Joint Committee Frequently Asked Questions

• 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.

• 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.

• 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.

• By taking a joint approach we have a stronger voice and will help reduce inequality 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.

• That split of the eight boroughs of NW London does not exist anymore.

• For the Joint Committee to operate there have been revisions to the constitutions of the CCGs, and the terms of reference for the Joint Committee have now been agreed.
• Broadly speaking the Joint Committee will agree those issues that span several boroughs such as the agreement of NW London 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.

• 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.

• All CCGs have to agree to a decision unanimously.

• The Joint Committee is held in public which means our residents are welcome to attend. 
• All papers are published online ahead of the meetings.
• We 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.
• The meetings can be viewed online for those not attending in person.

• 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.

• There is an independent chair who was recruited in 2018.

• The Joint Committee operated in shadow form since January 2018. 
• In September, a suite of papers went to each CCG Governing Body.  This included the Terms of Reference for the Joint Committee.
• Revised CCG constitutions have now been agreed and can be seen on each CCG website.  
• This means the Joint Committee has now moved out of shadow form.

• The decisions made at CCG Governing Bodies are most relevant to that corresponding local authority whereas decisions made at the Joint Committee may 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.

• 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. 

• 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.

• 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.

Yes.

• Yes, we will review the arrangements after six months of operation.

• 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.