Councillors grill health bosses on plans to merge services across north-east London

Hackney councillors continue to raise concerns around nationally-dictated plans for a centralised merger of the borough’s local health body across the entirety of north-east London.

The plans began with the NHS Long Term Plan, launched in January of last year, which expect all parts of England’s health services to be organised within integrated care systems (ICS) with large population footprints of over a million people.

Primary care networks will work on more focused levels of between 30,000 to 50,000 people.

Councillors sitting on the Health in Hackney scrutiny commission, who have long made calls for more information as to how local accountability would function under such a system, raised further concerns yesterday at not having seen a constitution for the new organisation, despite a vote to endorse the plans by members of the current City of London and Hackney clinical commissioning group (CCG) coming up in October.

Committee chair Cllr Ben Hayhurst said: “We’ve got an outstanding CCG, and an outstanding hospital. There are obviously questions on a Hackney level about whether we need this change, but I appreciate there is a diktat from above as to how this change is coming down the line.

“What concerns me at the moment is that we are being asked to consider this without a constitution in place, and without being able to see the formal agreement on what powers they are giving up and what the agreement is.

“My concern has always been the medium- to long-term analysis of this. At the moment under primary legislation, [the CCG] gets the money to commission the Homerton. That provides a solidity and a back-up to the health framework in Hackney.

“The concern is without a formal written agreement, we could be ten years down the line when none of us might still be here in our current roles, but people at a north-east London level could decide they don’t want an acute provision at the Homerton or something.

“I’m concerned that we have that protection over our own health economy. You can call me selfish for saying that and perhaps I should think more globally, but under this new arrangement if we agree it without seeing the constitution what guarantees do we have medium to long term?”

City & Hackney CCG managing director David Maher said that Hayhurst’s concerns were “fair”, reassuring listening councillors that the constitution for the plans is under development and has been sent to local GPs, with members of the local CCG currently seeking greater clarification on how working arrangements locally are going to operate.

The CCG boss added that such detail as described by Hayhurst would not be articulated in the constitution in any case, adding that the framework currently agreed upon provides a “tether of accountability” locally, with Homerton chief executive Tracey Fletcher to be part of the new leadership structure.

Lea Bridge councillor Deniz Oguzkanli also spoke out in scepticism at the planned changes, saying: “Every few years we seem to be making significant changes, and this is one of those changes. I question whether a case for this change is made out. I also question the timing of the change, given that we are in the middle of a pandemic.

“I have serious concerns and issues about accountability and local involvement, because you are talking about seven CCGs from eight local authorities merging into one.

“I also question how much this commission can contribute when a clear case is not made out and we have not seen the constitution.”

Managing director Maher “empathised” with Oguzkanli’s comments, responding: “We have a CCG running cost allowance, so change is being developed within that framework.

“On whether our resources being faced in the right direction in response to Covid, I would say we are doing our absolute best to keep on top of all the details including Covid, and these changes which are running against a timetable that is not set by us.”

It is understood that local health leaders attempted to defer the changes being put in place due to the time lost in responding to Covid, but this was blocked by NHS England, which, according to CCG chair Dr Mark Rickets, said ‘You have already had an extra year. You’ve got to get on with this’, causing the changes to be put forward “with renewed pace”.

It was explained to councillors that the NHS’ commissioning board’s set out its calls for legislative change to remove competition from the market, to reduce the requirement for commissioners of services to use market forces to define best value.

The ICS reforms seen as a means of breaking down the boundaries between the purchasers of health services and their providers, according to Maher allowing “greater robustness to manage market forces until legislative change takes place”.

The single organisation to be formed in north-east London is planned to be split into three integrated care partnerships (ICPs) – one in the footprint of Barking, Havering and Redbridge University Hospitals NHS Trust, one aligned with Barts Health and the East London Foundation Trust (ELFT), and one to ELFT and the Homerton, underpinning the entire ICS.

Local health and wellbeing boards will shape health management in the wider population, which Maher said is “increasingly more important” as health networks attempt to reckon with the consequences of Covid and the inequalities laid bare by the pandemic.

The Town Hall’s public health team has also been in discussion with Maher to set up a Population Health Hub, which would coordinate wider population health strategies.

Following quizzing from Town Hall speaker Cllr Kam Adams on how accountability will operate for locals on health matters, Maher explained that there will be seven local ICS members’ forums who will elect a chair who will form part of the north-east London governing body, and who will also be part of the local care structure locally and sit on decision-making bodies in City & Hackney.

Dr Rickets said: “Some of the exciting stuff is about moving from contractual formal arrangements to something where we all come together to share planning, to share responsibility and accountability, the financial management of the system.

“There are levels of checks and balances across the system. It allows us to move into a shared way of working where we are all accountable, and we hold each other to account, and we manage population health in a much more holistic way, rallying all the resources that we have to the greater good.

“That allows us to step into much more ambitious areas of prevention and the wider determinants of health, and really engage with the voluntary and community sector, and have this model where we are working busily at the City & Hackney level, and the key driver of how things will be delivered will be a neighbourhood of 30,000 to 50,000, and then there are things that go on across the north-east London level.

“This does come with opportunities, this change. I know it is not of our making, but we are going to do a damn good job of making the best of it.”