Developing strong relationships with councillors as well as public health and social services leaders must be high on the list of all clinical commissioning group board members, says David Smith
Clinical commissioning groups have a substantial list of functions to perform but expectations are high that they can live up to their aspirations. In the post-Francis world, with renewed emphasis on accountability and assurance, there will be a real tendency for CCGs to be looking inward into their own organisation or upwards to NHS England (the renamed NHS Commissioning Board).
This will be a mistake. Looking outwards to local partner organisations and to patients and the public has to be the mantra. CCGs cannot afford to remain NHScentric organisations.
Critically, the relationship with local authorities, elected members and senior council officers has to be nurtured and CCG leaders will need to devote time and energy to this. In the past these relationships have tended to be the province of primary care trust chairs and chief executives engaging in various local strategic partnerships or attending the health overview panels. There are few examples of GPs being actively engaged in such matters, but now GPs need to pick up the baton.
‘If you really want to be effective locally you must understand how your local authority works and you must put time and energy into cultivating these relationships’
The fledgling health and wellbeing boards are an obvious place to start. GP leaders need to be visible at these meetings and should be actively shaping the work programme and agendas. However, from yesterday they will have been committees of the local authority and therefore subject to political control, something which will be very new to the majority of CCG leaders, used to operating in the NHS system.
Unlike the NHS, local authorities are politically led bodies and as such CCGs have to nurture their relationships with the politicians.
Developing personal relationships with council leaders, opposition party leaders and portfolio-holders for adult, children’s and public health services should be high on the list of all CCG board members.
CCGs must be attuned to the local politics and must quickly get to grips with local authority decision making processes. They need to know who the key decision makers are and who makes things happen in their area – the two groups may of course be different.
It is easy to say that CCGs must develop relationships with everyone locally. The reality is that CCGs have to decide for themselves whether the movers and shakers they need to work with and influence are the local political leaders, or the council officers, such as the chief executive or the directors of social and children’s services.
These people can be very powerful in many local authorities. Unlike the NHS, local authorities have a pretty clear distinction between the politicians and the officers. This is very different from the collective responsibilities of NHS boards, with directors and non-executives and of course CCG boards, where everyone on the board has a vote.
‘Developing relationships with the local authority is a big ask and no doubt will not always be given priority’
If you really want to be effective locally you must understand how your local authority works and you must put time and energy into cultivating these relationships. Pitching up at the health and wellbeing board every couple of months is unlikely to be enough. Clinical leaders of CCGs will have to engage in local strategic partnerships and be visible to their local authorities.
CCGs will also need to acquaint themselves with the local arrangements for health scrutiny. In early February the government laid before Parliament the secondary legislation under the catchy title of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. These regulations enable local authorities to scrutinise matters relating to the planning, provision and operation of health services in the local area.
The regulations place a greater obligation on health bodies to consult on substantial variations or developments in services. This has in my opinion always been a grey area – what constitutes a substantial variation is often a matter of judgement, not fact. CCGs need to be working with their local committees at an early stage when contemplating substantial change and ensure that they do not trip up over a failure to consult.
Only time will tell how the role of the health and wellbeing board and the health scrutiny arrangements work in the long run and whether their functions are complementary rather than competitive.
Get to know your scrutiny committee
CCGs may find it rather bizarre when they have agreed a strategy with the health and wellbeing board only to find it being scrutinised later by the health overview and scrutiny committee, when changes as a result of the strategy are proposed. My advice for CCGs is to get to know the chair of their health scrutiny committee, understand their concerns and agree how they are going to work with them.
In Kingston we have already benefited from close working with the local authority. My joint role as director of health and adult services for Kingston Council as well as chief officer for Kingston CCG means we are ideally placed to keep abreast of developments across both organisations and to work together.
Our GP board members also work increasingly closely with the health and wellbeing board and health scrutiny committee. The benefits are already evidenced through our programmes to jointly commission new health and social and mental health services.
This month our joint working also enabled us to open a modern purpose-built health centre on the site of the old Surbiton Hospital, along with a primary school that opened in September. This has met major priorities for both organisations by helping to address demand for health services and school places at the same time.
On top of everything else the CCG has to do, developing relationships with local authority councillors and officers is a big ask and no doubt will not always be given priority. The more enlightened CCGs will see their relationships with their local authorities as being mission critical. The reward will be proportionate to the effort put in.
David Smith is chief officer at Kingston CCG and director of health and adult services at the Royal Borough of Kingston upon Thames