Financially troubled CCG 'distracted' by service reform, review finds

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The “desire” to report positively to NHS England and “too much focus on service redesign” contributed to mismanagement at a London clinical commissioning group, a report into its governance has found.

A document by the former chief officer, seen by HSJ, sets out the lessons learned by Greenwich CCG following a report by Deloitte.

The CCG has since appointed Joanne Murfitt as its new chief officer and Ian Fisher as finance director. Ms Murfitt succeeded Annabel Burn in October.

The CCG placed itself in “financial turnaround” in February after finding itself in deficit for the 2015-16 financial year. It was unable to set a balanced budget for 2016-17.

In the document, Ms Burn listed the factors she believed had caused this situation, including:

“Periods of highly stressed governing body relationships that distracted from core business.”
“Insufficiently risk aware decision making.”
“Postponing difficult decisions, frequently reopening contentious decisions made, creating delay.”
“Large increases in non-elective acute activity with an inadequate response.”
“A desire/habit/culture to report positively to the governing body and NHS England.”

The review also found “too much focus on service redesign and major transformation and too little focus on delivery through current contracts”.

The lessons learned document also said the CCG had not kept proper track of its savings programmes in 2015-16.

It said there were “underdeveloped QIPP schemes included in the operating plan based on modelled activity [that was] not fully consolidated in contracts”.

Greenwich CCG recently agreed to carry out an impact assessment into the awarding of a contract for musculoskeletal work to Circle Health. The decision was contested locally and the distraction from the day to day running of the CCG was another factor named in the review.

The lessons learned document said: “The CCG has experienced some significant events which were not foreseen, for example the legal challenge of a procurement process. This type of event can consume a significant proportion of time for senior management, and governing body members, and there is a risk that they may act as a distraction from ‘business as usual’. As far as possible, the CCG could further improve the way that it manages normal operations of the CCG, whilst still effectively responding to future challenges of this nature.”

The CCG also commissioned an independent review into the coding of non-elective activity at its main provider, Lewisham and Greenwich Trust, but would not release its findings. It is now being considered under the Freedom of Information Act.