• City and Hackney CCG and Hackney council integration plans have been paused after NHS England raises concerns over governance processes
  • Deloitte to review governance around the integration proposals
  • Hackney health scrutiny board raised concerns over plans to appoint single accountable officer for all CCGs in North East London STP

Plans by NHS and local authority commissioners in London to fully integrated their budgets have been paused after NHS England launched a review into governance around the process.

NHS England has commissioned a review of the processes used by City and Hackney Clinical Commissioning Group, Hackney council and the City of London Corporation, ahead of plans to integrate health and social care budgets.

city of london

Source: Davide Gabino

The CCG planned to pool £335m with the local authorities

The decision follows Hackney health scrutiny board raising concerns over plans made by the North East London sustainability and transformation partnership to appoint a single accountable officer across seven CCGs in east London (see box).

In March, HSJ reported that City and Hackney CCG planned to pool £335m – the majority of its budget – with Hackney council and the City of London in 2017-18.

However, according to minutes published by the health scrutiny board, the integration plans have been paused while Deloitte reviews the “decision making processes within [City and Hackney] CCG”.

The minutes said: “Because the full integration had been paused the [integrated commissioning bodies] (separate ones for Hackney and the City) rather than having delegated decision making powers of their own, could only make recommendations back down to the three statutory bodies which currently have those necessary powers: the CCG, Hackney council and the City of London Corporation.”

NHS England said it also commissioned a legal review of the integration plans, which found “no major issues”.

An NHS England spokeswoman said: “NHS England London region supports the strategic direction set out in the CCG and local authority integration plans; however, given the scale of budget pooling, we wished to review the detail of the proposed arrangements to ensure no issues could emerge at a later date, that the needs of the local population would continue to be met and that the CCG could continue to play a full role in the East London Health and Care Partnership.

“The governance review has recently completed and we are in the process of reviewing the report.”

A spokeswoman for the CCG, City of London and Hackney council said “[We] are together waiting for the outcome of the governance review and report. We look forward to moving forward with our plans for integrated commissioning over the coming months.”

Concerns over single accountable officer for seven CCGs

Hackney health scrutiny board sent a letter to City and Hackney CCG on 19 June raising concerns that plans for the single accountable officer across seven groups may “weaken” local accountability.

City and Hackney CCG has not yet signed an STP agreement that includes plans for a single accountable officer for the CCGs in North East London.

According to minutes from the Hackney health scrutiny board, published on 12 June, CCG chief officer Paul Haigh said his role would become “redundant” as part of the plans and he did not intend to apply for the single accountable officer role.

The minutes said: “A member stated that two months previously the CCG had refused to sign the memorandum of understanding [for the STP] and [NHS England London] had then threatened directions against it. This put the future of the chair and chief officer in doubt…

“A member asked if this was an usurpation of the seven CCGs. [Mr Haigh] replied that the City and Hackney CCG governing body had felt this was the current direction of travel.”

A CCG spokeswoman said: “As the proposals for the accountable officer develop, all CCGs in North East London will be having discussions with their partners to help shape the proposal and inform the decisions made by each governing body.”