Local NHS services have been given a binary choice over how they are governed

A leading Hackney councillor has spoken of his “significant reservations” over countrywide changes to the way local health systems operate.

Cllr Ben Hayhurst, who chairs the borough’s health scrutiny panel, fears the reforms, which are likely to see healthcare commissioned by a single body covering the entirety of north-east London, are “not in the best interests of Hackney”.

This reorganisation of health services within integrated care systems (ICS), part of the NHS Long Term Plan, could do away with the current local model in which one clinical commissioning group (CCG) directs services across Hackney and City of London.

Councillors and medics this week discussed a consultation which gives these local NHS services a binary choice over how they will be governed.

Option 1 would see a committee with an Accountable Officer bind together current statutory organisations.

Option 2, NHS England’s preferred choice, would introduce a corporate NHS body for an ICS that would bring the functions of the CCG under its umbrella.

Cllr Hayhurst said: “While this might seem quite bureaucratic and structural, it obviously has quite significant ramifications as to how the healthcare system operates.

“The NHS is a very top-down organisation as it is, and it does not surprise me that accountable officers at every sustainability and transformation partnership (STP) will be in favour of Option 2, which is what the hierarchy of NHS England wants.

“I understand the pressures that may be going on internally, but I’m conscious as to whether that is the right thing for this borough, this area, which has a very good working local model, which seems to be very similar to what Option 1 is.

“I am slightly concerned that we just go along with something that is not necessarily in the best interests of Hackney.

“I’m very concerned that in two to four years’ time we don’t have this excellent coterminous system in City & Hackney for all of us, and have been subsumed into something larger, with commissioning decisions taking place in a population of three million who do not understand different ethnic and community groups in our community.

“I have that concern and significant reservation if commissioning moves too far out.”

Analysing the proposals, Hayhurst said Option 1 is “far more in the mould of what [City & Hackney] have been hitherto aiming for, rather than a command and control top-down option”.

It is understood that local health bosses will nevertheless be picking Option 2 as their preference in their response to the consultation, with East London Health & Care Partnership documents showing it is considered “better for long-term ambition and vision”.

CCG managing director David Maher reassured listening councillors that there is “no significant expectation” that the merger will bring redundancies, with NHS England expecting that the ICS reforms could release administrative savings of around £700m over the next five years.

The plans also aim to improve population health and healthcare outcomes, to tackle inequality, to enhance productivity, and to help the NHS support broader social and economic development.

Under Option 2, a statutory ICS body would “repurpose” City & Hackney CCG, whose governing body and model of GP membership would be replaced with an overarching ICS board. This board would have representatives from NHS providers, primary care, and local government “as a minimum”, according to the plans.

A new framework of duties and powers would be created, and individual organisations’ powers of veto would be removed.

According to Maher, the plans have allowed the north-east London region to already make some savings which have been invested back into frontline services, though he noted that City & Hackney had always underspent its admininstration budget by around 20 per cent, leaving “no real fat for us to trim”.

Quizzed on the Town Hall’s position on the different options, council health boss Chris Kennedy admitted that his preference for Option 1 had recently shifted to the latter, pointing to arguments that “given the history of NHS reform we’re probably going to get Option 2 in the end”.

He added: “For Option 1 you have to ask yourself the question about that board. If you want to go for that, at a City & Hackney level, you have to accept that you will be sitting round the board with discontented members or people not nearly so happy with the provision by their CCGs, or the place as defined for them, as we are.”

The NHS England consultation encourages respondents to agree that Option 2 “offers a model that provides greater incentive for collaboration alongside clarity of accountability across systems, to Parliament and most importantly, to patients”.

A November briefing by membership organisation NHS Providers said: “These proposals represent a significant evolution in NHS England and NHS Improvement’s (NHSE/I) thinking about how to embed system working arrangements.

“We will need to consult widely with trust leaders on their views about how
these arrangements could improve outcomes for patients and support a fuller collective focus on population management and a reduction in health inequalities.

“We will work with colleagues in NHSE/I and trusts to consider the impacts of these proposals on their existing accountabilities and powers and ensure any new legislative framework is sufficiently enabling and allows for appropriate local determination.

“What we do know is that trust leaders – and partners from across the health and care system – agree with NHSE/I about the need to avoid any top-down, inflexible reorganisation of the NHS, particularly in the middle of a pandemic.

“While NHSE/I is rightly seeking to avoid such disruption, we will work with
them, the Department of Health and Social Care (DHSC), and others, to seek an enabling national policy and legislative framework. With that in mind, NHSE/I and DHSC must facilitate a robust debate with the health and care sector about the scale and implications of both these latest proposals and the proposed legislative reform, which build on the prior proposals we have already supported.”

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