Unlawful NHS mergers threaten Privatisation under cover of COVID, say Merseyside campaigners

Campaigners on Merseyside are demanding local health bosses reject massive merger plans which would clear the way for further NHS privatisation, removing public accountability in the midst of the pandemic.

Consultant Dermatologist Andrea Franks said,

“Covid-19 has not gone away and this half-baked merger which lumps the whole of Cheshire and Merseyside into one artificial unit will interfere with patient care and keep the public at arms length.”

Covid-19 recovery priorities include Clinical Commissioning Groups’ mergers as whole of English NHS switches to 42 ‘Integrated Care Systems’

In July, NHS England/Improvement issued instructions on Phase 3 Covid-19 priorities for the NHS. This included a statement indicating the policy direction for the future of local NHS commissioning, which would “typically lead to a single Clinical Commissioning Group across the system.” (The system being the Integrated Care System.)

Across Cheshire and Merseyside, this would see nine Clinical Commissioning Groups dissolve in favour of one Clinical Commissioning Group for 2.3 million people.

This is noted in the Liverpool Clinical Commissioning Group’s Chief Officer report (paper B1) to the Governing Body, which meets today (8th September 2020).

A campaigner reports that the Liverpool Clinical Commissioning Group Governing Body meeting has just addressed campaigners’ submitted questions and fully acknowledged that they are being told to merge across Cheshire & Merseyside. What will happen is not yet clear.

The quango’s instructions to merge all nine Clinical Commissioning Groups, might otherwise have escaped detailed attention from the Governing Body – as the Chief Officer’s Report to the Governing Body only dealt glancingly with this issue.

The section on the Clinical Commissioning Groups’ merger mostly focusses on NHSE/I’s rejection of the earlier proposal for a N Merseyside CCGs merger:

CCG Merger

“In March 2020 the Liverpool CCG Governing Body approved a proposal to make an application to NHS England for the establishment of a North Mersey CCGs, following support from the CCG’s membership. This was also supported by the GP memberships of Knowsley, South Sefton and Southport and Formby CCGs. Since March, the four CCGs have been developing an application which was due to be submitted in September 2020 for the establishment of the new CCG in April 2021.

“The recently issued Phase 3 guidance setting out new priorities for the NHS included a statement indicating the policy direction for the future of CCG commissioning, which would ‘typically lead to a single CCG across the system.’ This direction was confirmed in a letter to all North West NHS organisations from Bill McCarthy, NHS England North West Regional Director, which stated that ‘The default expectation is that there will be one CCG per ICS, enabling strategic commissioning and the devolution of more functions to the system level…decision making and energy will be located in place based leadership alongside Local Authority colleagues to tackle longstanding inequalities…..’ The Chairs of the four CCGs met with leaders from NHS England and the Cheshire and Merseyside Health and Care Partnership in August to understand what this means for the North Mersey CCG proposal. The outcome of the meeting was that NHS England considers an application for a North Mersey CCG is not on a scale that matches the national or regional direction. CCGs will enter into further discussions with NHSE/I and Cheshire and Mersey Health and Care Partnership in September.”

Fragmenting the NHS in England into 42 Integrated Care Systems

The 9 CCGs’ merger was dreamt up and dictated by NHS England, as part of a plan to convert the English National Health Service into 42 separate ‘Integrated Care Systems‘.

A flotilla of private companies including Deloitte, PWC, KPMG, Virgin and over two dozen US firms are accredited by NHS England, via the Health Services Support Framework, to develop Integrated Care Systems.

Privatisation of NHS commissioning

This amounts to the privatisation of NHS Commissioning, as Commissioners are required to pay private companies to do the work for them of setting up and using a commercial insurance-based model within the NHS shell of Integrated Care Systems.

And in case hiring companies on the Health Services Support Framework isn’t enough to enable them to do this job, NHS England has “invited” scores of Clinical Commissioning Groups to work with Optum and PWC to change their commissioning processes in line with USA accountable care organisations’ methods.

Last September, NHS England added an “Innovation Greenhouse” lot to the Health Services Support Framework, according to documents issued to suppliers. (Info from the NHS Procurement website.) This was in order to provide faster routes for Integrated Care Systems to buy “tried and tested innovations for patients, populations and NHS staff”.

The plan for Clinical Commissioning Group mergers so there is one per Intergrated Care System is propelled by NHS England Chief Executive, Simon Stevens. Mr Stevens was previously the President of Global Health at US-based UnitedHealth, the world’s largest healthcare company with a revenue of $242.2 billion.

There has been no consultation with Councillors, health staff, or the public, despite legal requirements when CCGs dissolve

However the Cheshire and Merseyside Local Authorities must be aware of NHS England/Improvement’s instructions. The Cheshire and Merseyside STP Board includes ‘place leads’ for the local authorities, so it’s inconceivable that the Councils don’t know about NHSE/I’s instructions to prepare to merge the 9 CCGs into 1.

For example, Simon Banks – Healthy Wirral is the Wirral rep on the Chesire and Merseyside Sustainability and Transformation Partnership Board. Here’s the list of members of Healthy Wirral. It includes Wirral Council. And as Chief Officer of Wirral Clinical Commissioning Group, he’s the head of integrated commissioning with Wirral Council.  So what is the Council’s position on the Clinical Commissioning Groups’ merger?

On Friday, Fazakerly Councillor Paul Brant told KONP the Labour Party in Liverpool opposes

“any proposals which might alter the local accountability of decision making bodies in the NHS, create structures which might not reflect natural boundaries or patient flows, and we are opposed to privatisation of the Commissioning or other functions of the Clinical Commissioning Groups.”

Earlier proposals were halted by NHS England in April, as Covid-19 pushed health care to the edge of collapse. But the massive shake-up is now being forced through in the face of a looming second pandemic wave and Winter crisis.

Update: the plot thickens – Wirral Clinical Commissioning Group says local integrated commissioning at a place level (i.e. Wirral) remains vital

Update 10.9.2020 – Wirral Clinical Commissioning Group has told Defend Our NHS’s Kevin Donovan that,

“No application has been made by NHS Wirral Clinical Commissioning Group (CCG) to merge with any other CCG by 1st April 2021, nor will any application be submitted by 30th September 2020.”

Kevin Donovan asked the Clinical Commissioning Group’s governing body meeting on Sept 8th to share its reponse to NHS England’s instruction to submit:

“Plans to streamline commissioning through a single ICS/STP approach. This will typically lead to a single CCG across the system. Formal written applications to merge CCGs on 1 April 2021 needed to give effect to this expectation should be submitted by 30 September 2020.”

He also asked the CCG to:

“describe how Wirral residents and health professionals will be involved in the process of amalgamation”

In their reply, Wirral Clinical Commissioning Group explained,

“One of the key principles of the 2020/21 NHS Operational Planning Guidance is the “system by default” model with the desire to create one CCG per Integrated Care System (ICS) footprint.  The Cheshire and Merseyside Health and Care Partnership, the ICS footprint that covers Wirral, has been asked to develop a plan for the future of strategic commissioning in Cheshire and Merseyside, noting the requirements of “system by default”.  It is our understanding that the ICS wishes to take forward this work in partnership with existing CCGs and local authorities as they recognise that local integrated commissioning at a place level (i.e. Wirral) remains vital to ensure delivery of appropriate services for place population, whilst equally acknowledging the national policy direction. 

“We can confirm that we have had no formal communication or notification from NHS England and Improvement (NHSE/I) and/or the Cheshire and Merseyside Health and Care Partnership on this issue and no decisions have been considered at this time.  It is not clear what the next steps are at this point, but NHS Wirral CCG will work with our local population, neighbouring CCGs, the Cheshire and Merseyside Health and Care Partnership and NHS E/I to understand what this policy directive means for Wirral”.

As we stated in our April 2019 response to NHS england’s Long Term Plan legislation proposals, the position of CK999 remains:

Responding to NHS England’s “engagement” on the proposed NHS Long Term Plan legislation, we said:

“We think NHS Improvement should be abolished, along with NHS England and Clinical Commissioning Groups and the purchaser-provider split. This would enable a rational planning and payment process to be set up, whereby the regional and local responsible bodies – Special Health Authorities, Health Boards or Community Health Councils – plan and cost the provision of health and social care on the basis of local needs and within the global regional/local sum provided by the Secretary of State/Treasury on the basis of Parliamentary decisions about the budget.”

3 comments

  1. Of course the privateers have to define their packages for convenient financial purposes, which have little relation to the delivery of Integrated Care Services to the people of Mersyside. And will the ICS set up a responsible decision making body to manage the integration and set-up of a super-efficient operating regime? Of course not – decisions will be signed off by existing bodies which will be disbanded in due course leaving the financial anarchy which Cummings so loves – much as portended in SYBICS.

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  2. In Wirral it gets worse. You are right to single out the role of the CCG. It was Defend Our NHS (which has campaigned on the issues for years and kept councillors and the public informed) which told councillors about the latest Stevens instruction. The chief executive of the council, alerted to our email promptly wrote to all the group leaders on the council and actually said (hold on to your hats) “we as a Local Authority have not been made aware of any proposed changes”.
    CCG and Council really are in it together, locked in some kind of weird mortal embrace.

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