the health secretary needed to strengthen the “accountability measures” of the Legislative Reform (Clinical Commissioning Groups) Order 2014 by introducing a legal amendment at the “next legislative opportunity”.

The order cannot be redrafted at this stage of its passage through Parliament.

Under amendments proposed in the letter, Healthwatch representatives would be given a mandatory non-voting seat on any committees formed by CCGs.

Currently, CCGs are not legally required to give local Healthwatch representatives a seat on either their individual committees or on any they establish.

Ms Bradley has also called for a duty to be placed on all lead or coordinating commissioners to “act within existing local accountability mechanisms” and “have due regard to existing local agreed priorities and plans”.

She has also advised the Department of Health to jointly issue statutory guidance that places a “requirement on CCGs to enhance their public engagement and involvement when working in collaboration or under joint commissioning arrangements”.  

Marc Bush, director of policy and intelligence for Healthwatch, told HSJ that he has noticed a “greater appetite” among CCGS for “regional based commissioning”.

“What we’re finding is that middle level is increasingly - because of the financial restraints - the level that people are having to make or talk about difficult decisions,” he said.

He added that effective accountability structures “only exist at a national or local level”.  

 “You [will] end with decisions being taken by people who are not connected with the areas that are being affected,” Mr Bush said.

“The decisions they’re making are at such a huge scale and involve such important questions about reconfiguration that [commissioners]… can’t afford not to take the public with them on that journey.

“Poor engagement in the decision making process will end up in them having to face long protracted campaigns from local residents not wanting [services] to close down as a result of any decision they weren’t involved in.”

Steve Kell, co-chair of NHS Clinical Commissioners, said: “We would reject the need for any further statutory or mandatory top-down requirements or reorganisation of CCGs.

“Having a joint committee doesn’t take away any of the statutory responsibilities of… patient and public engagement.

“CCGs still need to ensure they have strong transparent and accountable patient and population engagement in their plans, through Healthwatch and local CCG mechanisms.”