My colleague Lord Philip Hunt reported on the Labour Lords Blog that the new governance arrangements for the new Clinical Commissioning Groups (CCGs) through which most local NHS money will be channelled are odd in the extreme, saying:

“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!”

Last night’s debate in the Lords on the Government regulations setting out how CCGs are to operate showed up the sheer absurdity of the arrangements and the normally-sensible Minister, Earl Howe, tied himself in knots trying to explain why certain categories of person were to be excluded from the Boards of CCGs and why it would NOT be a conflict of interest for GPs on the Boards to so arrange local services so that their practices benefitted.

I rather lost my temper when it was suggested by former Tory Health Minister, Baroness Cumberlege, that local councillors should in all cases be excluded from CCG Boards on the grounds that they would be incapable of making difficult decisions affecting their electorates (what does she think local councillors are having to do at the moment given the budget cuts that the Government has imposed on them?).

However, the debate also highlighted the absurdity of the Government’s proposals which would prevent someone being appointed to be a “lay member” of a CCG Board if they were employed by a local authority anywhere in the country; or – even more bizarrely – prevented someone who is a member (not even a governor) of a local NHS Trust, when in some areas every person who uses the local hospital is automatically enrolled as a member of the Trust!

You can read the full debate here and my rant was as follows:

“In this debate we are perhaps being asked to suspend our disbelief that the governance arrangements for the clinical commissioning groups make sense. We are being asked to suspend our belief on the question of whether pigs may fly. However, the extraordinary statement from the noble Baroness, Lady Cumberlege, that somehow locally elected councillors are incapable of making decisions which affect the livelihoods of the populations that elect them is disgraceful.

Baroness Cumberlege: My Lords, I object to that. I said that they have a role on health and well-being boards, which is where the strategy is set out, and that is where the NHS, local authorities, Healthwatch and other organisations come together.

Lord Harris of Haringey: I understand that. My point is that the noble Baroness does not seem to understand that today, all over the country, locally elected councillors are making decisions about closures because they are having to balance the reductions in budgets that this Government are forcing on them and on their local communities. They are making those decisions on behalf of the people whom they represent. Why is it being said that somehow they have a conflict of interest which means that they are incapable of making decisions along with colleagues about health matters?

There are issues of principle here and issues of sheer practicality. The issue of principle concerns conflict of interest. The noble Baroness, Lady Cumberlege, has talked about conflict of interest. Perhaps we will also hear about that from the noble Earl in a minute. However, the biggest conflict of interest will be the fact that the primary care practitioners are key elements of the boards of CCGs’ governing bodies. They are not being excluded; it is just everyone else who is being excluded. Let us be clear about who is being excluded. It is not simply elected members but any employee not just of the local authority in the CCG’s area but of any local authority in the country. Therefore, any person who, under paragraph (4) of Regulation 12, the CCG feels has knowledge about the area and who does not have the misfortune of being an elected councillor but does have the misfortune of being a part-time employee of a neighbouring local authority is exempt.

When the Minister replies, I should like him to explain to us why every single employee of every single local authority in the country is being excluded from participation in CCGs. While he is about it and we are talking about conflicts of interest, we have already heard the point made by my noble friend Lord Hunt of Kings Heath that any person who has been public-spirited enough to decide to become-and frankly it is a fairly meaningless undertaking-a member of a local foundation trust or a local NHS trust is also excluded from membership of a CCG. Again, what is the point of that? It is being said that any person who is public-spirited enough already to have had some engagement with the local NHS is not allowed to sit on the board of the CCG.

This is frankly fatuous. You have ended up with a situation in which you have enshrined one set of conflicts of interest and excluded from the membership of the CCG all sorts of other people who could make a valuable and useful contribution. I am afraid that for the first time in our considerations I agree with 99% of what the noble Baroness, Lady Jolly, said. The 1% with which I disagreed was that we should allow this instrument to go through and review it again in two years’ time. It is so flawed and riddled with poorly thought-out considerations of what would work at local level, and so dismissive of the best judgment of local people to decide who is best to be part of the board, that frankly we should endorse my noble friend’s Motion. I urge the Minister to withdraw the regulations and bring forward revised, more sensible regulations.”

 

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