Huge cuts-driven changes to NHS and social care commissioning in Isle of Wight

Huge changes to the Isle of Wight’s NHS and social care commissioning are underway, following a “capability and capacity review” by the management consultancy company PwC.

A recent study found that management consultants make things worse!

In the wake of the PWC review, major changes to the Isle of Wight Clinical Commissioning Group’s powers and responsibilities have come as a surprise to Protect the NHS campaigners.

These changes are summed up as “ Developing a new commissioning model for the Isle of Wight”:

  • Commissioning at scale (ie across the whole of the Hampshire and Isle of Wight Sustainability and Transformation Partnership) – specifically this means the Isle of Wight Clinical Commissioning group is joining the Hampshire Clinical Commissioning Groups Partnership and the Hampshire Maternity and Children’s Commissioning Collaborative.
  • Integrated Place-Based Commissioning with the Isle of Wight Council (ie for the Isle of Wight Integrated Care System – formerly known as an Accountable Care System, but rebranded by NHS England to avoid connotations of the USA’s health care system).

These changes are driven by spending cuts required by NHS England

Last December, NHS England put the Isle of Wight Clinical Commissioning Group under legal directions, after the Clinical Commissioning Group reported it couldn’t see how it was going to make all the spending cuts NHS England required and was likely to be £2.2m short of the NHS England target.

NHS England’s legal directions required the Clinical Commissioning Group to commission a capability and capacity review within six weeks, and then submit an “organisational plan” within four weeks to deliver on the findings.

The sustainability plan had to show how the Clinical Commissioning Group will operate within its budget for 2018-19 and “subsequent financial years”.

PWC – one of the notorious Big 4 accountancy companies recently lambasted in connection with the Carillion scandal – was commissioned to do the capability and capacity review. You can find a summary of this review on p34-39 of the 24th May 2018 IoW Clinical Commissioning Group Governing Body papers (no longer accessible online but downloadable here:

Commission jointly with Hampshire Clinical Commissioning Groups – or stay in legal directions

It is clear from their capability and capacity review that PWC told Isle of Wight  Clinical Commissioning Group to join the Hampshire Clinical Commissioning Groups Partnership as a condition of being taken out of legal directions.

“Joining the Hampshire Partnership is an opportunity for the CCG to evolve the way it delivers its business and develop new approaches to address issues.”

And p 38 Next Steps spells out:

“1. The CCG should develop an action plan to respond to our findings which should reflect the opportunities flowing from integration with the Hampshire Parnership.[sic]
2. The action plan should articulate how the CCG’s leadership, governance structures, processes and behaviours will develop in the short and medium term.
3. Alongside this action plan, the CCG must produce its Clinical and Financial Sustainability plan, showing how the CCG will be financially sustainable in 2018/19 and beyond.
4. Developing and delivering on actions against these plans will demonstrate to NHS England the CCG’s readiness to have its legal directions removed.”

The Operational Plan 2018/19 Exec summary (p 35 in the April 26th Isle of Wight Clinical Commissioning Group Governing Body papers)  summarises the situation:

The Operational Plan 2018/19 Exec Summary p91 adds:

Operational Plan 2018/19 Exec Summary p91

This slide from the IoW Clinical Commissioning Group Governing body papers for the Extraordinary Meeting on 26 April 2018 purports to show what the future of the Isle of Wight  Clinical Commissioning Group will be.

Cursory information presented to Isle of Wight NHS Commissioners’ Governing  Body

There is a bit of information about the New Commissioning Model in a paper presented to the Governing Body Meeting on 29 March 2018 (unfortunately no longer accessible online): “Welcoming the Isle of Wight CCG to join the Hampshire CCG Partnership”:

The April 26th extraordinary meeting of the CCG Governing Body, which approved the Operational Plan 2018/19, received a bit more information about New Commissioning Models:

Exec Summary (p 46)

Capitated outcomes-based contracts for places?

The bit about capitated outcomes-based contracts for places seems to be about Objective 2 in the 29 March 2018 Governing Body paper “Welcoming the Isle of Wight CCG to join the Hampshire CCG Partnership”:

Objective 2 in the 29 March 2018 Governing Body paper “Welcoming the Isle of Wight CCG to join the Hampshire CCG Partnership”

At a guess, the 3 capitated outcomes-based contracts for places would be for the 3 multidisciplinary locality services.

Update: The Hampshire Clinical Commissioning Group Partnership later became a single Clinical Commissioning Group for Hampshire, Southampton and the Isle of Wight.

Local, place-based commissioning -the Isle of Wight Council and Clinical Commissioning Group have a lot of questions to answer

Local place-based commissioning seems to be about the Council and NHS together commissioning an Isle of Wight Integrated Care System (aka Local Care Plan) by “implementing a New Models of Care commissioning framework approach.”

This baffling slide is from the CCG Governing Body papers for the 24 April 2018 Extraordinary Meeting. It begs MANY questions.

Such as where and what is the Alliance Agreement for ratifying into contract? And who approved it and where is the record of the discussion? Plus what actually is covered by each of the dark blue boxes? Where is all that info – like who is party to the Alliance Agreement and what are its main functions? What are the agreed arrangements relating to services contracts for delivery of the Services? What services does this Alliance Agreement and Contract cover? What are the contractual terms? Where are the outcomes/products of all the Activities to ensure readiness to launch the Alliance. What are the financials?

All this is totally OPAQUE and it should be clear and available to the public.

Arrangements for the Isle of Wight CCG as a member of the Hampshire and Isle of Wight CCG Partnership

In the paper “Welcoming the Isle of Wight CCG to join the CCG Partnership,” the following arrangements are proposed, from 1 April 2018:

Joining Hampshire collaborative commissioning for Children’s and Maternity services

The Minutes of the March 2018 meeting (Section 5.4) of the IoW Clinical Commissioning Group Governing Body show that it was joining Hampshire collaborative commissioning for Children’s and Maternity services:

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