NHS Halton CCG and NHS Warrington CCG have been working together for a number of years, sharing expertise, knowledge and skills. Over this time there has been a lot of joint working that has provided some real benefits in terms of an effective and efficient way of working.
However, in November 2018 NHS England advised CCGs that the Running Cost Allowance (this is the budget for the administrative and corporate overheads) would be reducing by a further 20% by 2020/21. In addition, the NHS Long Term Plan published in January 2019 signalled the direction of travel, with streamlining of commissioning and a focus on 'place' and Integrated Care Systems.
This has presented both CCGs with a real challenge and since last November the CCGs have been working to identify actions to reduce running costs but have now exhausted all internal actions to reduce spend and it is simply impossible for the CCGs to make the required reduction in isolation.
When considering what could be done to make the savings and at the same time meet the ambitions of the NHS Long Term Plan the CCGs have been exploring all potential options, including; mergers across Cheshire, Mersey, Mid Mersey and Halton and Warrington, integration with the Local Authorities, alignment of commissioning across a wider footprint.
The long list of options were evaluated against criteria that included; benefits for patients, alignment with the NHS Long Term Plan, being coterminous with local authorities, Clinical leadership and financial management.
A joint meeting of the NHS Halton CCG and NHS Warrington CCG Governing Bodies took place on 7th August 2019. At this meeting Governing Body members discussed the long list of options in detail. The Governing Body members then assessed the options individually to determine which option(s) were the most viable.
The three top scoring options were:
Option 1 – Formal merger of the two CCGs
This would build on the current integrated working arrangements but will mean the establishment of an entirely new CCG, with a single management team, governing body and one set of statutory duties to be delivered, coterminous with the local authorities. Savings would be made as the duplication would be greatly reduced. In addition, this would support the ambitions of the NHS Long Term Plan, retaining a focus on 'place' across both Halton and Warrington, whilst supporting the streamlining of commissioning and reducing running costs.
Option 2 – Do Nothing
This option would be to remain as is, with two separately accountable CCGs. There are already some benefits in terms of the integrated management team, the move to a single functional base and the alignment of some work programmes. However, there will still be a lot of duplication in terms of governance arrangements, with two governing bodies, accounts, commissioning plans, work programmes etc. This option would maintain the status quo but does not offer any benefit in terms of economies of scale nor deliver the required reduction in costs or fulfil the vision of becoming a strategic commissioner in line with the NHS Long Term Plan.
Option 3 – CCGs integrate with their respective Local Authorities
This option would be integration as it would not be possible for the CCG to fully merge with the Local Authority as a single entity as Local Authorities and CCGs are different legal entities with separate statutory responsibilities. This option would also require a considerable amount of time to implement, even with complete sign up of all organisations and a level of duplication would remain as CCGs are accountable for delivering the financial and constitutional targets. In addition, this option may not meet the financial requirement to achieve a reduction in the running cost allowance by 20% in the mandated timescales.
At this point the case for change is being developed against each of the three options, and as part of this process we want to seek and listen to the views of our stakeholders including partners, providers, patients, the public and third sector organisations.
People can provide us with their views by completing a short survey at
During September all the feedback will be considered as part of the case for change for each of the options and will be used to inform the decision making. A decision is expected by the middle of September.
Therefore, it is really important that you share your views with us as soon as possible to enable us to consider this as part of the decision-making process.
Depending on the outcome and the decision, there will be a further engagement programme in line with the implementation of any changes.
Further Information can be found on our dedicated webpage http://www.haltonccg.nhs.uk/get-involved/future-commissioning-arrangements