HSJ’s roundup of the day’s must read stories and debate in healthcare

Going in the wrong direction

Contrary to the NHS’s popular policy of moving care closer to patients, data from the Health and Social Care Information Centre shows fewer mental health patients are being seen in the community.

There were 671,000 fewer contacts with patients by community based services in 2014-15. This included large falls in services normally highlighted by the sector as helping to prevent admissions to hospital, such as crisis and home treatment services and assertive outreach teams. The largest fall in contacts was in day care services.

While mental health providers are seeing fewer patients in the community, the number of contacts overall has increased. The number of patients detained under the Mental Health Act rose by almost 10 per cent year on year to 58,400 – the third successive year of a rise in detentions under the act.

The number of detentions in NHS hospitals increased by 4,000, or 8 per cent, to 51,970 and in the independent sector by 25 per cent to 6,430.

The reductions have prompted fears in the sector that some services that can help reduce acute demand are being scaled back amid financial cuts, despite the government’s policy of achieving parity of esteem between physical and mental healthcare.

Taking the clinical out of CCGs

NHS England has suspended its rule insisting clinical commissioning groups must have a clinician in at least one of their top two roles (chair and accountable officer), in the case of financially struggling Bedfordshire CCG. This took place in the spring, but had gone unnoticed until now, and is thought to be the first time this requirement – which is not in law, only NHS England guidance – has been set aside.

The move was in order to bring in an interim chief officer to turn around the organisation. Probably wise – but it does run contrary to the original rules which help put the “clinical” in CCG.

The national body has made clear this is only temporary, that there are clinical deputy chairs, and that one of the top posts will soon be filled by a clinician. So, nothing to get too upset about.

It is worth noting, though, as part of the unfolding evolution of NHS commissioning. The government’s original 2010 “GP consortium” proposals made it clear the GPs would be put in control. This was rapidly watered down, and more than two years after CCGs were created there are dwindling numbers of GPs in accountable officer (AKA: chief executive posts) and fewer than a fifth of groups with a GP majority on their governing body.

The fact of CCGs taking on primary care responsibility – therefore intensifying conflict of interest for GPs in CCGs – and the drive to get primary care clinicians working on reforming and developing their own services rather than commissioning are two good reasons why GP involvement in CCGs could continue to ebb away.

It’s worth remembering though that, in law at least, CCGs are governed and constituted by their GP practice members.