There was an interesting meeting over at the Finsbury Ward Partnership last week, where the topic under discussion was how local health services will be affected by the reforms approved by the government earlier this year. The meeting drew a range of local residents, voluntary organisations and doctors keen to hear what the local Clinical Commissioning Group (CCG) has been up to and what other delights might be in store for our health services. About 35 people attended.
A woman from Public Health set the stage, and we were told we were very lucky to have a whole group of people employed to examine this. Can it possibly be true that most other localities refrain from collecting public health statistics? Gathering information and disseminating it under the new regime will now be fully the responsibility of local councils, no longer shared with the NHS.
She ran through the differences in life expectancy in different parts of the borough, and the main diseases killing people. Heart disease, cancer and COPD top the list, with diabetes also common, and particularly so in the Clerkenwell part of Finsbury, where men have the shortest life expectancy in the whole of Islington, despite being slightly less ‘deprived’ according to census stats. These were very much presented as ‘lifestyle’ choices the poor make. The numbers of people with mental health issues is also on the rise, with Islington shown to be a leader in this category. The audience pointed out several other possible factors, like lack of open space, lack of greengrocers, and possibly even a GP to help keep track of their health. (More about this later.)
Cllr Janet Burgess (Executive member of the Cabinet for Health and Adult Social Care) then talked about the new Health and Wellbeing Board, which will be stocked with Cllrs, GPs and other health professionals, reps from HealthWatch, which locally will be the reconstitution of the current patients’ rep body Link. Its purpose is to scrutinise the decisions of the CCG, and if an unresolvable dispute arises it can appeal to the National Commissioning Board (not the Secretary fo State for Health as in the past).
Next was what we were all waiting for: an explanation of how the local Clinical Commissioning Group will work. The CCG, working of course in close consultation with absolutely everyone, will commission (that is, buy in) all heath services except those which they don’t. This includes the GPs themselves, prison health services – and something the presenter left out, maternity and early childhood services. There will be only one in Islington, so it will be essentially a neo-PCT, with less control over fewer services. We were shown a fairly simple chart showing the hierarchy of the NHS before the reforms and a much more complicated chart (even after fairly gross simplification) showing 7 tiers replacing the three which existed before, and nearly twice as many CCGs replacing the PCTs around the country. So much for simplifying bureaucratic structure.
The CCG will be buying in services from the hospitals and community service providers, and the speaker, a GP at City Road Practice who is Vice-Chair, emphised that the tenders would weighted for quality and experience (thus favouring those formed out of former NHS services) ‘as much as’ price. Veteran health campaigner Wendy Savage queried the claim that services would have to put out to competitive tender at all, in the wake of the judgement in Stroud last spring. In general there was much support for the use of legacy NHS services over for-profit private companies.
Former Bunhill councillor Joseph Trotter and others raised questions throughout the evening about the lack of GP coverage in his area, which is served by only one GP practice, where the Clerkenwell side of Finsbury has three. A GP from that practice noted the rather alarming fact that they are signing up 20-30 new patients a day. The new CCG, however, will not be commissioning GP services – the national NHS Commissioning Board will do this. This rather essential body is, however, still ‘in the process’ of formation, with a structure which can still only be guessed at.
For the last 20 minutes another member of the CCG gave a rather confusing talk about ‘integrated care’ – basically getting the different agencies talking to each other better and co-ordinate things between them so that the whole burden is not on the patient. No one could doubt this would be a Good Thing, and in fact it has been a stated goal of both the NHS and the Council for some years now, with seemingly little progress to judge from the stories which came from the audience. When asked how this programme was going to square the circle of competitive tendering vs co-operation between services, the speaker gave a rather technical answer involving targets and point scores. Hopefully the CCG will take their lead from the Stroud case and ignore the tendering process altogether. If nothing else it would save a lot of time for our already over-burdened doctors.
No doubt we’re lucky that the local CCG seems more concerned with patient care than with promoting the hollow concept of ‘choice’. We need to hold them to it. If you’re concerned about health services in your area, join your practice’s Patient Participation Group, and/or get in touch with Islington Link, which represents patients throughout Islington. If you want to keep track of how the changes are affecting the NHS – and action you can take about them – there’s London Health Emergency and nationally Keep Our NHS Public.
By popular acclaim the next Finsbury Ward Partnership meeting will be about housing.
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