This was a request on facebook. Here is a stab at an answer.
Basically the Clinical Commissioning Groups are accountable to the Secretary of State for health. In terms of planning what health services they are going to buy, NHS England pretty much tells the Clinical Commissioning Groups what to do.
(NHS England is the other name for the NHS Commissioning Board. It is a government quango with responsibility for commissioning specialist hospital services, etc. It is run by Simon Stevens, who previously worked as vice president for global American private health company United Health. His 5 year Forward View for NHS England (2015-2020) is based on importing United health “care models” and “modern workforce” methods and terms into the NHS.)
Monitor, the NHS “market” regulator (kind of like Ofgem for the NHS) oversees the Clinical Commissioning Groups’ compliance with competition law. This basically means they have to put bids for services they want to buy out to competitive tender. In other words opening the door to private health companies.
Because the central government has cut local authority funding to the bone, so Councils can’t any longer provide adult social care services they are statutorily responsible for, the Councils now rely on NHS money top sliced off our hositals Trust budget, that the Clinical Commissioning Groups pay to Councils via the Better Care Fund. This means that the CCGs and the Councils are joint commissioners for a number of so-called “Care Closer to Home” services through the Better Care Fund. (This is one reason why the Joint Health Scrutiny Committee are such a bunch of wusses – the Councils are basically in bed with the CCGs.)
The Councils through their Scrutiny Committees have considerable powers – and the duty to use those powers – to make sure that the CCGs don’t act in ways that are contrary to the health care needs of their populations. They can stop an unfit consultation going ahead, through referring it to the Secretary of State for Health, and they also can stop the implementation of proposals that are contrary to the health care needs of the population, again through referring them to the Sec of State.
Although the Councils said on Monday 22 Feb at the Joint Health Scrutiny Committee meeting, that their legal teams have told them they don’t have the power to stop the consultation going ahead by referring it to the Sec of state, they didn’t explain how they justified this decision. I am asking for an explanation of their justification for this because it is contrary to reliable legal advice that I have obtained. I think it’s a question of “won’t” not “can’t”, on the part of the Councils. Hope this makes some kind of sense.