Dr Helen Tattersfield, clinical lead from Lewisham CCG steps up to the weekly CCG Series platform to talk about the reality of local decision making.
Two weeks into formal authorisation and what is really different?
Dr Helen Tattersfield, clinical lead from Lewisham CCG steps up to the weekly CCG Series platform to talk about the reality of local decision making.
Two weeks into formal authorisation and what is really different?
The national newspapers talk of radical re-organisation, threats of wholesale privatisation of the health service and fragmented services, while advocates of the system talk of local decision making and 'joined-up working'.
Here in Lewisham, clinicians have spent months preparing for this opportunity, learning new skills and building the crucial local relationships on which these reforms will stand or fall.
We have made plans along with our population and colleagues in health and social care and had visions of a truly engaged and joined-up service, meeting the increasing needs of our local population in an equitable and cost effective way.
We have passed all the tests and were authorised with no conditions, we were officially judged fit for purpose, our team was prepared, our relationships established and a few significant health improvements were already under our belt.
But all is not what it seemed.
Problems at the adjacent South London Healthcare Trust, resulting in planned provider reconfiguration, threaten to so alter Lewisham Healthcare that almost every plan we had in place will have to be rethought or abandoned all together. Pathways set up will need to be renegotiated with five providers – attempts at early discharge and admission avoidance will require heroic efforts by social care to provide equivalent input into this number of providers.
Yet at the same time unusual pressure in the system combined with inevitable low staff morale is producing long waits in A&E, ambulance diverts and general deterioration in service provision.
Not content that much of this has been imposed from above or is the result of unusual seasonal factors and not confident in our ability to manage this despite our full authorisation we are now summonsed to monthly ‘assurance’ meetings with NHS England time we would rather spend in planning and negotiation with our local providers.
So is local decision making really a reality? What can we really influence or will it really be business as usual with at distance managers making all the decisions but local clinicians taking not just the blame but the increased work load as well.
My hope and why we are still here is that only by being strong, competent and assertive local commissioners will our local population get the services they need and deserve and our task is to fulfil that role on their behalf.
This will be an interesting year!
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