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Health leaders fear political flak for closures

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Clinical commissioning group leaders are enthusiastic about their ability to improve services, including through controversial moves such as closing emergency services and limiting treatments, but they fear politicians will stand in their way.

Health reporting HSJ and LGC logo

The concern was outlined in the Barometer survey by LGC’s sister title Health Service Journal, which questioned 116 leaders of clinical commissioning groups (CCGs).

More than one in four said they were likely to attempt to close or downgrade an accident and emergency unit in the next year.

However, they were concerned politicians would stand in the way of their changes.

Fifty percent said they thought “political opposition to service changes” would be a “significant barrier” to change in the next year. A further 31% said this would be a “small barrier”.

NHS Merton CCG chair Howard Freeman, a GP and chair of a London-wide clinical commissioning council, said: “When it is the big picture it is easy for politicians but when it’s their own constituency it is a different story.”

He added the introduction of the failure regime for trusts would help convince politicians there was no alternative to hospital reconfiguration.

The research also revealed that nearly nine in 10 CCG leaders were likely to introduce bans or limits on some treatments.

NHS North East Lincolnshire CCG accountable officer Peter Melton, a GP and member of the group developing a national commissioning assembly, said many CCG leaders believed access to some NHS services would need to be more limited.

He said resources should be shifted away from “those with the greatest expectations to those with the greatest need”, for example from some cases of surgery, which have limited benefit, into prevention and long-term care.

Pie chart: CCG highest priority for service improvement

Respondents were asked to rate confidence in their ability to improve services between one, representing no confidence, and 10. The average result was 7.1 and the most commonly picked number - with 34% - was eight.

HSJ’s parallel Barometer survey of hospital trust chief executives last month asked them a similar question. Their confidence level was 6.1.

CCG leaders were also asked to rate confidence in their organisation’s effectiveness, and the result was 7.9. When hospital chief executives were asked to rate commissioners’ effectiveness, the result was just 3.1.

Maps showing CCG stats

The most common priority area for service change for CCGs was urgent and emergency care, with 63% naming it their top priority.

NHS Commissioning Board national director of commissioning development Dame Barbara Hakin said: “These results are very encouraging. CCGs believe they can make a difference, which is fantastic, and they believe they are going to be fit for purpose.”

 No relationship %Very good %Good %Neutral %Unhelpful%Very unhelpful %Bullying %
Primary care trusts/primary care trust clusters13140121025
NHS commissioning board national team3331640602
NHS commissioning board regional team2152242533
NHS commissioning board local team14192630713
NHS commissioning support service5214235430
Member GP practices055423100
Hospital provider organisations0294717611
Local authorities048474100
Regulators - Monitor or Care Quality Commission52560202
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