Calderdale Clinical Commissioning Group meeting 10th May

This was the first Calderdale Clinical Commissioning Group (CCCG) meeting after the  House of Lords approved the NHS ‘section 75’ regulations on 24th April.  These hotly-opposed regulations open up the NHS to far more private sector competition. Caroline Molloy, writing on the Open Democracy website, states that

“overturning the NHS Privatisation Regulations was always going to be tough. Nonetheless, the spectacle of Lords with private healthcare interests, voting them through, raises fundamental questions about our democracy.” 

Now that these new NHS privatisation regulations are law, how can local campaigners work effectively to keep our NHS public? Calderdale 38 Degrees NHS Group is looking for ways to work with Calderdale Clinical Commissioning Group (CCG) to protect Calderdale NHS from privatisation. This report is based on notes from Calderdale 38 Degrees NHS Group.

An early priority has to be to stop Calderdale Clinical Commissioning Group from handing over its powers to (a completely unaccountable and soon to be privatised) Commissioning Support Unit. Commissioning Support Units have been set up under the 2012 Health & Social Care Act, and are supposed to support the Clinical Commissioning Groups in their areas. But according to General Practitioner Council chairman Dr Laurence Buckman, Department of Health guidance

“basically says in 2016 we’re going to offer this to the private sector”

and that that CCGs would be left with little choice but to use large, commercial organisations to provide a huge range of commissioning support services.

Is the Calderdale CCG a forum for democratic discussion or rubber stamping? 

Calderdale 38 Degrees NHS Group attended the Calderdale CCG meeting as members of the public. In the first half of the meeting they asked a number of questions  about various items on the agenda. This had the effect of opening up the meeting to the CCG GPs, who usually don’t discuss or comment on CCG officers’ reports.

However, during the break, the Calderdale CCG Chair, Alan Brook, told Calderdale 38 Degrees NHS Group that he was introducing new rulings, in order to mostly restrict public questions to written ones that would be answered at the beginning of the meeting. Calderdale 38 Degrees NHS Group suggested a second slot towards the end of the meeting, so that it would be possible to ask questions arising during the meeting. He said he would look into this and proposed a five to ten minute spot on the agenda.

After the break, the meeting returned to its carefully stage managed form, GPs returned to virtual silence and officer reports were presented and approved with little comment from them.

Questions from Calderdale 38 Degrees NHS Group

Ownership of Commissioning Support Unit

Calderdale 38 Degrees NHS Group asked about ownership of the Commissioning Support Unit. Matt Walsh , Calderdale CCG Chief Officer said that the West and South Yorkshire and Bassetlaw Commissioning Support Unit currently operates as a subcommittee of NHS England.  The relationship between the CCG and the CSU is underpinned by a contract or Service level agreement. Within that there are financial and performance measures which Calderdale CCG will be monitoring to ensure they get the support they have commissioned from the CSU. According to Matt Walsh, Central government intended to test commissioning support options and Calderdale CCG “will be actively involved in that conversation.”

What on earth does this mean? Calderdale 38 Degrees NHS Group assumes Mr Walsh was referring to Department of Health guidance about how CCGs should function from 2013. Clusters of Clinical Commissioning Groups would form commissioning support units, and from 2016 they would be encouraged to form social enterprises and partner with the private sector. These Department of Health proposals introduce commercially-focused criteria to determine who is eligible to provide commissioning support.

Pressures on Calderdale Accident & Emergency services from an extra £160m cut

West and South Yorkshire and Bassetlaw Commissioning Support Unit Executive Steering Group (ESG) plan to  achieve savings of £160m over five years. Calderdale 38 Degrees NHS Group asked how this would be likely to affect A&E services, given that there has been a significant increase in emergency admissions during 2012/13 with a combined over-trade in emergency short and long stay admissions of £1.6m. (An overtrade is when the cost of a particular service is higher than the budgetted amount.)  This is a significant issue for Calderdale and Huddersfield NHS Foundation Trust. Year on year there has been a 3.8% increase in emergency admissions.

Calderdale CCG replied that they were working on this and that they were studying in particular, primary care costs and community care options. In addition, Dr Chris Day of Calderdale 38 Degrees NHS Group reports that,

“Matt Walsh referred to Dr. Majid Azeb of Southowram Surgery, Care Quality Commission member  (and  of  M & N Medicals Ltd ) in response to our questions and he talked enthusiastically about apparent concessionary streams which seemed to mean a lot to him but was incomprehensible to me.”

Actions speak louder than words, and an action that Calderdale 38 Degrees NHS Group noticed was,

“Matt Walsh’s leg tapping under the table when the supply of new computer systems was mentioned followed by Chief Finance Officer Julie Lawreniuk’s foot tapping even faster as she warned about costs and the projected cuts.  This issue did not appear in any of the reports. No doubt it was intended to be raised in the confidential part of the meeting after the public had been excluded. We have no way of knowing. The minutes from the previous secret session we were promised are to be presented in this secret session, so patients and members of Calderdale community have no chance to view the content of any of them.”

Calderdale’s breach of the annual objective for MRSA  and  C.Difficile 

NHS Calderdale breached the annual objective set for MRSA by 2 cases during 2012/13.

NHS Calderdale breached the annual objective set for C.Difficile (44 cases) by 23 cases during 2012/13.

Both MRSA and C Difficile are serious bacterial infections.

The Calderdale CCG reported that the 2011/12 figures for breaching the  Clostridium difficile annual objective were around 90 (among the worst in the country) and the target last year was set at half of that level. Calderdale CCG said that there has been a big push on limiting use of antibiotic prescription at primary care level and anyway, at least there has been an improvement on the previous year.

Calderdale CCG Procurement policy – some background

Section 75, the secondary legislation passed by the House of Lords on 24th April, opens the NHS to competition from private healthcare providers. The ConDem government claimed that their hands were tied on this because of European Union procurement law. But in fact this is not the case. As Caroline Molloy explains on the Open Democracy website, the problem is not EU procurement law, but future international competition law under the terms of a EU/US Free Trade Treaty that is to be negotiated at the forthcoming G8 summit in June. In relation to this negotiation, Caroline Molloy writes,

“Cameron has already said that ‘everything is on the table’. But our NHS does not have to be included in such treaties, governed primarily by international obligations to investors and corporations. It can and should be excluded as a public good. Otherwise, it would be difficult for any future government to halt, let alone reverse, the accelerating privatisation of our NHS.”

This is the context for Calderdale CCG setting its Procurement Policy, which was on the agenda at the May CCCG meeting. Unable to ask questions about this at the meeting, Calderdale 38 Degrees NHS Group is now arranging to to meet with Martin Pursey, Head of Calderdale CCG Contracting and Procurement.

According to Calderdale 38 Degrees NHS Group, Calderdale CCG Procurement Policy seems to be a standard document provided to many CCG’s (e.g. Cheshire).

Calderdale 38 Degrees NHS Group says,

“It appears, from a glance through this section, to have originally been prepared by lawyers from a healthcare company for mass distribution.  It is not clear if any changes have been made after consultation with GPs or other board members.”

The Calderdale CCG Procurement Policy is governed by the Public Contracts Regulations 2006 which transpose European Directives into UK law. They place legal requirements and procedures for awarding contracts above a certain threshold amount.

Within the EU Procurement rules, Health and Social Services come under the heading: Part B –  only some of the EU procurement rules apply.

Where legally-enforceable contracts are to be awarded for Part B services with estimated full-life value above £173,934, there is a limited statutory requirement to apply some of the EU procurement rules, that relate to competitive tendering. In other words, there is plenty of room for manoeuvre in terms of whether or not health services have to be put out to competitive tender.

It is anticipated Calderdale CCG will subject an increasing number of services to competitive tendering. There is no “checklist” that will definitively determine the appropriate use of competitive tendering, but Appendix D in the Calderdale CCG Procurement Policy provides an indication of the aspects to be considered when deciding whether competitive tender is appropriate.

(Updated to clarify Matt Walsh’s statement about the relationship between Calderdale CCG and the West & South Yorkshire & Bassetlaw Commissioning Support Unit.)

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