• CCG’s problems “among broadest and deepest we have ever seen”, says external review
  • Cambridgeshire CCG says it accepts the review’s findings
  • The CCG appoints new chief and promises improvements

Cambridgeshire and Peterborough Clinical Commissioning Group’s “deeply concerning” problems “are among the broadest and deepest set of issues facing any CCG we have worked with”, according to a highly critical review by leading consultants.

The CCG, one of the largest in the NHS with a £1.2bn budget, said it accepted the findings of the review. The review, by PricewaterhouseCoopers, said its leadership must take responsibility for “ineffective governance” and a “breakdown” in financial control.

In an email seen by HSJ, CCG chair Gary Howsam told senior staff: “The governing body accepted the findings and recommendations [of the PwC review].

“I thought it was important to let you know the seriousness of the situation for the CCG and that our focus will be on delivering our improvement and delivery plan, working alongside our partners and communicating regularly with you as important stakeholders in the system.”

The CCG, which has seen its finances spiral to a £42m deficit by the end of 2017-18, supplied a redacted version of the review to HSJ.

The review said: “We are deeply concerned with the breadth and depth of capacity and capability issues of the CCG coupled with the scale of the financial challenge in 2018-19.

“Based on our experience of working with a large number of CCGs nationally, the issues facing the CCG in relation to capacity, capability and financial recovery, combined with the financial challenge facing the local health system, are among the broadest and deepest set of issues facing any CCG we have worked with.

“The governing body must take responsibility for the leadership and governance issues identified and urgently put in place plans to address them.”

It said it would take “a number of years to achieve financial sustainability” but it could make “significant progress in addressing its deficit in 2018-19, although it warned it must avoid simply shunting costs onto other parts of the system.

The review’s critical findings, however, follow NHS England upgrading the CCG from “inadequate” to “requires improvement” just last year.

The report, NHS Cambridgeshire & Peterborough CCG – capability, capacity and independent review of financial position (March 2018) (see attached), also said reviewers found:

  • Instability at leadership level impacting on delivery and causing uncertainty for staff;
  • A lack of experienced leadership and capacity, resulting in insufficient grip, control and energy to drive improvement;
  • Lack of direction at the STP delivery unit, leading to lack of focus on supporting CCG recovery.

The large CCG, coterminous with its local sustainability and transformation plan, has appointed Jan Thomas as accountable officer, a role she has held in an interim capacity since April.

The new boss must ensure the CCG’s improvement plan is signed off by NHS England by July.

The CCG said the decision to combine the CCG accountable officer and STP accountable officer, as had previously been the case, had not been “the right one”, and Ms Thomas’ sole focus would be on the CCG.

Ms Thomas said: “Our governing body takes this report and its recommendations very seriously and we have spent the last couple of months developing an improvement and delivery plan to address the issues in the report.

“The plan particularly focuses on taking the organisation forward, as part of our local health and care system, bringing our finances under control and transforming services to ensure we deliver good quality, affordable services for the people of Cambridgeshire and Peterborough.”

The CCG’s financial slide in numbers

Year Financial position

2014-15

£8.0m deficit

2015-16

£15.7m deficit

2016-17

£32.3m deficit

2017-18

£49.2m forecast exit underlying deficit

Source: the NHS Cambridgeshire & Peterborough CCG – capability, capacity and independent review of financial position (March 2018)