Agenda item
NORTH EAST LONDON SUSTAINABILITY AND TRANSFORMATION PLAN; ACCOUNTABLE CARE SYSTEM
Minutes:
Jane Milligan, Executive Lead for the North East London Sustainability and Transformation Plan (NEL STP) introduced this item. She pointed out that there had been minor updates to the item which had been circulated. She confirmed that, nationally, there had been a significant amount of discussion on the subject of accountable care and that a lot of work had been done, some under the banner of devolution. She confirmed that, at some point soon, there would be a clear taxonomy, whilst pointing out that the population base was important when considering how to deliver the plan.
Paul Haigh, Chief Officer of the Clinical Commissioning Group for the City of London and London Borough of Hackney, stated that there were four work streams that brought together commissioners and providers. Mr Haigh confirmed that the work streams would look at the totality of funds and would identify exactly what they were trying to achieve.
Selina Douglas, Deputy Chief Officer of the Clinical Commissioning Group for the London Borough of Newham, confirmed that the building blocks for integrated care were in place and that they needed to consider how it would be taken forward. She referred to the fact that the CCG in Newham was hoping to streamline their services and pointed out that it was important that all concerned were working towards the same goal. Ms Douglas explained that they were hoping to significantly transform the service in July 2017.
Steve Gilvin, Chief Officer of the Clinical Commissioning Group for the London Borough of Newham, referred to the challenging position they were in and stated that it was important to step away from the system of financial incentives.
Councillor Munn referred to page 17 of the revised slides, specifically no.5 in the list of questions that the WEL ACS had asked themselves – “how should we go about the move to an ACO/ACS (assuming we agree that we want to)?” Councillor Munn asked why they would not want to move to an ACO/ACS. She also referred to no.14 and enquired whether they had come up with any solutions. Ms Douglas stated that it was important to adopt a different approach however she conceded that they were not sure what that approach might look like. She confirmed that the focus would be on integrated care and that a system framework needed to be developed on accountability. She stated that they would want the system framework to be as borough-based as possible.
Councillor Masters referred to the circulated revised document and asked how the London Borough of Newham felt about the prospect of capitalised budgets. Mr Gilvin stated that the London Borough of Newham already had capitalised budgets and gave the view that this was an opportunity to look at how they worked with providers. He stated that the funds were for the public and therefore needed to be spent in the appropriate way to potentially achieve financial viability. Mr Gilvin confirmed that an in-principle view had been given on how the money would be spent, but stated that a lot more detail was required before there was confirmation.
Councillor Masters asked for an explanation of Primary Care at home. Ms Douglas responded that there were a number of budgets nationally for Primary Care at home and that work was underway with care practitioners to decide the best way forward. She gave data as an example, stating that it needed to be decided how it would work, what systems would be used and how to make the information that becomes available meaningful for the ACS. Ms Douglas then referred to the importance of having a system that provided the desired outcomes and that each area was organised around the needs of the population.
Ms Milligan confirmed there were similar models in Tower Hamlets around supporting integrated care – including mental and physical health. She pointed out that it was important to ensure there was a learning platform in not just inner London, but also Outer London. Ms Milligan explained that there was a big focus on prevention and that they were moving forward in terms of implementation.
Denise Radley, Director of Adult Services, explained that Tower Hamlets Council was very much focussed on Tower Hamlets Together as a core partnership. She also confirmed that there had been significant investment in developing a new framework, however they were not yet in the position where a detailed model could be agreed.
Councillor Hayhurst asked if it was planned to take funding allocated to the CCG and redistribute that sum around the three ACS. Mr Gilvin confirmed that there was a borough based partnership with the aim to deliver that approach. He stated that the London Borough of Newham would prefer a borough based arrangement as the Council was trying to move away from compartmentalisation.
The Chair agreed that compartmentalisation was one of the risks when three such models were developing. She then asked for some detail on the London Borough of Hackney’s approach. Mr Haigh explained that the London Borough of Hackney’s model had emerged from devolution and was similar to the models of the other boroughs represented at this meeting. He stated that the Council preferred a borough based model around a set of outcomes.
Ms Milligan stated that payment per item did not support a partnership approach. She said that it was important to identify a number of key thresholds as this would add extra benefit. She also explained that it was important to find a way to develop whilst ensuring that, for example, urgent primary care was available without the need to attend Accident and Emergency. Ms Milligan stated that the biggest challenge was the fact that they do not know what the outcomes will look like. Mr Gilvin added that, with this approach, there was a risk that it would not incentivise clinicians to do right by their patients. He also said that providers needed to be financially viable going forward. The Chair enquired as to whether he was referring to care providers only and Mr Gilvin responded that a comprehensive piece of work was required on this subject.
Ms Radley referred to discussions that had been had at Tower Hamlets Council on the broader social care market. She stated that, should accountable care be integrated, then it would need to focus on the broader social care market.
Councillor Hayhurst stated that he was concerned that the local authority and CCG would lose control as things progressed and asked for clarification on timescales in relation to the budget. Ms Milligan explained that CCG had statutory decision making powers and that the timescales were being developed. She said that by December 2017 it was important to have reached an understanding of what the timescales would be as the plan was to test the proposals by 2018/19.
Councillor Hayhurst asked for thoughts on Hackney Council’s proposal to pool all relevant budgets. Ms Milligan confirmed that there was a commitment to integrated budgets. She stated that it was important to consider where resources should be allocated to be most effective. She pointed out that providers might need support in order to get the best outcomes.
Councillor Hayhurst referred to the fact that there was a budget shortfall and expressed concerns at the proposal to re-evaluate and come up with a new system when the money to fund that system was not available. Ms Milligan explained that previous experiences had yielded positive outcomes and said that there was evidence that such approaches had a positive impact. She gave dementia as an example.
Councillor Masters asked what proportion of local budgets would be included in the ACS for Newham and Tower Hamlets Councils. Mr Gilvin explained that the proportion would depend on the range of acute services that would be provided. He confirmed that further discussions were needed on this subject.
Councillor Masters referred to a task and finish group that had been set up and asked whether it had completed its work and for clarification on who was on the group. Mr Gilvin confirmed that the group ensured structured collaboration. He explained that it was the intention to liaise with all community providers within the London Borough of Newham. He said that work had commenced, however, there was some further work required on establishing the sub-groups which would sit beneath the task and finish group.
Councillor Masters then asked whether a strategy had been developed for ACS proposals. Mr Gilvin stated that, as a test, a number of events had been organised in Stratford in order to develop a strategy. He said the next stage was how the ACS would deliver the strategy.
Action: Councillor Masters asked that a list of all the working groups be provided to Members of the Committee.
Supporting documents:
- item 4 cover sheet STP, item 4. PDF 51 KB
- Item 4 - ACS Update INEL JHOSC, item 4. PDF 1 MB
- ACS Update INEL JHOSC 260617 (UPDATED VERSION), item 4. PDF 993 KB