The NHS is set to undergo a major shake-up this year, which will fundamentally change the way the service works.
Currently, the NHS is organised into Clinical Commissioning Groups (CCGs), which plan and buy healthcare services for their local areas.
In Cheshire and Merseyside there are nine CCGs, one for each borough, but they are set to be scrapped in favour of just one ICS (Integrated Care System) which will commission NHS services across the entire region of more than 2.5m people.
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Today’s meeting of Wirral Council’s Health and Wellbeing Board discussed the impact this might have on healthcare in the borough.
The move to an ICS was set to take place in April, but the bill is still going through parliament meaning the change is set to be delayed until July.
It is hoped that consolidating the different commissioning groups into one will help to share ideas across the region, tackle health inequalities and improve the lives of the poorest fastest.
But not everyone’s so sure.
Some believe the way Integrated Care Boards (ICBs), which will take on some of the current functions of CCGs, will work allows for far greater private sector involvement in the running of the NHS.
The board of each ICB would include a chair, a chief executive and representatives from NHS providers, general practice and local authorities as a minimum.
But beyond that, they have flexibility to create committees, with the potential for sub-committees below these, which some fear will mean ICBs delegating budgets to provider collaboratives, which may include the private sector, giving them a greater role in the functioning of the NHS.
Although NHS England will agree the constitutions of ICBs and hold them to account, campaigners have argued that corporations could gain a far bigger role in NHS decision making through ICBs.
When the ECHO put these claims to the Department for Health and Social Care in November last year, a spokesperson said that “the NHS is not and never will be for sale”.
The spokesperson added: “The bill builds on the NHS’ own proposals for reform and gives the NHS more power, not less.
“It will support a health and care system which is less bureaucratic, more accountable, and more integrated in the wake of the pandemic.”
In recent months, a number of Wirral councillors have expressed concerns in public meetings about the impact the move to an Integrated Care System could have on care in the borough.
For instance, at last September’s Health and Wellbeing Board meeting Liberal Democrat councillor Dave Mitchell asked Graham Hodkinson, Wirral Council’s director of health and strategic commissioning, who would make the decision to spend money on behalf of the constituents he represented.
Seeking to reassure him, Mr Hodkinson replied that while a number of decisions will be made at a Cheshire and Merseyside level, Wirral Council and the ICB would also have a role in commissioning Wirral’s health services.
At a November meeting of Wirral Council’s Partnerships Committee, Cllr Jo Bird, who represents Bromborough, was worried that the move to an ICS was more about balancing the books than the rights of patients.
Cllr Bird asked Simon Banks, Wirral CCG’s chief officer, what assurances he could give that the new system will say yes to patient demands on healthcare services rather than no.
Mr Banks said the ICS was about improving care and not simply a book balancing move, but he said the new system would have to live within its means.
At today’s meeting, which included four councillors and a number of council officers and health professionals, there appeared to be less fear about the upcoming move to an ICS.
Cllr Phil Gilchrist, who leads the Lib Dem group on the council, said from what he had heard there would not be any disruption for NHS staff and that there will be a “seamless” move into a new organisation.
The Eastham councillor added people’s minds may have been diverted by the discussion over the government’s catch-up plan for the NHS following the backlog caused by the pandemic in recent days and acknowledged that the structures of the ICS may change in the years to come.
But he wanted to press Mr Banks for an assurance that the move to an ICS will not cause short-term disruption.
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Mr Banks said there will be business continuity and a seamless transfer to the new system.
He added that while the move to an ICS might be an administrative change on the face of it, it will give the NHS the ability to move from competition to collaboration, recover from Covid-19 and work with partners on the key determinants of health, such as housing and education.
This, he said, was the “exciting bit”.
Wirral CCG’s chief officer was clear that the new system will function as it should do on day one and deliver “transformational change” after that.
Labour councillor Yvonne Nolan, who chairs the health and wellbeing board, said it would have an important role in developing the ICB for Wirral.
Cllr Nolan added that there was uncertainty at the moment, but there are “huge possibilities if we get this right”.
