Exclusive CCG leaders have raised concerns that they are becoming the ‘lowest common denominator’ in decisions regarding the provision of hospital services, critically undermining clinical commissioning three months before it will begin.
The comments come as a campaign led by Lewisham CCG to prevent controversial plans to close Lewisham A&E was yesterday dismissed by the trust special administrator (TSA) appointed to reconfigure services in the failing South East London NHS Healthcare Trust.
The concerns emerged in an email circulated among London CCG leads in the wake of the campaign to save Lewisham A&E, and before the decision by the TSA yesterday.
In the email, Dr Zuhair Zarifa, chair of Newham CCG, said he ‘could not agree more’ with a letter from Lewisham CCG chair Dr Helen Tattersfield to health secretary Jeremy Hunt.
The letter, first reported by Pulse, warned she warned the decision to impose the hospital changes without the support of the local CCG ‘threatened the whole ethos of clinical commissioning’. Yesterday the TSA acknowledged the reservations of Lewisham CCG, but went ahead approved the plans to close the A&E.
In the email, Dr Zarifa wrote: ‘We are a year or so dealing with a mega trust, Barts Health. There has been a total disconnect between us and the local Newham site, all the good clinical working relationships and local knowledge are lost.
‘Although we are one of the biggest clinical commissioners dealing with the new trust, we feel our views are diluted and we have lost the local ethos and knowledge. It is said that together with other local CCGs we can/will exert more leverage; I have not seen anything to support that view, if anything it is the reverse. It seems to me that eventually we will get to the “lowest common denominator” position with one size fits all.’
He added that Lewisham CCG’s fears around the creation of a centralised trust were ‘our current reality’ and that Newham CCG was ‘working to change the dynamics’.
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Dr Zarifa told Pulse that he had no problem with Barts itself, but with a ‘mega Trust’ and the ‘collaborative commissioning of four large CCGs. He added: ‘I feel there was an erosion of the CCG’s commissioning individuality.’
Dr Clare Highton, chair of City and Hackney CCG, also said she supported Dr Tattersfield’s letter as it was important CCGs had a powerful voice in hospital reconfigurations.
She wrote in the email: ‘In City and Hackney we also have a smaller district general hospital, the Homerton, with which we work well.
‘There is evidence that smaller hospitals are more efficient as well as preferred by residents, and I think the evidence for centralising is sometimes overplayed by specialists. I would also support the principle of a CCG being a powerful voice in reconfigurations.’
When approached by Pulse, Dr Highton said she stood by the comments in the email.
Dr Charles Alessi, chair of the NAPC, said hospital reconfigurations should not take place unless they have CCG support. He said: ‘What message are you giving to the public if these bodies are going against the wishes of clinical commissioners?’
The email was sent by London Clinical Commissioning Council, the LCCC was approached by Pulse, but did not provide any comment in time for publication.