Engaging our population on the future of health commissioning

The challenge

Health and social care services across Coventry and Warwickshire are working together to look at better ways of improving the health and wellbeing of our population. Local health commissioners believe that they need to change to meet the opportunities and challenges of the future.

Local commissioners have developed a number of scenarios to determine the best way of organising health commissioning going forward, making the best use of resources and working more closely with providers and the community and voluntary sector.

What we did

Before any decisions are made on the future of health commissioning for Coventry and Warwickshire, it was important to find out what people thought about the proposals. A number of stakeholder events were held with staff, CCG GP membership, the CCG Governing Bodies and key stakeholders, including representatives from our patient groups and the community and voluntary sector, as well as colleagues working in health and social care.

The purpose of the engagement activity was to bring together a wide range of key stakeholders from across Coventry and Warwickshire, including colleagues working in health and social care, voluntary and community organisations, councillors, carers and patients and their representatives with the aim of:

  • Giving attendees background information and putting things in context to help them understand why local commissioners are considering changing;
  • Presenting a number of potential scenarios for consideration and the assessment criteria against which they would be measured;
  • Capturing attendee’s initial thoughts and reactions to this information;
  • Providing clarity that this piece of engagement was specifically around the future of health commissioning as it pertains to meeting the needs of a future integrated care system for Coventry and Warwickshire.

These events were not:

  • A platform for us to persuade people of our thinking; it was a listening exercise and was part of our engagement process;
  • Aimed at the wider public; rather, they were targeted and focused events with CCG staff, CCG membership and representatives from various key stakeholder groups, including patient and public representation and advocacy groups, from across Coventry and Warwickshire;
  • A platform to make decisions; instead they were a chance for people to further inform our thinking.

The events were an essential part of our process and, by taking the time to listen to and fully consider the views of patients, carers, staff, our membership and other key stakeholders in all engagement activity, as well as giving due regard to equality and diversity in our engagement activity, the CCG Governing Bodies were better able to make an informed recommendation of the preferred option for the future direction of the organisations.

The key findings which have emerged from the all of the engagement events are set out below:

Support for change

The vast majority of those engaged were in agreement that there was a need for change to both an Integrated Care System (ICS), but also that health commissioning needed to change to help enable development of the ICS.

A full merger was the most preferred scenario

At each session, most agreed that a full CCG merger was the most logical scenario for achieving the objectives set out in the future model of health and wellbeing for Coventry and Warwickshire, though it was widely recognised it would not be an easy, quick or cheap process.

Possibility of implementing a joint management team across three CCGs first before moving to full merger

At each session, questions were raised over whether, due to the tight timeframes, there was a possibility of doing a “best of both worlds” approach, which would involve first moving to a joint management team to build the foundation of the new commissioning structure before eventually moving towards a full merger. It was felt this approach would see the quickest impact whilst mitigating potential disruption to the system.

Building robust “places” – and not losing local identity – is critical to success

All were in agreement that success or failure of the health and wellbeing system was dependent on building and supporting strong “Places”, which we described as Coventry, Rugby, Warwickshire North and South Warwickshire. Loss of local voice and identity were highlighted as being a concern when thinking about moving to a single commissioning structure. The need to maintain strong links between the Places and the single commissioner was repeatedly raised as a point of importance.

Involving the local population and their representatives is seen as a another critical measure of success

During our stakeholder engagement, the message was heard loud and clear that local people, and those that represent them (whether that be in the community and voluntary sector or elected officials) were eager to be involved as much as possible in the future development of a system which improves the health and wellbeing of our entire population. Transparency, openness and the opportunity to feed into and influence planning and delivery were considered of vital importance in order to both make an integrated care system successful, but also to get buy in and enable population behaviour change.

Supporting our staff is vitally important

It is recognised that any change to the status quo will introduce uncertainty, worry and potential changes for CCG staff, and all stakeholders agreed that the importance supporting staff during any changes was something that couldn’t be overstated. Understandably, amongst our staff groups, job security was a significant concern for the proposals, although the majority were in favour of changing the commissioning structure.

“Do nothing” was not a viable scenario

All but one person was in agreement that do nothing was not a viable scenario, either due to pressures from NHS England or for achieving the aspirations of the future model of health and wellbeing for the area.

Improving clinical quality, making better use of resources and improving access to services were seen as the most important assessment criteria

Although it was widely recognised that all of the assessment criteria presented had value, the majority of attendees agreed that improving clinical quality, making better use of resources and improving access to services were the most important.

This feedback was included in a case for change document, outlining the proposed options and all the various components for consideration. This document was submitted to the CCG Governing Body in May 2019 to support them in making a recommendation to the CCG membership on the preferred option.

Who we worked with

A number of engagement sessions were held across Coventry and Warwickshire:

  • The Governing Body for each of the three local CCGs;
  • Each CCG’s membership, which is comprised of the local GPs for each CCG;
  • Local health and wellbeing leads, such as Chief Executives of the local NHS providers, leaders of the local GP federations/alliances and Local Medical Committee Chairs;
  • CCG staff;
  • Patient and public representatives;
  • Voluntary and community sector representatives;
  • Local councillors and elected members;
  • Both local Healthwatch organisations

The outcome

Overall, the overwhelming majority of those engaged agreed change to the commissioning structure was needed in order to support the development of an integrated care system and improve the health and wellbeing of the population of Coventry and Warwickshire. The majority also agreed that a full organisational merger and move to a single commissioning group was the most logical decision, but that maintaining strong “Places” and ensuring those Places had a voice and equal representation was of paramount importance.

Next steps

The CCG membership will take part in a vote, as per the CCG constitution, to decide on the future of health commissioning for Coventry and Warwickshire. The outcome of the vote will be known in February 2020.

 

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