Why We Are Against Merger of CCGs

The plan to merge all of Kent’s CCG’s (Clinical Commissioning Groups) into one for all of Kent.
CCGs organise all NHS care at a local level. They decide how to spend the money, how care will be delivered, they make commissioning decisions and have legal responsibility to deliver care as per the NHS institution. There are currently eight CCG areas in Kent: Canterbury/coastal; Ashford; West Kent; Thanet; South Kent Coast; Medway; Dartford, Gravesham and Swanley; and Swale.
– It will further disenfrachise an already disenfranchised area – Thanet – and will lessen the local patient voice for all areas. we have already seen how Thanet’s needs concerned were steamrollered by the Kent HOSC regarding the stroke plans.
– Decision making and commissioning will all happen at a Kent and Medway levelonce this happens, not at a Thanet level, or an Ashford or Canterbury level as it does now.
– Thanet has VERY different needsand concerns compared with wealthier west Kent, and needs it’s own decision makers who understand the needs of this area.
– Accountabilityis getting more remote with this change. Accountability will be lessened. Thanet people feel like their voices are lost already.
– Monthly meetings are likely to be held at rotating venues; previously all meetings of the CCG were held at the TDC offices in Margate. Now they could be in Sevenoaks, Tonbridge, Ashford, Dartford, Maidstone, Sheppey etc…
– The merger process locally has been mishandled and the CCG have failed in their duty to consult
 – The merger process has also been questioned at a national level, and campaign groups have sought legal advice regarding the legality of proceeding without consultation. We hope that the mergers are halted.
The letter is attached and also pasted below:

FAO: Clive Hart, Dr Jihad Malasi,
Caroline Selkirk, Glenn Douglas,
and Michael Ridgwell

COMPLAINT: The decision to merge Kent’s eight CCGs into one
In reference to the Thanet CCG Extraordinary Mtg of Thanet CCG Governing Body (26.09.19)

At the meeting yesterday of the governing body of Thanet CCG, the members present were asked to agree to the merging of Kent and Medway’s eight CCGs into one ‘super CCG’ for all of Kent and Medway, covering approximately 1.8 million patients.

As a witness to this, I noted that the governing board members did not give a clear and resounding yes, but there was a hesitant and mumbled yes from most. A few kept quiet, and when asked if there were objections, said nothing. So the plan has been approved and the application will be made on Monday.

Please reconsider
I hope you will reconsider this hasty move, as it will result in far less of a patient voice for Thanet, less accountability, and it will remove the powers that Thanet currently has to commission its own NHS services as it sees fit. Thanet has starkly different needs from those of west Kent, and this change will result in the further disenfranchisement of Thanet’s NHS patients.

Take for example the Thanet CCG meeting held yesterday. Ten minutes were set aside for questions from the public (which was much appreciated). Myself and several others asked questions and had them answered, it ran over a little, and in the end we had most of our questions covered in approximately 15 minutes. Think about how this would work after a merger of eight CCGs; if you were to allow sufficient time at monthly meetings in the same way, for all areas, it would require two hoursto be set aside. This is hardly practical.

It is not acceptable to withdraw the contact with the public, the opportunity to ask questions face to face, and the current relative accessibility of meetings. Thanet locals will find it very difficult to attend meetings if they are going to be held in different locations each month. Imagine someone on a low income and with little free time making the journey to Sevenoaks, Ashford, Tonbridge or Maidstone from Thanet. The cost and additional time needed will make it a great deal more difficult, if not impossible for most people in Thanet, and in particular the seldom heard voices that you are supposed to cater for.

Kent is a large geographical area, and the demographics vary greatly from the wealthy areas to the poorer ones. This change does not suit us and it won’t benefit us.

Accountability in NHS decision-making has been shown to be lacking already in the current system (the consultation regarding the review of acute stroke services being an example). This change will weaken it further.

Legality, and scant consultation
We also question the legality of the merging of CCGs. It has come to light that a merger of this type requires a twelve week consultation, and that the scant ‘engagement’ process that you have undertaken thus far falls significantly short of consultation requirements. Legal advice has been sought by other campaign groups confirming that CCG mergers require full consultation by law. You must be aware of this – therefore, we ask that you halt your application as there is a question mark over its legality.

How Thanet CCG arrived at the conclusion that it has adequately consulted on this
In Thursday’s meeting held in public, Caroline Selkirk stated “Thanet voted for this as did the other CCGs”. Dr Jihad Malasi explained that a ‘double majority system of voting” had been used. It was explained that this had involved asking both GP practices and the patient population; and 75% of both had consented to the merger. After the meeting I asked Clive Hart, Dr Neden and Dr Malasi to explain what this meant, and learned that 75% of GP practices had approved the decision, which is self explanatory – but the ‘patient population’ part is less so. It actually means that some of the GP surgeries asked their patient participation groups (PPGs), and got to a figure of 75% consent that way. That is effectively just asking a handful of people. I asked if the process had been minuted or documented in any way: it hadn’t. We also don’t know if the PPG groups sent out advance warning that this consultative action would be taking place. We know that at least one did not (the Eastcliff Practice in Ramsgate).

The fact that neither patients nor GPs agreed 100% is of course a concern. Even more worrying is the reliance on asking attendees at PPG meetings and using only this as the only measure of patient opinion. Given the following factors, this is beyond unacceptable:

– Most patients do not even know what a PPG is
-It is a self-selecting group
– The groups are not representative of the population
– The sample size is minute
– The groups appear not to have been given prior notification of what was happening at the meetings
– No notes, minutes or any other documentation is available

A Letter from Thanet District Council
I attended he meeting with three Thanet District Councillors: Cllr Gregory (Salmestone), Cllr Farrance (Salmestone) and Cllr Rawf (Beacon ward). They were very surprised to learn that Thanet district Council had sent a letter approving the plans for a merged CCG. Cllr Farrance is on a TDC committee where the matter was discussed, and has no memory of consent being arrived at. Those councillors and SONiK will be following this matter up.

Other Concerns
– When the Thanet CCG governing body was asked by Caroline Selkirk if they agreed to applying for a merger, no show of hands took place. A few said yes. Not all said yes.
– The members of public in attendance asked that all governing body members give their full names, but many avoided this by giveing a partial name (no surname) or mumbling their name or role.
– The people of Thanet will be greatly disenfranchised by this change – even more so than they are currently. This cannot be emphasized enough. The NHShas a duty to allow and providefor adequate patient voice in decision making processes. This change will diminish that allowance.
–  Caroline Selkirk stated during the meeting that “the new strategic committee will commission on the basis of outcomes” We need to understand more about what this this means. The NHS constitution states that care must be provided on the basis of need. If any change is being made to that commitment then there must be full consultation and adequate publicity.
– We also heard that Glenn Douglas is retiring as the Single Accountable Officer for Kent and Medway and from his other role as Assistant Leader of Kent and Medway STP. Can you confirm if he is retiring from Kent and Medway NHS entirely, or only from those two roles?

Meeting Participants:
Can you confirm that these are the Thanet CCG Governing board members who took part in the meeting?
Sarah Vaux (Chief Nurse)
Caroline Selkirk
Dr Jihad Malasi (Clinical Chair, Thanet CCG)
Clive Hart (Lay Member, Patient Engagement)
Dr Sue Martin
Dr Susie Marsden
Antony May (Acting Company Business Secretary)
Dr Ash Peshen
Dr John Neden
Dr Gauri Jha (GP member, Westgate Surgery)
Maria Jackson, Independent Registered Nurse (dialled in)
Ivor Duffy, CFO (dialled in)
Mark Leutchford, Comms Mgr for EK CCGs (non voting?)

Please respond with answers to the questions and a confirmation regarding whether or not you will put the merger of Thanet CCG on hold or not.

Kind Regards,
Carly Jeffrey
(Save Our NHS in Kent campaigner and Ramsgate resident)