Frequently asked questions (FAQs) - the Joint Committee

Frequently asked questions – Collaborative working and the Joint Committee of CCGs

  1. What is the Joint Committee?
  • In North West London we have eight statutory NHS bodies, these are the eight Clinical Commissioning Groups of Brent, Central, Ealing, Hammersmith & Fulham, Harrow, Hounslow, Hillingdon and West. 
  • The CCGs have a long track record of working together on issues that require a multi-borough approach, and have decided this would be helped by creating a Joint Committee with delegated powers for joint decision making in specified areas.
  1. Why are you working collaboratively?
  • In order to ensure that our residents have access to the health and care services they need, we need to have clear leadership, a strong clinical and patient voice and to operate as efficiently as possible.
  • There are some decisions which are better taken together, once.
  • We want to work as efficiently as possible and this requires us to share responsibilities and roles
  • Therefore, the NHS CCGs are building on their long history of working together in NW London to progress this further with a combined leadership structure and a Joint Committee.
  1. What do you mean by combined leadership?
  • The CCGs have appointed three senior posts that will both work across NW London and sit on the eight governing bodies.  These posts are: the Accountable Officer, who is the chief officer for the eight governing bodies, the Chief Finance Officer and the Director of Quality and Nursing. 
  • We will continue to have Chairs for each CCG and local management teams led by a Managing Director.
  1. How will eight CCGs working together benefit patients?
  • By taking a joint approach we have a stronger voice and will help reduce equality in care for patients.  
    • For example, we have a much greater negotiating power when we work as one and we can seek greater improvements for patients, such as reducing the time between a referral and treatment by speaking to our providers with a single voice.
  • It also allows us to provide greater scrutiny and influence on any decision that affects our area.
    • For example, we will have more influence on improving patient safety and the quality of services local people get from our hospitals and other providers if we join together.
    • Taking a decision in public once rather than the same decision in public eight times will also improve the efficiency of the organisation and enable decisions to be made more quickly which in turn allows service improvements to be implemented earlier for patients.
  1. What does this mean for the way the CCGs were previously organised in two groups (Brent, Harrow & Hillingdon and Central London, West London, Hammersmith and Fulham, Hounslow and Ealing?)
  • That split of the eight boroughs of NW London does not exist anymore.
  1. What decisions will be made where?
  • For the Joint Committee to operate there will need to be a revision to the constitutions of the CCGs, and the terms of reference for the Joint Committee will need to be agreed.
  • Broadly speaking the Joint Committee will agree those issues that span several boroughs such as the agreement of NWL strategy and commissioning decisions for services that span multiple boroughs (such as acute commissioning).  Issues that are specific to a single borough, such as the commissioning of community and primary care services remain at borough level.
  1. Does this reduce the CCGs’ local accountability?
  • Not at all. The CCG remains the accountable body and Governing Body meetings continue with key local decisions, being taken at those meetings.
  • CCGs representatives on the joint committee will consult with members of their governing bodies before taking decisions and the proceedings of the joint committee will be reported to governing bodies where members of the joint committee can be held to account.
  • All CCGs have to agree to a proposal at the Joint Committee for it to be taken forward.
  • There are some decisions which, if taken once at a NW London level, will enable us to be more efficient, implement improvements quicker for patients, have a stronger negotiating power and provide a better scrutiny over decisions affecting the whole region.
  1. Will decisions be made by consensus or majority?
  • All CCGs have to agree to a decision unanimously.
  1. How accessible will be the meeting be?
  • The Joint Committee will be held in public which means our residents are welcome to attend. 
  • All papers will be published online ahead of the meetings.
  • We will make sure that the cover sheet for each paper is written in plain English, summarising what is being discussed and including a clear audit trail online showing the paper and the decision.
  • We are currently working with our patient representatives to ensure that meetings are accessible and can be viewed online for those not attending in person.
  1. How can the public feed into the Joint Committee?
  • The public will be able to submit questions which will be put to the Joint Committee members as they can at CCG Governing Body meetings.  Any questions which cannot be answered at this time will be answered online.
  • There are lay member representatives on the Joint Committee.  They were elected by the CCG Chairs and existing lay members of NW London.
  • The public can continue to feed their views through the CCGs, lay members or local Healthwatch.
  1. Who chairs the Joint Committee?
  • There will be an independent chair and this position is expected to be recruited to by the end of September 2018.
  1. What is the timeline for the operation of the joint committee?
  • The Joint Committee has been operating in shadow form since January 2018. 
  • It is anticipated that it will come out of shadow form once revised CCG constitutions are agreed towards the end of 2018
  • In September, a suite of papers will go to each CCG Governing Body.  This includes the Terms of Reference for the Joint Committee.
  • After this, the harmonised constitution will be put to members.  If this is agreed then the Joint Committee will move out of shadow form.
  1. How will Joint Committee speak to local authority scrutiny committees?
  • The decisions made at CCG Governing Bodies are most relevant to that corresponding local authority whereas decisions made at the Joint Committee made me more appropriate to discuss at the Joint Overview and Scrutiny Committee.
  • However, we will discuss this with local authority colleagues and work with them according to their wishes.
  1. What is the equalities impact?
  • We are carrying out an analysis of the equalities impacts of these changes, which will be considered by each CCG. We will ensure we have considered all equalities impacts and put any appropriate mitigations in place before establishing the Joint Committee
  • We would observe that setting up a Joint Committee can help us to address inequalities through more easily addressing unwarranted variation in the quality of care.  We will of course need to be on guard against the risk that taking a strategic view means we lose sight of particular groups and their needs. 
  1. Will there still be local CCG governing body meetings?
  • Local governing body meetings will continue, and due to the development of the Joint Committee, it is proposed to have less frequent Governing Body meetings.  It is proposed that they meet quarterly in future.
  1. Is this about saving money?
  • It’s about moving to a more efficient way of working which means we can implement service improvements quicker for patients.
  • By being more efficient we also believe it will reduce bureaucracy and administration costs
  • We will take out 10% of management costs this year and next across NW London. 
  • Changes such as this will help us reach that aim.
  1. If the terms of reference change, will each CCG need to agree new terms of reference?
  • Yes.
  1. Will the new governance arrangements be reviewed?
  • Yes, we will review the arrangements after six months of operation.
  1. Are CCGs permanently part of the Joint Committee?
  • CCGs remain statutory bodies and their membership of the Joint Committee is a decision taken by their governing body, in the interests of improving outcomes and joined up working.
  • As CCGs are sovereign, they can agree to change their involvement with the joint committee, but collaborative arrangements between the CCGs are likely to endure in some shape or form.