The issue

Devon CCG is the largest in the country with a budget of £1bn. Since its inception in 2013 it had developed a significant financial deficit and local NHS providers were also under pressure both in terms of clinical performance and financial sustainability. National regulators had intervened in an attempt to improve matters but the CCG remained off plan. The scale of the problem had a National profile, the more so because Devon is relatively well resourced in financial terms. NHS England had continued to press the CCG for more radical plans and the area had also been the subject of a national programme of work known as the “challenged health economy” process. Significant external support had been provided to secure an agreed way forward none of which has succeeded. 

The CCG recognised that without urgent action they would face a loss of autonomy and be unable to exert effective leadership for the system. Carnall Farrar were asked by the CCG to undertake a thorough capability and capacity review and to recommend changes to organisational form and structure, leadership capacity and capability and to secure support for those recommendations from key partners and NHS England. 

The work

We recognised that to be effective in this locality would require working with and through local people. There is considerable local leadership stability and it can be difficult to recruit people from elsewhere so the challenge of this assignment was to undertake an objective appraisal whilst aiming to develop and support local capacity where possible. 

CF undertook an extensive interview process including national and local leaders, clinicians, partners and stakeholders. A detailed review of all relevant documentation was undertaken and the key issues synthesised. Challenge sessions were held both on a 1:1 basis and for the executive team and the Governing Body at which the diagnostic was both shared and developed.  

Outline recommendations were made which the Governing Body accepted and were used as the basis for an agreement with NHS England about the forward plan. Subsequently coaching and mentoring support was provided to key leaders to support them through the next steps. 

The output

  • Extensive interview process detailed review of all relevant documentation
  • Challenge sessions held
  • Outline recommendations
  • Subsequent coaching and mentoring support to key leaders

The outcomes

The CCG secured an agreed plan and has undertaken a process of restructuring both of the top team, the organisation and the governance processes. NEW Devon as a system remains financially challenged but there is corporate acceptance of the need for a shared strategy across providers and commissioners. The CCG has received positive feedback about the way in which it has embraced and responded to the review. Devon is now an area which will pilot the success regime, and the CCG leadership has not only remained in place but has taken a lead role in establishing the programme of work. Carnall Farrar has been successful in a competitive bid to support this programme on behalf of the three national bodies. This has allowed us to build on the progress made locally and the good relationships established across the area. The CCG has been successful in driving through some very challenging service change programmes recently and is poised to take on board the consequences of this next stage. 

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