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CCG Series: Rhetoric or reality?


12 February 2014

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Chair of East Surrey CCG and joint chair of his local health and wellbeing board, Dr Joe McGilligan has fully bought into the NHS post-Health and Social Care Act. But have all the changes made a difference? 

Chair of East Surrey CCG and joint chair of his local health and wellbeing board, Dr Joe McGilligan has fully bought into the NHS post-Health and Social Care Act. But have all the changes made a difference? 
Clinical commissioning groups (CCGs) have been legal entities for nearly a year now and there’s just over a year before the next general election. People are asking if we’ve made any difference – but I think it’s far too early to tell.  CCGs are still evolving and learning and finding the skeletons that have dogged the NHS since its inception. Previously if something was not working or unpopular you just changed its name and carried on. Health authorities became primary care trusts and there was always the feeling we were rearranging the deck chairs on the Titanic. 
This time it is different because the clinicians leading the NHS are still very much involved on the frontline, knowing how their decisions will affect patients in their daily lives.
The Francis report was released more than a year ago and people are questioning if the culture has changed. Culture is what you do when no-one is watching and now the NHS is under so much scrutiny from the regulators as well as the media that any slip is reported with the caveat of systemic failures highlighted in the Mid Staffs report. This constant denigration of the service is only serving to demoralise a struggling workforce. I believe everyone goes to work to do a good job and mistakes happen, but instead of learning from them in a no-blame culture such as in the airline industry, we persecute and prosecute and then wonder why no-one spoke up sooner. 
There are too many conflicting forces with too many myths preventing true transformational change. Unfortunately, there is no business model that works for the NHS. It has grown organically with more and more complex layers and interdependencies with incredibly tricky politics thrown in that challenge the most able minds. The Integrated Transformation Fund has had its name changed to the Better Care Fund (BCF) because the original name suggested we needed to pay to get integration and transformation rather than doing it and getting better care.
The BCF is the start of co-commissioning with the councils and where the difficult decisions have to be taken. We need to face the public with real choices about what the public pound will pay for and what it can’t. This is not new money and can only come from acute contracts to provide care in the community – it’s not to fill potholes! Local politicians be involved in any reconfiguration debates and must sign off any plans that may be unpopular with the incumbent providers, which may lead to mergers or closures. 
A councillor levelled the myth that the NHS can be saved by not treating immigrants at me recently. I replied, the day a doctor turns away a patient is the day I stop treating people free at the point of delivery. 

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