The future of NHS commissioning arrangements for NHS Halton Clinical Commissioning Groups and NHS Warrington Clinical Commissioning Groups.

This survey closes on 29th September 2019
What are we asking for your views about?

The future of NHS commissioning arrangements for NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Groups.

What are Clinical Commissioning Groups?
Clinical Commissioning Groups took over responsibility for planning, buying and monitoring (commissioning) local health services in April 2013. They work to improve population health, by tackling health inequalities, to improve life expectancy and the quality of life and to ensure local people can get the services they need when they are unwell.

Why are changes being made?
In November 2018, NHS England told clinical commissioning groups that they would be reducing CCG running costs (this the budget for the corporate overheads and administrative functions of the CCG) by 20% by 31st March 2020/21.  

In addition the NHS Long Term plan, published in January 2019 describes how the commissioning environment will continue to evolve and how CCGs will operate in future.  The new approach to Integrated Care Systems needs health commissioning to change to support development of two critical parts:

  • Development of ‘Place’ – meaning better, faster service integration by alignment of commissioning resources e.g. pathway redesign, contracting expertise, case management etc. with providers around local populations.
  • Streamlined, single commissioning resources for a population focusing on outcomes-based commissioning, strategic change and financial management. This links to the running cost reduction in that CCGs have been mandated, by NHS England, to reduce their running costs by 20% as part of these new structures by 2020/21

What does this not affect?
The proposed changes does not affect frontline patient services or any other NHS provider organisations like hospitals and mental health, community or family doctor (GP) services - or any health and care services provided by the NHS or local councils. It does not affect any services they buy from voluntary and community sector (VCS) or any other organisations.

What changes are being considered
Over the past few months a lot of work has been done to explore every way possible to make the savings, including whether there was an opportunity to merge with the CCGs across both Cheshire, Merseyside and Mid Mersey (St Helens CCG and Knowsley CCG), in addition to integration with Local Authorities.

All the options were evaluated through a robust process by the Governing Bodies.  The outcome of the evaluation was the identification of the three top scoring options.  These being:

Option 1 - Formal merger of the two CCGs

This would build on the current integrated working arrangements but will mean the establishment of an entirely new CCG, with a single management team, governing body and one set of statutory duties to be delivered, coterminous with the local authorities. Savings would be made as the duplication would be greatly reduced.  In addition this would support the ambitions of the NHS Long Term Plan, retaining a focus on ‘place’ across both Halton and Warrington, whilst supporting the streamlining of commissioning and reducing running costs.   

Option 2 – Do Nothing

This option would be to remain as is, with two separate accountable CCGs.  There are already some benefits in terms of the integrated management team, the move to a single functional base and the alignment of some work programmes.  However, there will still be a lot of duplication in terms of governance arrangements, with two governing bodies, accounts, commissioning plans, work programmes etc.  This option would maintain the status quo but does not offer any benefit in terms of economies of scale nor will it deliver the required reduction in running costs or fulfil the vision of becoming a strategic commissioner in line with the NHS Long Term Plan.

Option 3 – CCGs integrate with their respective Local Authorities

This option would be integration as it would not be possible for the CCG to fully merge with the Local Authority as Local Authorities and CCGs are different legal entities with statutory responsibilities.  This option would also require a significant amount of time to implement, even with complete sign up of all organisations.  The integration would be complex and a level of duplication would remain as CCGs are accountable for delivering the financial and constitutional targets.   In addition this option would not address the financial requirement to achieve a reduction in running cost allowance by 20% in the mandated timescales.

How will your views be used?

All of the views that are received will be summarised and presented to the clinical commissioning groups governing bodies for consideration.

Who will make the final decision?

The Case for Change will be presented to the respective Governing Bodies for consideration.  Each Governing Body will then make a recommendation to the CCG membership.  NHS England will then be informed of the decision of the membership and provided with the Case for Change which will include the views and feedback from all key stakeholders, including partners, providers and the public.

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* 1. Are you responding as an individual or a representative of an organisation? If an organisation please state which one.

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* 2. Please state which CCG area you live in or your organisation covers

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* 3. To what extent do you support NHS Halton CCG and NHS Warrington CCG formally merging

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* 4. Please explain your answer

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* 5. To what extent do you support the CCGs saying the same

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* 6. Please explain your answer

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* 7. To what extent do you support the CCGs integrating with their respective local authority

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* 8. Please explain your answer

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* 9. Have you any other comments

Thank you for taking the time to complete the survey. 
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