There were no apologies for absence.

The Chair welcomed everyone to the Committee and asked for introductions.

Councillor Ben Hayhurst, from Hackney Council, declared a pecuniary interest as he sat on the Council of Governors at Homerton Hospital. 

To agree the minutes of the meeting held on 19 April 2017.

The Committee agreed the minutes of the meeting, held on 19 April 2017, subject to the following amendment:

On page 2, Denise Radley – Corporate Director of Health, Adults and Community being added to the list of officers present.

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  ...  view the full minutes text for item 4.

Ms Milligan introduced this item, together with Mr Fradgley, and explained that the report would provide Members with an overview of the work being undertaken to develop mental health services as part of the North East London Sustainability and Transformation Plan.

Mr Fradgley referred to the fact that there was now significant drive to make mental health a national priority.  He stated that investment in that area was needed as much as it was in acute illnesses.  Mr Fradgley then explained that inner North East London had the highest level of mental illness in the country and that there was significant increasing demand for mental health services.  He also stated that there had been a 10% increase in those with mental health issues requiring primary care and that it was expected that that growth would continue.  Mr Fradgley highlighted the fact that good mental health services were provided in inner North East London and that they were leading the way in terms of innovation. 

Mr Fradgley pointed out that they were focussing on mental health inequality and the fact that mental health issues were often a problem for those with complex needs.  He confirmed that 51% of those with complex needs had a mental health problem.  He also pointed out that East London NHS were focussing on improving access to talking therapies for those from BME communities. 

Mr Fradgley then referred to the following key priorities for East London NHS around mental health:

·    Improving the number of mental health sufferers in the inner North East London  area

·         Suicide prevention

·         Helping those with mental illnesses to find employment

·    Improving access and parity in relation to mental health services (whilst keeping the waiting list to two weeks)

·         Considering how mental health would fit into the ACS system

Mr Fradgley went on to explain that approximately 50% of those individuals who were known to mental health services were under 65 years old.  He stressed the importance of ensuring mental health services were not placed at risk and the need to give due consideration to how the above priorities would be delivered. 

Rhiannon England, Mental Health Clinical Lead for the City of London Corporation and the London Borough of Hackney, referred to the innovative models that they had developed.  She pointed out how important such services were as there was a high need for mental health services due to the high levels of deprivation in the borough concerned.  Ms England stated that there was a very strong level of primary care in her boroughs and that a particular area of interest and focus was frequent users of primary care services.  She pointed out that many frequent users had a mental health problem. 

Ms England also referred to the difficulty in balancing good patient care with a lack of funding.  She confirmed that inner North East London could learn from the outer North East London boroughs in relation to crisis care.  She explained that the number of children and young people requiring crisis care was  ...  view the full minutes text for item 5.

Accountable Care Officers

The Committee was informed by the NHS that they were recruiting a single Accountable Care officer for Inner North East London and Members requested a discussion on the subject, as the appointment could potentially represent challenges to local accountability of health services.

Councillor Munn expressed concerns about the removal of accountable care officers from individual CCGs.  She explained that if there was just one Accountable Officer, this would change the way the NHS operated with little transparency or legal basis for the change. 

Councillor Hayhurst pointed out that the loss of Accountable Care officers could potentially result in a lack of local control and leadership. 

Councillor Masters concurred with Councillors Munn and Hayhurst.  She added that she was concerned that there was not a clear breakdown of what issues would be dealt with at the Accountable Care officer level.

Ms Milligan explained that the removal of Accountable Care officers had not yet been agreed by CCG Boards as it was still at the design stage.  Mr Haigh added that they were still in the early stages of discussion and confirmed that firm proposals would be put to each of the CCG bodies in July 2017.  He added that the change of the management process was complicated and how the ACS would be regulated needed to be considered.  He stated that the relevant budget would stay with the CCGs and that the only way the budget could move would be via risk share.  He stressed the importance of transparency around how the money would be spent. 

Ms Milligan explained that it was intended to work closely to try and free up resources and time to support borough developments.  She added that the proposed singleAccountable Care Officer would benefit Londoners.  She referred to the fact that there were challenges concerning the addresses of patients with larger providers.  She said that local arrangements were not necessarily being moved.

The Chair gave the view that local authorities needed to be involved in relevant discussions and should be considered a key partner.

Councillor Munn asked for an explanation on the duties undertaken by an Accountable Care officer.  Mr Gilvin explained that the role was set out in their constitution, however, he confirmed that the officer’s powers were those delegated to them by the CCG.  He added that clarity was needed around the arrangement of functions and stated that a strong commissioning team would be required. 

Councillor Hayhurst stated that a formal case for the proposals should be put before this committee and asked for a commitment that this would happen as, otherwise, the committee would be signing off a model which had not been subject to scrutiny. Ms Milligan explained that timelines were still being worked out.  Mr Gilvin confirmed that he would take councillors’ comments back to relevant officers for discussion.