• Kent and Medway STP leader said commissioners remained “fragmented”
  • Remarked accountability had become “more complicated”
  • Glenn Douglas now says the comments, made in a report to a November meeting, are no longer valid
  • Leaders have recognised need to speed up

A candid assessment of the health system across Kent and Medway has concluded the sustainability and transformation programme has not unified the system, is dominated by providers and little significant action has been taken on improving commissioning.

The comments were made in Glenn Douglas’ report to a clinical commissioning group governing body meeting this month, despite himself being the accountable officer of all eight CCGs in the Kent and Medway STP.

He has since distanced himself from the remarks, saying they reflected a “moment in time” and the system had moved on.

Mr Douglas – previously Maidstone and Tunbridge Wells Trust chief executive for 10 years – became joint AO in the spring.

His report, published by West Kent CCG and dated 27 November, said: “Limited progress has been made in addressing the fragmentation and dilution of commissioning effectiveness that has limited CCGs in their ability to make and carry out plans to achieve their clinical vision and seen some unable to meet their statutory functions.”

It suggested the CCGs have so far identified only very restricted areas for commissioning once across the system.

“Although there have been many meetings in which configuration and functions of commissioning have been discussed, little significant action has followed,” the paper said.

“It is recognised the STP has not ‘unified’ the system which is now more complicated in being clear where accountability, responsibility, authority, power or control reside or can be exercised. CCGs have done little to leverage their commissioning influence as system leaders, rather leadership has fragmented, [leaving] a provider dominated STP by default.”

It also stated, however: “Recently there is recognition by the steering group of the need to respond to these challenges with increas[ing] pace, define the Kent and Medway strategic commissioner function and start the wider system work on provider integration.”

When HSJ asked about the paper, Mr Douglas said: “This wording reflected the situation in Kent and Medway at a moment in time and is not an accurate picture of how things are now.

“The eight clinical commissioning groups have been working together since April this year to design the strategic commissioner…

“In October, the steering group to develop [a] strategic commissioner, which includes all eight CCG clinical chairs, agreed in principle its structure and broad objectives, and a timetable for setting it up so it is operational by April 2020.”

Signs of divisions have emerged since the CCGs moved to a joint AO in the spring, with two initially being reluctant to work so closely together, and public concerns about the cost of running the STP.

In addition, CCGs in the north and west of Kent are planning to consult on changing IVF policies, while those in the east are sticking to their current policies.