To receive an update from officers of the NHS Commissioning Board on the organisation’s role and priorities.
Minutes:
It was explained that the Board was now known as NHS England and that its main roles were to directly commission primary care and specialised services and to allocate the budget to local Clinical Commissioning Groups. NHS England also had a number of other roles however including health service strategy, civil emergencies, national standards setting, leadership development and helping commissioners to be more effective.
The London region of NHS England was split into North, Central and East areas and the establishment of NHS England had reduced complexity in the NHS. A policy of ‘assumed autonomy’ had been implemented with CCGs which meant there would be a more supportive, assurance driven process of supervision. Each region had a director of delivery – Paul Bennett for the region covering Havering and regional teams were made up of nursing, medical and finance colleagues.
NHS England managed the delivery of care across the whole of the sector and focussed on both standards and financial issues. Current challenges included the winter and spring pressures on A&E and the introduction of the 111 telephone service. NHS England wished to ensure that CCGs were being suitably ambitious and there were still some conditions placed on many CCG authorisations. The NHS England representative was also attending meetings of Havering’s Health and Wellbeing Board.
NHS England was also involved with the regional quality safeguarding group which brought together all the agencies involved in safety and quality. The Healthwatch representative present considered this to be a very positive development.
A Member felt that the role of NHS England was too bureaucratic and that more focus was needed on local services. It was explained that the new NHS structure was leaner than previously and that NHS England was a smarter organisation than the previous Regional Health Authorities. The Director of Public Health agreed that the UK had lower health care administration costs than the USA but felt that this should continue to be monitored.
There was a financial limit in the administration costs of the CCG of £25 per head of population. Although the Havering population was rising, it did not necessarily mean that the CCG would get more funding; this would depend on the allocation formula.
The Director of Public Health wished NHS England to support efforts to increase Havering’s public health allocation which was the third lowest in London. The NHS England representative accepted that Health Service structures were complicated but reiterated that the priority was to ensure good services on the ground. NHS England was itself held to account by the NHS mandate and local and regional teams ensured scrutiny of NHS England’s work at a local or sector level. Local problems could also be raised by NHS England via their role with the Health and Wellbeing Board on which they were represented.
While NHS England had the responsibility of allocating funding to CCGs, it was emphasised that this would be done with a relatively light touch. Expectations around the required delivery of services would be set by the NHS Mandate and by the NHS Outcomes Framework. Struggling CCGs would be supported more directly by NHS England. Standards of performance for CCGs were expected to be published later this month.
As regards the acute sector, it was explained that BHRUT would be held to account for the performance of Queen’s Hospital by the CCG which would itself be held accountable by NHS England. The NHS Trust Development Agency also addressed standards in Hospital Trusts.
Performance information for the CCG was now available and it was suggested that this could be scrutinised by the Committee in the future. This could for example include data on how BHRUT were performing against their contract with the CCG. Although NHS England saw the same CCG performance data, this was from a different perspective and officers felt that the CCG should be held to account by both the Overview and Scrutiny Committee and NHS England.
NHS England also commissioned some local primary care services which also had an impact on the numbers going to A&E etc. It was confirmed the four hour rule for A&E performance was not being dispensed with.
The Healthwatch Havering Chairman suggested it would be useful if all partners could get together in the coming weeks and seek to work through local relationships in the health sector. It was suggested that Healthwatch Havering should take this forward outside of the meeting. The Director of Public Health felt the outcome of this work could also potentially be presented at the Public Health England conference.
The Committee noted the update.