• Crawley CCG and Horsham and Mid Sussex CCG both ran substantial deficits in 2017-18
  • Review urged CCGs to take rapid action
  • Commissioning alliance says problems have been addressed

Two clinical commissioning groups showed a “lack of grip” and “over optimism” about their financial position, while one of them was demoralised by a long standing investigation into an alleged conflict of interest, a governance review has revealed.

The review into Crawley CCG and Horsham and Mid Sussex CCG identified a perception that some of the governing body’s clinician members did not consider finance their responsibility, while some governing body members did not feel they were kept informed of the financial position.

Horsham and Crawley both ran large deficits of £39m and £19m respectively in 2017-18 and NHS England put the CCGs under legal directions in November 2017.

The review, which was a requirement stipulated by NHS England’s directions, also suggested members felt the financial situation was outside of budget holders’ control and there was little challenge in meetings on key financial issues, such as the significant risk that the control total would be missed.

In particular, the review highlighted a £12m debt which had been on the balance sheet for three years, noting there was a lack of understanding surrounding why it existed and why it had remained unresolved for so long.

The review, which was carried out earlier this year but only made public last week, called for rapid action to regain control of the financial position.

The review included an independent investigation, which was commissioned by NHS England and is yet to report, into an alleged conflict of interest at Crawley CCG which had “culturally impacted CCG morale and it will be key for the CCG to actively address the findings reported”.

HSJ reported in July 2017 that the CCG’s chief clinical officer and chair were standing down to make way for new leadership.

The review also raised questions about the extent to which decisions, such as those concerning the commissioning strategy, were the responsibility of the GP practice membership of the two CCGs. It added this slowed decision making and was unusual.

The review into the two CCGs, which work closely together, was one of a series ordered into the five CCGs making up the Central Sussex and East Sussex Commissioning Alliance, which now share an accountable officer.

But the four separate reviews – the others cover East Surrey CCG, Brighton and Hove CCG, and High Weald Lewes Havens CCG – show that, among some governing body members, there was a lack of understanding of the role and structure of the alliance, and there were concerns that individual CCGs could be negatively affected by it. Of the CCGs, High Weald Lewes Havens was the least positive about the opportunities offered by the alliance.

The reviews also raised concerns about other CCGs, including a five hour governing body meeting with 488 pages of papers, insufficient challenge by members and issues with the quality of data in some papers.

In a joint statement, the clinical chairs of the Central Sussex and East Surrey Commissioning Alliance said: “These independent reviews were part of the agreed actions that needed to take place when some of our CCGs were placed into legal directions by NHS England last year. We decided to extend the reviews to all the CCGs of the alliance to ensure we had an entire picture of the strengths and weakness of the governance within and capacity of each of our organisations.

“The reviews were commissioned to help us share best practice, identify and learn from areas that needed improvement, and to allow us to work in a more effective, consistent and efficient way. We welcome the findings of these reports and many of the recommendations were already recognised and have already been taken forward and addressed.

“We have an action plan in place that aims to address the outstanding areas where we can improve and this is something that we will remain focused on as we continue to develop as an alliance of CCGs.”