East Sussex NHS groups to merge and cut number of managers

Clinical commissioning groups replaced primary care trusts in 2013 and are responsible for planning and commissioning many health services in their areas
Clinical commissioning groups replaced primary care trusts in 2013 and are responsible for planning and commissioning many health services in their areas

A senior NHS leader has faced questions on proposals for major changes to the Clinical Commissioning Groups (CCGs) in East Sussex.

On Thursday (June 27), members of the East Sussex Health Overview and Scrutiny Committee (HOSC) heard from health boss Adam Doyle about plans to reduce the number of CCGs in Sussex from seven to three.

Under the plans the High Weald Lewes Havens, the Eastbourne, Hailsham and Seaford and the Hastings and Rother CCGs are to merge into a single body covering the whole of East Sussex. Similar arrangements would be put in place for West Sussex. 

Committee members raised a number of questions about what the proposals would mean for local residents, including voluntary sector representative Jennifer Twist, who said: “From a governance perspective, could you tell us a little bit about how local representation will be maintained on the East Sussex CCG board?”

Mr Doyle, who is the sole chief executive of all seven Sussex CCGs and a further CCG in East Surrey, stressed that the potential governance arrangements are yet to be decided.

But he said it would be likely to involve local representatives, each representing roughly 100,0000 residents.

With a population of around 800,000 residents, this arrangement would be expected to see around eight local representatives on the East Sussex CCG board.

Mr Doyle said: “The person on the governing body, lets just say representing Hastings, would be there representing the people of Hastings as a commissioner. 

“What I have to ensure we do, to make sure this model works, is provide an infrastructure around that individual to ensure they can get the local feedback and play it into the governing body. 

“We have still got to work through the governance model and work through the representation, but that is how I think we will safeguard the localism in a large organisation.”

Mr Doyle also spoke of national pressure on CCG budgets, saying all CCGs were required to cut their back office costs by 20 per cent following guidance from NHS England.

This would come to a gross figure of around £5m across all eight CCGs under his control, Mr Doyle said.

This prompted further questions from Hastings Borough councillor Mike Turner (Lab), who raised concerns about the cost of providing local representatives with support. 

Cllr Turner said: “It is a lot of work for one person. To be able to liaise with all the patients, voluntary organisations, local representatives and so they would need resources to do that. 

“As one of the reasons for creating this single body is to cut down on the number of staff and resources, you are going to have to increase them in order to get all of that information so a person can come forward on to the board with all the local concerns, knowledge etc.”

Further concerns were raised by Hastings county councillor Peter Pragnell (Con, Hastings Ashdown and Conquest) over how a single CCG would address differing needs and health inequalities in its area.

Cllr Pragnell said: “There are, as you will be aware, areas of great disparate inequality in health outcomes across the county. 

“There are bits of Hastings, Bexhill,  Eastbourne and, in particular, the forgotten bits in isolated rural pockets, which have great needs.

“Will the people who need those services, who have those greater health problems, notice any difference? Will they notice an improvement?”

In response, Mr Doyle said the new CCG is likely to invest in community-based care and prevention work in order to address particular issues within local areas.

He said: “I completely recognise the differences across East Sussex. We have parts of Hastings, which have the highest teenage pregnancy rates across the country and we of course have an ageing population in part of Eastbourne. 

“It is my view, having worked in many parts of the NHS, that the way to manage health inequalities is to manage them in the communities where they exist.

“What I should say is that there is no plan yet. We have to write the plan that demonstrates we can do that.

“But I think the partners coming together creates the environment where you can write the plan in such a way that it meets those health inequalities.

Meanwhile Eastbourne Langney councillor Alan Shuttleworth (Lib Dem) raised concerns about how the 20 per cent cuts would affect local services, asking whether preventive services could face cut backs.

However, Mr Doyle said this would not be the case as the cuts are exclusively falling on the CCGs’ administration budgets, rather than their budgets for commissioning health services.

He added that savings would mainly come by making ‘high level managers’ redundant, saying many of these job cuts had already been made in the previous year. Further savings were expected as a result of the merger plans, he added.

More details of the merger plans are expected to come forward in the coming weeks, as the current CCGs’ boards hold further meetings to discuss the proposals.

If agreed, the CCG will assume shadow form from this autumn with the full merger expected to be completed by April 2020.