UPDATED: CCG backtracks over major cuts plan after DHSC intervention

Cambridgeshire and Peterborough CCG had been due to discuss the proposals at its board meeting tomorrow as part of a large package of cuts and savings it said was needed due to its perilous financial position.

It said it needed to save £32.7m to hit its target of achieving a £75m deficit in 2019-20 – a huge deterioration from the £35m deficit it recorded last year.

A paper on the IVF services for the board meeting published ahead of the meeting said the CCG’s recommendation was: “Option 1 - stop funding the provision of IVF indefinitely”.

“In this circumstance the CCG would stop funding IVF for the foreseeable future and not review the decision again unless there was a material change in its financial position,” the paper said.

But just hours after HSJ reported today (1 July) that the controversial recommendation was set to be put before the board tomorrow, the CCG issued us with a new statement.

It said: “The CCG has today [1 July] received new information from the Department of Health and Social Care about the commissioning of IVF services. Because of this the CCG has decided to review this information with NHS England and bring the decision back to the CCG governing body on 6 August.”

HSJ has asked the CCG to share the information sent by the department.

However, the news comes just weeks after health minister Jackie Doyle-Price wrote to CCGs on 17 June to warn them it was “not acceptable” to cut IVF services – a move taken by only a handful of CCGs to date, some of which have subsequently rowed back.

Such cuts caused an “unfair” postcode lottery, “psychological distress for patients” and “untold reputational damage” to the NHS, the minister said.

“I cannot emphasise enough that it is not acceptable for CCGs to offer no routine access to fertility services,” she added, according to the Observer newspaper.

The board was also due to discuss a significant package of other cuts at the meeting tomorrow.

Funding for a range of community services supporting older people and patients with long-term conditions, including an emergency rapid response team, could also be dropped.

The CCG has also recommended cutting funding for Dial-a-Ride, grants for multiple charities, a brain injury rehabilitation centre, ophthalmology services, and dermatology services (see below for full list).

A decision had been due at the meeting. But the CCG’s chair instead announced decisions would now be deferred until 16 July due to the board deciding it needed “more time to consider the new information and we seek clarifications”.

CCG clinical chair Gary Howsam said: “Since publishing our review of services, we have received a large number of submissions and new information from a number of organisations and we think it is right that we give our governing body more time to consider the new information and we seek clarifications if necessary. We are expecting to meet again on 16 July to review all this information.”

The service cuts were identified as part of a deficit analysis which warned the CCG was wasting around £20m because of “overlapping commissioned services that results in duplication and poor efficiency,” the board report said.

It published a paper on its community services review, which said it needed to cut the services’ £112m expenditure by £4.1m. It has so far identified £2.8m of those savings.

The CCG has also proposed cutting its joint emergency team, which provides rapid response support for older people and patients with long-term conditions – a service it has long heaped praise on. The review proposing its funding should be cut added it “provided excellent patient facing care for patients”.

The CCG’s £75m deficit, set out in a plan it submitted to NHSE in May, was part of Cambridgeshire and Peterborough’s Sustainability and Transformation Partnership systemwide planned £192.5m deficit.

The board papers said the CCG recommended decommissioning or ceasing its funding for:

• Dial-a-Ride;
• The Stroke Association;
• The Alzheimer’s Society;
• The Carer’s Trust Cambridgeshire and Peterborough, Norfolk;
• The Health and Wellbeing Network;
• The Evelyn Community Head Injury Service;
• RSS Ophthalmology;
• Evolutio – ophthalmology;
• DMC – dermatology;
• Oliver Zangwill (a brain injury rehabilitation centre); and
• The joint emergency team.

The CCG would like to “renegotiate service provision and/or payment for the following”:

• The Care Network;
• Cambridge Hearing Help;
• ACES Ophthalmology;
• Minor Eye Conditions;
• Concordia ENT;
• Sawston Microsuction;
• ENT GPSI (Charles Hicks Practice);
• Dermatology GPSI Buckden/Wisbech;
• Diagnostic Healthcare (formerly Excel);
• Global Diagnostics;
• Dexa scan (multiple providers);
• Specsavers Direct Access Audiology;
• Inhealth Audiology; and
• Vasectomy (various contracts).

Local providers have raised concerns. Cambridgeshire and Peterborough Foundation Trust which provides the JET service said axing the service would fundamental patient safety risks.

CPFT chief executive Tracy Dowling said: “[The trust fully understands] the need for commissioners to closely examine every area of its expenditure.

“However, we are deeply concerned for the safety of patients in the community should the recommendation to decommission the [JET] be decided. This service is more than an admission avoidance service – it is the urgent care community service.

“We have written to the CCG to outline the view of CPFT on the potential impacts of such a decision on both patients and on our dedicated, frontline NHS staff who are currently employed to deliver this specialist service.

“This service sees approximately 10,000 patients a year and on average patients are receiving urgent community care within two hours of making a call. ”