Big changes ahead for cash-strapped Brent Clinical Commissioning Group

Brent Clinical Commissioning Group (Brent CCG) which has an £11.2   deficit, is to move from Wembley Centre for Health and Care in Chaplin Road, Wembley to the Brent Civic Centre. In turn the social work team will be moved from the Civic Centre to the Willesden Centre for Health and Care.

Other nearby Clinical Commissioning Groups are also in deficit and so they, along with Brent will be moved into a ‘super’ CCG covering the whole of North West London to save costs.

The way each proposal interacts with the other is as yet not entirely clear. 

The Brent CCG move to the Civic Centre is premised both on saving money and improving working conditions and there is an additional justification based on the benefit  joint work with Brent council departments, although it is not clear why that does not also apply to the social work team.

One key element is the role of NHS Property Services (NHS PS). As covered previously on Wembley Matters as part of the gradual marketisation of the NHS they seek market rates for their properties and charge for ‘void’ (unused) spaces. Brent CCG will save on these charges but there is a risk that NHS PS will not accept the ‘hand back’ of the current space they occupy.

The Brent CCG is required to adopt the North West London ‘Agile Working Policy’ which doesn’t mean that they combine office work with yoga - it just means that they have no fixed personal desk and that there are more staff than there are seats available. I guess the agility comes in when they all leap over each other to try and bag a seat in the morning:

In addition to the rent  for accommodation on the 5^th and 6^th floor of the Civic Centre Brent CCG will have to pay Brent Council an additional, discounted, charge for use of the Boardrooms and Conference Hall. Staff will have to pay to park their cars at the Civic Centre if they wish to drive to work.

The rent paid by Brent CCG to Brent Council will be £299,000 annually, Brent Council will pay £180,000 annually for the Willesden Centre, but this will be reduced to £80,000 over the 10 year lease period because Brent will have to spend £800,000 to ‘kit out’ Willesden because at present it is a ‘shell.’

While all this is going on the move towards a single CCG to cover North West London has accelerated. This extract from yesterday’s Health and Wellbeing Board explains:

Single CCG Across North West London 

1.     The 10 Year Plan requires that there will be a shift to a CCG for every ICS area – in Brent’s case this would be a North West London CCG. This would mean a consolidation of existing CCGs, which will become leaner, more strategic organisations that support providers to partner with local government and other community organisations on population health, service redesign and long-term plan implementation. 

2.     The movement towards a single CCG may take place either via changes to the constitutions of the 8 individual CCGs in North West London or via a formal merger application to NHS England. In the latter scenario this would mean that Brent CCG would cease to exist as a legal entity and that commissioning responsibilities would be merged into a new organisation – North West London CCG. 

3.     A working group has been set up at North West London level to design the structure of the single CCG. Since North West London collaboration is currently in a significant deficit position, the movement towards a single CCG is being accelerated in order to achieve administration cost savings. Current plans are to finalise the new structure by the end of April 2019 and to approve a case for change in May 2019, with staff consultation progressing in June 2019. The plan is to have completed the move to a single CCG structure by April 2020. At the time of writing, it is anticipated that there will be a local ‘branch’ of the CCG that will be based locally within the borough. This local arm will be focused primarily upon primary and community care, and the development of the local ICP.

Will this mean that the super CCG will take up the accommodation at the Civic Centre or will it be allocated to a 'local branch'? 

What will be the extent of redundancies across the eight CCGs and how will those in the 'top jobs' be affected? 

What independent powers will a 'local branch' have?

How will both the 'super CCG' and the 'local branch; be democratically accountable to local residents?

Meanwhile a small but vital organisation, Brent Advocacy Concern, that has served disabled Brent residents for 30 years, have been caught up  in the new market rents policy and will have to find £16,000 in December for the annual payment for their space in the  Willesden Centre. A sum that they cannot afford and so they are faced with finding a cheaper alternative or closing down...

Brent Council poised to lease out 8th floor of Civic Centre to HMRC agency

Civic Centre office floors

Brent Council appears to be likely to lease the 8th floor of the Civic Centre to the Valuation Office Agency (VOA) and Executive Agency of Her Majesty's Revenue and Customs (HMRC).   The 7th floor is already occupied by Air France.

The space has been marketed by Colliers International who were also agents for the Brent Town Hall. Their advertisement can be view HERE.

Potential occupation has been limited by the fact that there is no public access to these floors and any access change would require additional expenditure.  A report going before Cabinet notes that interest in leasing the space has also been expressed by Job Centre Plus and the Brent Clinical Commissioning Group.  The latter would have advantages in terms of developing the working relationship with the Council. The VOA would be a back office operation with no 'public facing' role.

It is proposed that the space be leased for 10 years with a 5 year rent review and tenant break option.

Meanwhile Job Centre Plus has expressed an interest in property at 6 St Johns Road Wembley.

The report LINK notes:

3. Letting to the VOA also should significantly contribute to that [Property] savings target. It is not commercially sensitive to note that it should save £80k annually based on 2016/17 business rate figures, as these become the responsibility of the VOA. However, it is important to note that these savings are predicated on the 2016/17 valuations and not the 2017/18 revaluation. Therefore, these savings would likely be offset by a probable increase in rates.
   

The likely revenue from the lease has been deemed commercially sensitive and is available to Cabinet members but not the public.

Brent NHS CCG takes its toys away

Guest blog by Nan Tewari

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In the most extraordinary spectacle I have ever witnessed in over 40 years of attending public meetings and meetings of public bodies (two different things) on Wednesday evening, Brent NHS Clinical Commissioning Group (CCG) fell out spectacularly with its patient representatives. In short, the CCG refused a perfectly reasonable, unanimous patient request to change the order of the agenda items of the patient engagement meeting and in the face of patient disapproval, decided to close the meeting with no business having been transacted. The badly run meetings (by a CCG public appointee) had failed consistently to run on accepted lines, namely, apologies, approval of minutes. matters arising etc. and as a result, minutes of meetings held in November 2013, March 2014 and May 2014 have never been approved and therefore cannot be put onto the CCG website for the benefit of the public at large.

The law requires CCGs to consult with patients and the public on proposed changes to the delivery of health services.   Failure to comply with the requirement can be serious with the CCG being challenged by providers as well as by individual patients and groups of patients who perceive changes as being detrimental.  Even if the CCG is confident that it is making the best decision, it still needs to go through a proper and proportionate public engagement process.

In order to meets these legal obligations, the CCG set up a committee of its Governing Body called the Equality, Diversity and Engagement (EDEN) Committee to provide itself with assurance that its public involvement activity in the multiplicity of proposed service changes was as robust as it should be.

My fellow patient reps and I (some, appointed by the CCG and others, elected by fellow patients) worked really hard to help the CCG and pointed out where it could be open to challenge.  We take the view that we are neither a rubber stamp nor nodding donkeys, and it is our duty to withhold the desired assurances if patient involvement is unsatisfactory.  The CCG did not appreciate this one little bit and started a smear campaign against patient reps saying that we were failing in our duties.

The CCG is effectively rewriting the rules to tell patient reps how they must act. In the course of doing so, they are also breaching all of the accepted rules of public body committee procedure and have stated that their particular public body (the CCG) does not have to act in accordance with these norms.

I have taken up this guest blog spot, courtesy of Martin Francis, because there is nowhere officially in Brent CCG for patients to air their views on matters of public involvement in proposed changes to local health services as is required by s14Z2 of the NHS Act 2006 as amended by the Health and Social Care Act 2012. It would be interesting to hear what others patients and members of the public have to say.