Influencing Your Clinical Commissioning Group

Accountability Campaign resources NHS Commissioning Public and Patient Involvement

AIMS:

  1. To support theCCG to subvert the Health and Social Care Act
  2. To support the views of the population being heard by the CCG and being responded to by the CCG.

MAIN BODIES WHICH COULD BE INFLUENCED

  1. The CCG Board: these meetings are open. Items could be put on the agenda. It would also be possible for a public presence for some or all items.
  2. Other committees in the CCG: Strategy, Finance, and so on. The whole CCG is in principle open to local people being involved. Nonetheless, a clear case would need to be made and the presence of local people would need to be seen to be useful.
  3. Healthwatch: The aims of HW are here and below. In essence it will be the formal route by which local views and experience are gathered and fed to the CCG. HW has some powers, but not many.  However, HW will be open to local involvement. There will be many volunteers and probably a Reference Group to try and get wider engagement.
  4. Patient Participation Groups: these are voluntary groups in probably less than half of GP surgeries. They are usually focused on service provision in the surgery, but there is interest in joining them up to form a more strategic patient view. National support from NAPP
  5. Health and Well-Being Board: this has the Local Authority, CCG, HW on it and is run in essence, by the Director of Public Health. Usually chaired by the Leader of the Council. A national overview is here and below. It is meant to bring together the LA and CCG and to run the Joint Strategic Needs Assessment which identifies the needs of the populations and helps define the commissioning that needs to be undertaken to meet those needs. I am not clear how easy it will be to get local people on the HWB, but there will be sub-groups.
  6. The Public Engagement Group: every CCG  has to have a group for patient and public engagement. It is usually not open to the public, but it could be and I think there is an option for co-opting relevant people onto the group. Its job is to oversee all the Public and Patient Engagement activity in the area and to liaise with the LA which may be doing similar things.

Subverting The Health and Social Care Act

  1. Suggesting ways in which marketisation could be avoided. These might include:
    1. Ensuring that all providers have to have local knowledge.
    2. Ensuring all contracts are in the public domain and open to FOI requests
    3. Running integrated services across primary and secondary care
    4. There may be many other practical ideas
  2. Making public problems associated with local private contracts
    1. Through the press and our local knowledge/connections
  3. Making public problems associated with marketisation
    1. PFI
    2. The way in which hospitals are paid
    3. The way in which GPs are paid
    4. The nature of Foundation Trusts
  4. There may be many others.

 GETTING THE VOICES OF LOCAL PEOPLE HEARD AND RESPONDED TO:

  1. Get involved in Health Watch. This is usually the easiest and the most practical. HW is being formed right now and a delegation could discuss with HW how you might be involved.
  2. Speak to councillors about representation on the HWB.  Harder but might be possible.
  3. Talk to the chair of the CCG about how to get involved in committees. This would be a fair amount of ongoing work, but would have the most direct influence, particularly if we saw ourselves as routes out to the wider world, rather than cogs of the CCG.
  4. Form Patient Participation Groups in our own surgeries or get involved if there already is one. Again, a fair amount of work, but worthwhile particularly if you use your own surgery a fair amount.
  5. Intervene publicly at the CCG Board. This would involve reading the agendas in advance and putting in a presence where necessary.
  6. Gather views and have an agenda of our own. We may be able to boil down public views into a few key issues on which we could campaign.

Local Healthwatch

What is it?

  • The Health and Social Care Act 2012 sets out that local Healthwatch will be established in April 2013. Until then Local Involvement Networks (LINks) will continue to operate as usual
  • A local Healthwatch will be an independent organisation, able to employ its own staff and involve volunteers, so it can become the influential and effective voice of the public. It will have to keep accounts and make its annual reports available to the public
  • The aim of local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality

What will it do?

  • Local Healthwatch will have a seat on the new statutory health and wellbeing boards, ensuring that the views and experiences of patients, carers and other service users are taken into account when local needs assessments and strategies are prepared, such as the Joint Strategic Needs Assessment (JSNA) and the authorisation of Clinical Commissioning Groups. This will ensure that local Healthwatch has a role in promoting public health, health improvements and in tackling health inequalities
  • Local Healthwatch will enable people to share their views and concerns about their local health and social care services and understand that their contribution will help build a picture of where services are doing well and where they can be improved
  • Local Healthwatch will be able to alert Healthwatch England to concerns about specific care providers
  • Local Healthwatch will provide people with information about their choices and what to do when things go wrong; this includes either signposting people to the relevant provider, or itself providing (if commissioned by the local authority), support to individuals who want to complain about NHS services
  • Local Healthwatch will provide, or signpost people to, information about local health and care services and how to access them
  • Local Healthwatch will provide authoritative, evidence-based feedback to organisations responsible for commissioning or delivering local health and social care services
  • Local Healthwatch can help and support Clinical Commissioning Groups to make sure that services really are designed to meet citizens’ needs
  • Local Healthwatch will have to be inclusive and reflect the diversity of the community it serves. There is an explicit requirement in the Health & Social Care Act that the way in which a local Healthwatch exercises its functions must be representative of local people and different users of services, including carers.

 HEALTH AND WELL-BEING BOARDS

What are health and wellbeing boards?

The Health and Social care Act 2012 establishes health and wellbeing boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities.

Each top tier and unitary authority will have its own health and wellbeing board. Board members will collaborate to understand their local community’s needs, agree priorities and encourage commissioners to work in a more joined up way. As a result, patients and the public should experience more joined-up services from the NHS and local councils in the future.

Health and wellbeing boards are a key part of broader plans to modernise the NHS to:

  • ensure stronger democratic legitimacy and involvement
  • strengthen working relationships between health and social care, and,
  • encourage the development of more integrated commissioning of services.

The boards will help give communities a greater say in understanding and addressing their local health and social care needs.

What will they do?

  • Health and wellbeing boards will have strategic influence over commissioning decisions across health, public health and social care.
  • Boards will strengthen democratic legitimacy by involving democratically elected representatives and patient representatives in commissioning decisions alongside commissioners across health and social care. The boards will also provide a forum for challenge, discussion, and the involvement of local people.
  • Boards will bring together clinical commissioning groups and councils to develop a shared understanding of the health and wellbeing needs of the community. They will undertake the Joint Strategic Needs Assessment (JSNA) and develop a joint strategy for how these needs can be best addressed. This will include recommendations for joint commissioning and integrating services across health and care.
  • Through undertaking the JSNA, the board will drive local commissioning of health care, social care and public health and create a more effective and responsive local health and care system. Other services that impact on health and wellbeing such as housing and education provision will also be addressed.

 When will the boards be established?

By April 2012, health and wellbeing boards will need to be able to operate effectively in shadow form during 2012-13. Boards will take on their statutory functions from April 2013.

Who will sit on the boards?

The Health and Social Care Bill mandates a minimum membership of:

  • one local elected representative
  • a representative of local Healthwatch organisation
  • a representative of each local clinical commissioning group
  • the local authority director for adult social services
  • the local authority director for children’s services
  • the director of public health for the local authority

Local boards will be free to expand their membership to include a wide range of perspectives and expertise, such as representatives from the charity or voluntary sectors.

Membership is not the only way to engage with the work of the boards, all boards regardless of their political or geographic make-up will be expected to ensure that the needs of local people as a whole are taken into account.

How will local communities be able to get involved?

  • Boards will be under a statutory duty to involve local people in the preparation of Joint Strategic Needs Assessments and the development of joint health and wellbeing strategies.
  • Each health and wellbeing board will have a local Healthwatch representative member. Local Healthwatch will have a formal role of involving the public in major decision making around health and social care and its work is expected to feed into that of the health and wellbeing boards. To find out more about Healthwatch click here
  • All health and wellbeing boards will be accountable to local people through having local councillors as members of the board.