As we get ready to say goodbye to 2020, HSJ takes a look back at the 10 most read commissioning stories of the year.
A document outlining NHS England’s legislative recommendations said it would like integrated care systems to become “a statutory corporate NHS body… that additionally brings CCG statutory functions into the ICS”. There are around 130 CCGs, and 42 ICSs and sustainability and transformation partnerships, due to become ICSs. NHSE said it would, however, give an assurance of job security during the reorganisation transition period for CCG staff below the top level. The legislation as proposed by NHSE would also revoke section 75 competition regulations, created by the Health and Social Care Act 2012; and allow NHS services to be removed from the scope of the public contracts regulations 2015, to seek to insulate them from competition rules and regulation.
A bulk of 193 employees were put at risk by NEL Commissioning Support Unit including roles in finance, procurement, transformation, risk management and data analyst teams. They included band 4, 5, 7 and 8 staff, among others. HSJ was told by staff that CSU was spending substantial sums in support of costly senior interim staff supplied by external agencies, saying this should be reviewed before considering compulsory redundancies. Another union, Unite, alleged permanent staff were facing compulsory redundancy despite the CSU using some highly paid interim management staff.
Consultants at the Dudley Group Foundation Trust wrote to Dudley Clinical Commissioning Group over its plans to award a £360m integrated care contract to a new NHS trust.The contract covered primary care, community health and some public health services, and would include around 40 per cent of Dudley Group FT’s services. However, senior trust clinicians wrote a letter to the CCG, both trusts, and NHS England, requesting the development be paused for 12 months and for a review of the risks and benefits of the model to be carried out.
National guidance issued in January 2020 said there should “typically” be only one CCG for each of the 42 “integrated care systems” in England, which implied there could be flexibility for very large systems such as Cheshire and Merseyside. This encouraged four Merseyside CCGs — covering Liverpool, Knowsley, South Sefton and Southport and Formby — to press ahead with a merger plan, with a view to this transaction taking place by April 2021. Meanwhile, four CCGs in Cheshire completed their long-planned merger in April 2020. However, the four Merseyside CCGs were told by NHS England there must be a single commissioning body for the entire Cheshire and Merseyside system, as a bid for their four-way merger was rejected. It would cover a population of around 2.7 million.
The top leadership of NHS Test and Trace includes several senior figures brought in from retail, commerce and industry, but only one public health expert, a leaked structure document revealed in September 2020. The only clinician or public health expert is Susan Hopkins, an epidemiologist and Public Health England adviser on infection. The full “wider leadership team”, of around 80 posts, includes several other PHE experts, but no current public health directors, and no-one who has recently worked in public health locally.
In July, HSJ revealed NHS England and Improvement had used its legislative powers to discover why 16 clinical commissioning groups falsely claimed to have met the mental health investment standard. Under the national standard, all CCGs are required to increase their spend on mental health services by as much as the increase in their overall allocations. CCGs are then required to confirm to NHSE/I whether they have met the standard. Last year, NHSE/I told CCGs they would have to commission independent audits of their claims against the standard. NHSE/I wrote to 16 CCGs seeking an explanation after the audits showed their claims to have met the mental health investment standard in 2018-19 were false.
Matthew Tait will be seconded for two years to support ICS development across the south east. Claire Fuller, a GP and the senior responsible officer for the Surrey Heartlands ICS, took on his CCG role on an interim basis. Mr Tait was due to start his new role on 6 July, to initially support the development of the Buckinghamshire, Oxfordshire and West Berkshire system, working with James Kent, the then newly appointed accountable officer and senior responsible officer for the system, formerly a management consultant and health adviser to Theresa May.
The plan was to create two partnerships in north central London, each made up of an “elective centre” doing the inpatient work as a cold site, and a base hospital, that would continue to do emergency activity and some day-cases, as well as pre- and post-operative care. A new unit at University College London Hospital was to become an elective centre for one partnership, carrying out up to 400 more inpatient procedures per year, with The Whittington Health Trust as its base hospital. Chase Farm Hospital is the other centre, with up to 960 more patients per year. North Middlesex University Hospital Trust is its base hospital.
The GP members of West London Clinical Commissioning Group voted by a ratio of two to one against the health system’s plans to combine its eight constituent CCGs. The seven other CCGs voted in favour of the merger. The CCGs cover a population of 2.4 million and have a combined allocation of nearly £3bn. They worked jointly for two years as a “collaboration”, but this is the second time their efforts to merge have been knocked back. Last year the commissioners tried to merge the eight into one by April 2020, in line with CCGs in the South West, South East and North Central London systems, which was backed by London’s NHS regional team. The merger was later approved.
Sir Simon spoke at the HSJ integrated care virtual summit in September, revealing how NHS England will new legislation “in the first half of 2021” which will create a “legal form” for integrated care systems. He indicated there would be a large number of CCG mergers in April 2021 and also addressed the NHS’ approach to improving diversity and caring for its black, Asian and minority ethnic staff.