Agenda item

The Committee received a presentation covering Sustainability and Transformation Plans, the Hackney devolution pilot, and the Integrated Commissioning Model.

In December 2015, NHS England announced a requirement for five year Sustainability and Transformation Plans (STPs) to set out how local areas proposed to meet the challenges set out in the Five Year Forward View. The City of London Corporation was part of the North East London STP, which included eight local authorities, seven Clinical Commissioning Groups and three acute hospital trusts. Guidance from NHS England set out that all STPs would have a single ‘system’ budget made up of the operational budgets for each organisation involved. Funding could therefore be moved between organisations by agreement, provided the overall budget total did not change, which posed a potential risk where funding from local organisations may be used to support other organisations in the system that were experiencing financial difficulties. There were a number of challenges across North East London, including increasing population, deprivation, health inequalities, capacity in some services, fragmentation of service pathways, as well as significant financial pressures. New models of care were therefore being explored through the STP, the ‘Transforming Services Together’ programme (overseen by the Joint Health Overview and Scrutiny Committee), and the Hackney devolution pilot.

Paul Haigh from the City & Hackney Clinical Commissioning Group introduced the Hackney devolution pilot, one of five across London, which aimed to explore the delegation of powers to a local level to better support the achievement of plans. The pilot sought to develop an integrated health and social care commissioning and delivery model system, develop estate and implement new approaches to prevention. The City of London was not part of the pilot, but had been involved throughout to ensure potential benefits for the City could be realised and unintended consequences could be minimised. Mr Haigh outlined the six ‘building blocks’ of the pilot:

·         Practice based family nursing teams, with a pilot at the Neaman Practice;

·         Integrated community health and social teams in each quadrant, e.g. Care Navigators;

·         Quadrant based voluntary sector organisations delivering social, wellbeing and public health services;

·         Physically integrated single point of access for services for health and social care practitioners in and out of hours, e.g. ParaDoc, a pilot to provide a joint paramedic and GP clinical response addressing urgent primary care needs with the intention of reducing unnecessary conveyance to A&E via ambulance;

·         Empowering patients with skills and information to help them self-manage conditions and access right services when needed;

·         Strong and safe local hospital/provider landscape.

A key part of the Hackney devolution pilot was the Integrated Commissioning Model, which aimed to minimise transaction and management costs. It was consistent with the Hackney devolution pilot, based on the pooling of health, social care and public health funding with separate pooled budgets for Hackney and for the City of London Corporation. Agreement was now being sought from Members to explore this model further for the City of London Corporation, with a more detailed report being presented early next year. The aim was to launch in April 2017 with gradual development and a number of gateways to ensure stability and minimise risk.

Members discussed the presentation, noting that the scale of the problem was challenging - not necessarily just the amount of debt being tackled, but the fragmentation of the health service – and agreed that effective communication between a large number of Local Authorities, CCGs and care providers would be difficult.

Members challenged the devolution pilot’s focus on transactional change rather than transformation, and queried whether there was a danger of provision for City workers being overlooked and of different residential areas in the City being treated differently. Paul Haigh agreed that there was a focus on transactional change, but confirmed that transformational change would be addressed alongside this through the ‘building blocks’ identified for the Hackney devolution pilot. Officers advised that integrated commissioning would enable a clearer focus on City residents and workers and the different networks they need, as the Corporation would retain a separate pooled budget. Officers advised that separate agreements were needed with different commissioners where there were crossovers with other Local Authority areas. Although integration with Hackney would not change agreements with other LAs, it would enable the Corporation to reopen discussions and renegotiate provision. 

Members expressed their confidence in the City & Hackney CCG, but also their concerns over the target launch date in April, and asked for the follow-up report to include more detail as to alternative launch dates and to clearly set out the mechanism (i.e. when, how, and with what consequences) for the Corporation to withdraw from this model if it were unsuccessful. Members also asked that the follow-up report suggest key metrics and outcomes for the Committee to scrutinise against after implementation.

Members also noted this report would be considered the Policy & Resources Committee in December and queried whether it could go to that Committee’s November meeting. It was noted, however, that the report needed to be discussed by the Community & Children’s Services Committee and the Health and Wellbeing Board beforehand so their comments could be considered by P&R.

RESOLVED – That:

a)    the presentation be noted;

b)    the report at agenda item 7 be noted; and

c)    the follow-up report include additional details regarding alternative implementation dates, withdrawal mechanisms and metrics for scrutiny.