Agenda item

The Committee considered a presentation from Dr Neil O’Brian, Accountable Officer/Chief Clinical Officer at County Durham CCG (for copy see file of minutes).

The Accountable Officer/Chief Clinical Officer described the statutory duties and powers of the CCG and the existing structures in the North East and North Cumbria, which were made up of 8 governing bodies, with their own executive and management teams, councils of practice and various committees such as primary care, audit, quality and finance. 

He advised that Professor Sir Liam Donaldson had been appointed as Chair and Sam Allen as Chief Executive of the Integrated Care Board (ICB).  He advised of local authority input on the development of the Integrated Care System (ICS) and consultation throughout the process.  The structure of the board was such that it was mainly local authority members, but it would also include partners from primary care, police, fire, schools, Health Watch and the business sector.

He advised that engagement requirements for the draft constitution was to be completed by the end of November 2021.

The Chair queried the role of this Committee following the changes and the Accountable Officer/Chief Clinical Officer confirmed that the only change was that CCG employees would become ICB employees.

Councillor Martin was concerned that this constitutional change could be having a detrimental impact on frontline staff and the Accountable Officer/Chief Clinical Officer advised that most were unaware that it was happening.  Councillor Martin stated that it was reassuring that there would still be reports to Committee however he wondered what safeguards would be in place to ensure that they could challenge decisions of this regional body.  The Accountable Officer/Chief Clinical Officer advised that plans for a joint committee that would be served by local government and local health providers for County Durham were in place.  He acknowledged that if the ICB wished they could they impose something in local areas, however it would be subject to a consultation process and he reassured Members that this was not the culture that the ICB would want to promote.  He reminded the Committee that there was strong local authority representation on the Board.  Despite this, Councillor Martin advised that this local body still needed to be held to account. 

Councillor Crute was concerned at the pace that this was moving through parliament and that neither practitioners nor local people knew about it.  He was also concerned about the structure and was unsure what assurances the Committee had in preventing amalgamation of private and NHS services.  Councillor Crute hoped these changes would not open the doors to privatisation of the NHS. 

Councillor Crute then asked whether legislation would impact on local authorities and if the Committee would lose its power of referral to the Secretary of State, as this posed a serious threat and needed guarding.  The Accountable Officer/Chief Clinical Officer advised that there had been nothing to his knowledge that would remove that power and although the suggested change did not in his opinion promote the privatisation agenda, it was something to be aware of.  The private sector had a role and were the only reason that the NHS had been able to recover from the pandemic at the pace that they had.

Councillor Howey had concerns on the impact of County Durham and whether this affect south Durham areas such as Bishop Auckland which in her opinion, were already ignored.  If the ICS covered a larger area, she was concerned that smaller areas would suffer more than they were already. 

The Accountable Officer/Chief Clinical Officer advised that allocation of resources to County Durham would be transparent and with a budget of £1bn, new arrangements would be tracked.  All employees would remain, including clinical and managerial staff, but they would become ICB employees.  When a joint committee was in place, delegated authority would carry on the agenda.

In response to a question from Councillor Howey regarding ward closures, the Accountable Officer/Chief Clinical Officer advised that there was still a legal requirement to consult the public if there was any significant changes proposed to health services.

In response to a question regarding Professor Donaldson’s work in County Durham, the Accountable Officer/Chief Clinical Officer advised that he was able to work remotely.  Councillor Earley advised that he had lost count of how many times there had been a reorganisation and he found it bewildering that the NHS went through this many changes.  He believed that strategically this would become a super region and was interested in what the agenda was going to be.  He had heard positive comments about maintaining localism and protection from closures but Sunderland was competing for more services in order to protect Doctor training and this was a concern for him as it could take services out of Durham.

The Accountable Officer/Chief Clinical Officer advised that the ICS was the overarching body which was made up from representation from all areas and the board would reflect that.  He acknowledged his concerns about not having as much focus on wider hospital transformation pieces but there was still a need and legal right to consult on significant service changes which protected local services from forced changes.  He referred to one example of the Path for Excellence, which effected some residents of East Durham and confirmed that the population would be fully consulted.

Councillor Gunn was grateful for the presentation and suggested that the Committee wanted to ensure that the ICS would provide a comprehensive, universal treatment and care, which was free.  She was partly reassured that local authorities would still have a vital role to play through the Health and Wellbeing Board and scrutiny, and it was vital that Councillors were fully informed, but also vitally important for residents and patients to receive the information.

With regards to communication, this was a turbulent time as a result of the COVID-19 pandemic and she considered that there should have been a a period of stability, however did not seem to be the case with this bill.  Councillor Gunn was concerned about communication to residents and patients in order to reassure them about the changes as she was certain that there would be changes.  Information was difficult for herself to understand without reading a lot and going into detail and so she queried communication with the general public and asked for

clarification regarding local authority representation on the board.  She had read that it would be four for Durham County Council, despite the information stating only one representative from local authority.

The Accountable Officer/Chief Clinical Officer advised that there had not been a lot of communication on these changes as it was difficult to comment on a bill that had not yet been through parliament, but in addition there had been more important messages from the NHS to communicate to the public.

He confirmed that during the design stage, the Chair had recognised that the ICS was the largest in the Country and had concluded that it was not appropriate to have one local authority seat.  This was a unitary board and members from local authorities were there as board members with a background in local authorities, not to represent their own authority.  They had left the way the seats were allocated up to local authorities.

A Healy, Director of Public Health reassured Members that local authorities had played an active role through the Health and Wellbeing Board, to ensure they had an input and had helped in terms of the increased numbers.  Statutory duties remained and local authorities had been clear that they had an important role.

R Hassoon added that she had attended a patient residents group meeting where concerns about how the general public would be consulted in future had been raised.  Patient participation groups in general practice were not always taking place and it was confirmed that one had not had a meeting in two years.  Would like to think there wuyjld be some way patient reference  groups coujld continue, to ensure, understand health watch involved but not everyone involved in those organisations.

The Accountable Officer/Chief Clinical Officer advised that although most patients were not interested in this type of communication, it did not mean that the information should not go out.  There was a section in the draft constitution which explained the ICB’s responsibility on public and patient involvement and just as CCGs had a desire and legal responsibility to involve public and patients, so did the ICB, who  would build on practices and improve on those that were not up to scratch.

Councillor Kay queried why there were three boards were needed as this looked to be a slotting in exercise which mimicked the local government reorganisation in 2009.

The Accountable Officer/Chief Clinical Officer advised that the current organisation consisted of eight governing bodies requiring resources and was reducing to one, which could be an improvement.  He added that this was not an exercise in reducing running costs, so all people involved in working in the CCG in County Durham would still be continuing that work however, the statutory bodies running the NHS in this area had been reduced.

The Chair added that all the Chairs and Vice Chairs reported that all Committees had the same thoughts on transparency, communication and finance and it was pertinent to monitor this situation, however it was very much out of their control.

Councillor Crute noted that there was no report or recommendation for the Committee but given the concerns about communication and scrutiny’s role in amplifying the voice of the public, the Committee should ensure that these changes were communicated.  There was not one person whose life was not affected by the NHS and the way it was operated and it was incumbent on the Local Authority and as a Scrutiny Committee to ensure that they were communicated as in his opinion, if there was any regulation, it was light touch and concerning that there were no checks on regulations going through parliament.

As a bare minimum, Councillor Crute suggested that the Committee needed to follow developments as they went through parliament and review them as what was happening now may not remain the same.  He added that if those local authority seats were written in legislation, it could change in time and open the door to the private sector.

The Accountable Officer/Chief Clinical Officer advised that he would return to provide an update to the Committee when required.

Councillor Gunn fully supported the comments from Councillor Crute and added that there would have to be a structure in place by 1 April and it was likely that the bill would go through in December, so there were things that were happening that the Committee would need to be updated about.

The Accountable Officer/Chief Clinical Officer advised that the relationship between local authorities and the NHS and finance was still being debated and in response to a proposal from Councillor Gunn that the Committee be updated as soon as possible after the bill went through, the Accountable Officer/Chief Clinical Officer agreed he would return as soon as possible.

The Principal Overview and Scrutiny Officer confirmed that meetings were scheduled in January and March and agreed to consider reviewing those arrangements if needed to discuss the bill.

Councillor Gunn noted the pressures in additional meetings but stressed the importance of this and preferred that this item was not left until March if the bill went through after the meeting in January. 

The Chair advised that if the information was not ready for the meeting in January an additional meeting would be requested.

Resolved:

That the report and presentation be noted and that an update be provided to the Committee as soon as possible upon legislation being passed by Parliament.