Unhealthy merger for patients

Enfield residents could lose their say on local NHS services after a huge North London administration body was created without any public debate

The biggest shake-up in the NHS is underway with the creation next April of a single mega-CCG (Clinical Commissioning Group) covering Enfield, Barnet, Islington, Camden and Haringey.

It will be responsible for meeting the health needs of all 1,636,868 residents in five North Central London boroughs, spread over 204 GP surgeries, with a £2.1bn budget to provide all our hospital and primary care services.

This new bureaucratic monstrosity has been imposed by NHSEngland (NHSE) and NHSImprovement (responsible for hospitals and trusts} in a shot-gun merger without discussion and approval of patients, our Health and Well-being Board, or the council’s Health Scrutiny panel.

Despite the fine words that the re-organisation aims to reduce health inequalities in the Borough, the only firm objective seen so far is that the merger is intended to reduce management costs by 20%.

As yet, there is no sign of more NHS money coming to notoriously under-funded Enfield. In fact, to break even, Enfield CCG has to produce £15.4m in “savings” by the end of this financial year in March 2020. And find a further £17 million in “savings” – we mustn’t call them “cuts” – in 2021-22.

Dr Mo Abedi, the Enfield CCG Chair, was emphatic that these savings will need to come from the “providers” of NHS services. Though the Royal Free Group of hospitals (RFL) – a “major provider” for Enfield which includes Chase Farm and Barnet hospitals – itself recorded debts of £244m last year. Ominously, the RFL auditors cast “serious doubts” about its ability to “continue to provide healthcare services”.

Against this dire background we are being asked to be optimistic about the new NHS structure. Although NHSE gave its approval for the five-borough CCG merger on 21 October, by the end of that month Dr Abedi was still telling us that “we are in the process of developing a constitution” and an overall strategic plan.

Yet the draft constitution had no place for even a non-voting patient on the governing body – unlike the present Enfield CCG. There is a place for just one patient and public engagement rep, one Healthwatch rep for the five boroughs and just two Enfield GPs to represent our 47 surgeries.

No commercial company would be allowed by law to contemplate a similar venture without first producing a detailed structure, together with a list of objectives, a timescale for benefits and any downside envisaged. This would then be considered by all those affected, which in our case means Enfield’s 334,000 residents.

That is why health campaigners all over the country are outraged by the way our statutory rights to be part of the decision-making process – enshrined in the NHS Constitution – are being eroded by NHSE to prevent any public debate and consultation.

The merger will see the end of an Enfield health authority whose independence has been gradually eroded. It will be replaced by a new local Partnership Board whose members will include Enfield council’s chief executive, the chief officers of Chase Farm and North Mid. Hospitals, the CCG Chair and chief operating officer etc. As yet, there’s no one democratically elected to represent us.

We envisage that NHSE will, from April 2021, introduce a single budget for the combined CCGs which means that Enfield will have to fight for its rightful share of the pot if we are going to at last see some health inequality improvement between families living in the east and west of the borough.

Latest figures show that a woman living in Grange Ward in the west has 8.2 years of longer life expectancy than a woman living in Upper Edmonton. For men living in these wards the difference is just under four years – and the discrepancy has remained much the same for years.

Therein lies danger for all Enfield patients: that our voices will be silenced in future as the new all-powerful mega-CCGs railroad through ill-conceived and controversial service-cutting plans.

Our answer must be that we intend to remain an integral part of the NHS decision-making process as we’ve been since its inception 71 years ago.

We remember all too well how patient protests blocked the recent CCG attempt to end NHS hearing aids for people with mild and moderate hearing loss. We campaigned successfully to end the high cost 0844 phone number racket, once used by so many Enfield surgeries.

Currently, we are chasing a reluctant CCG to restore the blood test service at 13 surgeries withdrawn since last April, forcing many elderly people with disabilities to trek to a hospital.

You can have your say by attending the next CCG governing body meeting on Wednesday 18 December at 1.15pm, Holbrook House, Cockfosters.