Board games

Philip HuntPhil Hunt on the bizarre regulations defining Clinical Commissioning Group Board membership

The NHS is reeling under the most perverse changes it has ever faced as the unloved Heath and Social Care Act is enthusiastically implemented by Health Ministers.

The Coalition government inherited an NHS in the best condition ever, with world class facilities for patients, waiting times drastically cut and outcomes improving. Despite this, Ministers have been hell bent on destabilising the service in a rush to privatise and introduce market concepts aimed at pitting hospital against hospital and doctor against doctor.

One key plank of the changes is to put GPs in charge of commissioning services from hospitals through Clinical Commissioning Groups (CCGs).

A massive £60bn is to be entrusted to them despite very weak accountability and corporate governance structures supporting what are essentially a federation of GPs. Only two lay members will serve on the Board of each CCG so they will always be outnumbered by GPs who will have little or any accountability to the public. This is even more perverse given that the CCGs may make funding decisions which are advantageous to GPs.

Bizarrely, although the regulations we are debating in the Lords allow for a hospital doctor and a registered nurse to be appointed to the CCG Board, those employed by a local hospital are not. This is apparently because it would be a conflict of interest!

All of this does seem to be taking the market concept to ludicrous proportions. As the Royal College of Physicians have pointed out, the Boards should always include specialist doctors who work within the area covered by a CCG in order to help the integration of services across primary and secondary care. As it stands, the only hospital doctors or nurses eligible to serve will be ones who live miles away from the CCG concerned and it is difficult to see what they could bring to the table.

It is also difficult to see why a supposed conflict of interest of hospital doctors and nurses is any more of a problem than GPs sitting on the Boards of a CCG who as the RCP point out, may also provide some secondary care services within their surgery.

This is further compounded by the exclusion of councillors from being appointed. You would have thought they would be ideally placed to help local accountability and relationships with the local authority. Extraordinarily, if you are a GP and a local councillor you are also excluded, despite some GP councillors being leading lights in the development of CCGs.

As the Bill was going through Parliament, Labour Peers and MPs spoke up for patients and people everywhere who truly value the NHS and don’t want to see it fragmented. Equal vigilance is now required in relation to the dozens of pieces of secondary legislation that will now follow. The CCG regulations are a clear case in point and it is essential that Peers put the maximum pressure possible on the Coalition to withdraw its discredited proposals.

Lord Phil Hunt of Kings Heath is a Shadow Health Minister and Labour’s Deputy Leader in the Lords

Published 16th October 2012

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