LGC’s essential daily commentary.
Today’s positive progress: Social care DTOCs fall as total rises
Today’s mayoral insights: Rotheram and Houchen: ‘Mayoral model success depends on us’
Today’s case for comms: Simon Jones: Communicating a council vision isn’t a vanity project
Despite an almost complete lack of action from the government to address the health and social care funding challenge, on the ground the burning platform is driving significant changes to the health and social care landscape.
This week brought news that four more Greater Manchester CCGs are to share a chief executive with their local council, joining Steven Pleasant who has held the joint role in Tameside for more than a year and, in North East Lincolnshire, Rob Walsh took on the joint position in August.
Meanwhile it was also announced this week that Kernow CCG is set to become a department of Cornwall Council.
In Greater Manchester, three of the CCGs are to come under the oversight of the existing council chiefs: Carolyn Wilkins in Oldham MBC, Steve Rumbelow in Rochdale MBC and Theresa Grant at Trafford Council.
In Wigan, the only place where the CCG still has a chief officer in post, the new merged role will be subject to an application and interview process ringfenced to the two organisations. The appointment panel will include Wigan MBC leader Lord Smith (Lab), Greater Manchester Health and Social Care Partnership chief officer Jon Rouse and Wigan CCG chair Tim Dalton.
The smart money would be on council boss Donna Hall ultimately taking the role as it’s hard to see even the most capable CCG chief being able to step straight into the top job at a metropolitan council with its myriad unrelated service lines and a whole new kind of political dimension to contend with.
In Cornwall health and local government bodies are planning to create an accountable care system which will consist of an “integrated strategic commissioning function” hosted by the council and one or more accountable care partnerships delivering services. Leadership arrangements for the new commissioning function are yet to be finalised. However, given the chief officer of the CCG is an interim and Cornwall Council chief Kate Kennally has previous NHS experience, and was appointed following the agreement of the council’s devolution deal which included a specific commitment to greater integration, it seems unlikely she won’t take on the additional responsibility.
So that’s seven merged council and CCG commissioning functions. But even this may only be the beginning. Nobody in the NHS thinks CCGs in their current form have a long-term future.
A creation of the Lansley reforms introduced by the Health and Social Care Act, CCGs were intended to bring a bigger clinical voice to commissioning but what was really required was for primary care to have a more prominent and integrated role in the delivery of services. This is central to what many of the emerging accountable care systems or organisations are trying to achieve.
The Health Service Journal’s ever well-informed Dave West reports today on the latest thinking at the top of the NHS about how these new organisations could be constituted within the confines of the existing legislation.
ACOs are widely viewed as the future for NHS services and their very nature – providing services across the whole care pathway for a per-person budget – makes much of the work of CCGs redundant. Health commissioning in the future is envisaged as being much more strategic rather than activity focused.
Mr Rouse told LGC this year the conurbation’s devolution deal was attempting to put right what was wrong with the creation of the NHS – namely the lack of local government involvement and GPs, keen to maintain their status as private businesses, left slightly outside of proceedings.
But though the writing may well be on the wall for CCGs, the lack of appetite for major reform means we are unlikely to see their wholesale aboltion anytime soon. Indeed, even when sitting under the auspices of a council they retain their statutory status. However, this week’s developments suggest places can be bold in thinking about how health and social care services are organised in future.
Sarah Calkin, deputy editor