Big changes to the NHS

Big changes come into effect this month in the way our local health services are managed. Eight clinical commissioning groups (CCGs), including Brent, have merged into a single North West London CCG. This CCG  will also be working with every hospital, mental health trust, community trust and local authority in North West London as part of an ‘integrated care system’ (ICS).

People often ask if such changes really matter. My sense is that they really do and that they can be both a risk and an opportunity.

NHS doctors and managers tell me that the benefit to patients is that a single organisation and system can drive a consistent approach to high quality services, using data on population health to target improvements and tackle health inequalities. There are huge inequalities across our patch, with outcomes and life expectancy varying widely between the poorest and more affluent areas. We saw this play our tragically during the Covid pandemic, where the least well off, including many people in Brent, were disproportionately affected.

The role of local authorities in the ICS – which is expected to become a statutory body in April 2022 – is also important, as it means we can better join up health and social care services, building them around the needs of our communities by working as a single system.

We also have to recognise the risks. A bigger system across eight London boroughs – North West London will be the biggest CCG and ICS in the country – could easily become far removed from local needs and concerns in each area. We know public input to both health and local council services improve those services. So ensuring a strong resident voice, at both borough and North West London level, is going to be critically important.

So too is local decision-making. I am pleased that the single CCG will have strong borough-based teams – and particularly, that the intention is to create a local ‘integrated care partnership’ (ICP) between all part of the NHS and the council in each borough. While this may sound like lots of new jargon and bureaucracy, it is important. The balance of power between the ICS and the local ICPs will be important: ICPs should be setting the local agenda with their residents while the ICS steers the overall direction of travel for the system.

On balance, the changes feel like the right thing to do – residents often complain that services don’t work together closely enough. But the success of this latest NHS reform will really depend on all of us. If we can ensure that the local systems work and play their part in driving down health inequalities across the whole area, there should  be huge benefits for North West London. If we lose local voice and influence in a sprawling, centralised bureaucracy, we will have failed.