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Key community people excluded from NHS clinical commissioning groups

Richard Blogger describes the evaporation of the government's commitment to community engagement in the NHS.

During the passage of the Health and Social Care Act through parliament, the government made extravagant claims about patients being involved in decision making in the NHS.

Now that the Department of Health is finally producing the new regulations for the NHS under the Act (called Statutory Instruments) it is becoming apparent that the rhetoric was hollow. The government does not want greater patient involvement and is producing regulations to prevent it.

In June, the government published Statutory Instrument 1631, giving the regulations for Clinical Commissioning Groups (CCGs). These say that on the board of a CCG, there must be two “lay” (that is, non-clinical) people - one who has financial qualifications and is to be the chair of the CCG’s audit committee and one who is:

“a person who has knowledge about the area specified in the CCG’s constitution such as to enable the person to express informed views about the discharge of the CCG’s functions.”

The government tells us that this is the CCG board member who will represent patients, so it is interesting to see who can hold this position.

Schedule 5 of the statutory instrument gives a list of people who cannot be members of a CCG board (bankrupts, people with convictions or who have been dismissed from an NHS job etc), and these rules also apply to the lay members.

This schedule indicates that anyone elected (MP, MEP, MLA, or a local councillor) cannot be a lay member, even though these are positions where the representative has a connection, and, hopefully, a detailed knowledge of the community.

More interesting is Schedule 4 which gives specific rules about who cannot be a lay member.

Paragraph 4 says that “a chairman, director, governor, member or employee of an NHS foundation trust” cannot be a lay member.

This is a very wide exclusion and counterproductive. Foundation Trust governors are community based, they understand and represent the community and they have the skills of community engagement that a lay member of a CCG would need. Excluding FT governors is excluding precisely the sort of person that the CCG would want.

The wider exclusion of FT members is simply silly.

Membership of an FT is often wide and involves no obligation. Members do not have to pledge loyalty to the FT - indeed, people can be members of “competing” FTs in an area. There is no conflict of interest between being the member of an FT and being a CCG lay person. The regulation excludes a large number of people (there are reputedly more FT members than members of all political parties combined) for no reason at all.

The regulations for CCG lay members have been written to suck the lifeblood out of community engagement, because they exclude people who have been elected to represent a community (councillors, FT governors, etc) and who have the skills and opportunity to be able to present real knowledge of the community covered by a CCG.

They show that the government really are not serious about patient involvement in commissioning.

Richard Blogger writes about the NHS and social policy at NHS Vault.

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