• Staff at CCG’s headquarters had to be moved after roof partially collapsed
  • Review also found potential conflicts of interest went unchallenged
  • Chair says CCG has an “action plan” to address outstanding concerns

A governance review into a troubled clinical commissioning group has highlighted concerns over potential conflicts of interest, a disconnect with local GPs, and estate so poor that a roof caved in. 

The governance report, prepared by PwC and just released, recommended Coastal West Sussex CCG take a series of actions – including reviewing current and imminent procurements – to improve its approach to potential conflict of interests, and described the current management of such conflicts as “an area of risk”. 

The report found cases where members of the governing body who might have had a conflict of interest did not leave the room when relevant issues were talked about and even participated in discussions. 

The review highlighted that culture and staff morale had improved since the leadership team changed in April 2018, when Adam Doyle took over as accountable officer. The previous November, accountable officer Katie Armstrong announced she was standing down; although she remained in the role formally, interim staff had taken on the management side of the role.

However, the report added the CCG was still at an early stage in its “turnaround journey” and needed to re-engage with its GP members, while stakeholders felt disconnected from its five-year strategy and staff spoke of a lack of clinical leadership. 

Meanwhile, clinical leaders saw themselves as representing their local practices with no awareness of the broader responsibilities which came with being a governing body member. 

A previous “diagnostic review”, ordered by NHS England and carried out in 2017, told the CCG it needed to show “stronger evidence of gravitas and grip” and move away from a “reactive and negatively critical approach”.

PwC, which carried out the latest review last summer, suggested the CCG examine whether the governing body’s skillsets were sufficient to achieve its priorities. In 2017-18, the CCG had a deficit of £21.8m and it is expected to have a £12m shortfall this year, although this will be offset by commissioner sustainability funding. It has been under legal directions since March 2017.

The review was also critical of the “Coastal Care” initiative, which is meant to be a pathway to more integrated services and ultimately an integrated care organisation. It noted it was still embryonic and both lay members and the CCG’s six locality directors had a significant lack of knowledge of its progress. Some members, especially locality directors, said they were unaware of any joint commissioning with West Sussex County Council.

The report also revealed staff at Coastal West Sussex CCG had been working in poor quality estate. In early 2018, the roof at the CCG headquarters at The Causeway, Goring-by-Sea, partially collapsed, leaving the CCG in business continuity mode and some staff having to work at different locations until July. The building is owned by NHS Property Services.

The CCG also had a complex structure which was atypical of CCGs. Some papers to the governing body were too detailed and lengthy, and many of them were for information only rather than for a decision, the report said. The finance and performance committee did not receive overall performance information and did not, therefore, carry out its monitoring responsibilities.

Gill Galliano, acting lay chair of the CCG, said: “This review was part of the agreed actions that needed to take place when the CCG was placed into legal directions.

“We welcomed the opportunity to look into the way we have been working and receive an external view on our strengths and areas for further improvement in terms of our governance to allow us to work in a more effective, consistent and efficient way.

“We welcomed the findings last year and many of the recommendations had already been recognised and addressed by that time.

“We have an action plan in place that aims to address the outstanding areas where we can do better and this is something that we will remain focused on as we continue to develop as a CCG.”