• PwC report proposes “integrated commissioning authority” to hold a single budget in Lancashire
  • Also suggests social care and public health provision should transfer to NHS trusts, creating five integrated care providers described as “wellbeing corporations”
  • Senior NHS sources in the region told HSJ it appears to set out a vision of local authorities “taking over” health services

A single entity could be established to commission all health and social care services in Lancashire, with a councillor potentially given the casting vote on its board, a new report has proposed.

The document, commissioned by Lancashire county council, suggests a new “integrated commissioning authority” should hold a single budget and take over the strategic commissioning function from the county’s eight clinical commissioning groups.

Royal Lancaster Infirmary

Royal Lancaster Infirmary

University Hospitals of Morecambe Bay is already implementing a PACS model

The report, by consultancy firm PwC, does not specify what the future of the CCGs would be, but refers to the new commissioning body as a “partnership between the county council and health partners”.

It also suggests social care and public health provision would transfer to NHS trusts by 2019, creating five integrated care providers described as “wellbeing corporations”.

Senior NHS figures in the region have told HSJ it appears to set out a vision of local authorities “taking over” health services, and said they have not been involved in the process. The proposals would need to secure their backing to be taken forward.

Amanda Doyle, accountable officer at Blackpool CCG, said: “None of the organisations within our sustainability and transformation plan had input into, or sight of this report before it was published.

“It contains a lot of assumptions and some of the proposals would be outwith legislation.

“From my point of view I’m really supportive of the principle of aligning health and social care commissioning, and we have been working on an integrated strategic commissioner for the county. We will continue that work with the council.”

She also pointed out that Blackpool and Blackburn with Darwen also have upper tier unitary councils, so would need to agree to the proposals.

Another, who spoke on the condition of anonymity, said: “It’s clearly very ambitious and welcome as a basis for discussion. The direction of travel is broadly the same as that being discussed by CCGs, but the health economy feels it hasn’t really been involved.”

They said CCGs are “nowhere near ready” to merge into a single organisation with the county council, which is led by Labour.

There are also concerns about the level of governance that would shift to county level, and a loss of sovereignty in the five local areas.

Council elections in May could also deliver a Conservative leadership, which may not support the proposals.

The document will go before the full council next week, with the recommendation that a working group undertake a detailed review of the report.

The report stresses that “democratic accountability should be central to the model” and will “need to be embedded” at both commissioner and provider level.

It adds: “The legal structure for the commissioner could initially be set up as a virtual entity that is managed as a system… representation from the NHS will sit on the board alongside upper tier councils as the other major funders.

“The [county council’s] preferred view for the integrated commissioning authority is that the casting vote would sit with an elected representative.”

The report says the five integrated providers should be created under the primary and acute care system model, which is currently being implemented in the Morecambe Bay area under the vanguard programme.

If the other four providers follow the same model, this would mean East Lancashire Hospitals Trust, Lancashire Teaching Hospitals Foundation Trust and Blackpool Teaching Hospitals FT being the host or owner organisations in their footprints. The main acute provider for West Lancashire, currently Southport and Ormskirk Hospitals Trust, would then have an ownership stake in the provider for that patch.

Leaders would need to consider the new organisational form for a single commissioner, but the report suggests that a joint venture or community interest company could be established and jointly owned by the public body partners.