Local people being cut out of decision making about their health services

The way decisions are made about local health services is changing. Early indications from local Healthwatch suggest that this is resulting in the public feeling less able to have their say.

The GPs and other health professionals responsible for running Clinical Commissioning Groups (CCGs) are forming joint decision making bodies, known as committees in common, to make decisions on health services at a regional level.

However, these new committees, or ‘Super CCGs’, are circumventing the local scrutiny and accountability measures put in place by the Government's health reforms. In particular they are failing to engage with the public, are not accountable to local democratic oversight and are meeting in private.

A failure to listen to public expectations, fears and needs will result in poorer outcomes for us all and public acceptance of change will rightly be low.

Currently it is very difficult for CCGs to set up these regional bodies but the Draft Legislative Reform CCG Order 2014, which is currently going through Parliament, will make the process much easier without putting in place any additional checks and balances for local people to have their say.

Concerns raised by local Healthwatch across the country suggest the way these early 'Super CCGs' are behaving is symptomatic of a wider cultural issue with CCGs and their public engagement, with many of them failing to involve their local populations in major decisions about redesigning services - from hospitals and GP surgeries to dentists and care homes.

A recent straw poll of the Healthwatch network suggested at least a third of local Healthwatch across 152 areas in England are concerned about being able to influence the public engagement activities of their CCGs.

Whilst we recognise that arrangements for regional decision making are useful, particularly for services used by people across wide or neighbouring areas, these new committees must involve local people and ensure local accountability for decision making.

As the consumer champion, Healthwatch England is therefore using its statutory advisory powers to write to the Secretary of State to outline the following concerns that the legislative changes will result in:

  • Disengagement with local accountability mechanisms such as Health and Wellbeing Boards
  • Poor current public engagement by CCGs and the emerging committees in common
  • Major decisions, such as models for service reconfiguration, being taken in closed sessions of the committees
  • Insufficient planning for future public engagement and the vital conversations around service reconfiguration that will directly result from decisions made by the committees in common.

On behalf of the Healthwatch network and the local residents they represent, Healthwatch England is calling on the Secretary of State to consider the following before agreeing to the new legislation:

  • Introduce a mandatory seat for local Healthwatch on any joint committee
  • Place a duty on all lead CCGs to have due regard for existing local priorities and plans
  • Ensure all CCGs sign up to act within existing local accountability mechanisms, even if it means being held to account by a Health and Wellbeing Board outside of their jurisdiction.

Anna Bradley, Chair of Healthwatch England, said:

"The Government's health reforms were designed to put local people at the heart of decision making processes. Yet the experience of local Healthwatch suggests that this is not what is happening on the ground.

"We understand the benefits of commissioners working collaboratively but it remains crucial that local people are involved, asked what they want and understand how decisions will affect the way services are delivered in their area.

"The NHS and social care services desperately need to work together with the public to ensure services are shaped by people to create a sustainable system that delivers the care we want and need.

"A failure to listen to public expectations, fears and needs will result in poorer outcomes for us all and public acceptance of change will rightly be low."

Local Healthwatch were set up under the Health and Social Care Act 2012 to act as the consumer champion for local people. It is our role to promote and support the involvement of local people in the commissioning, provision and scrutiny of local services.