To receive a verbal presentation on integrated care

– ESCW Deborah Cohen, Service Head of Commissioning and John Wardell CCG

The Service Head Commissioning and Strategy tabled an update report which has been appended to the minutes.  She reminded the Panel of the presentation made by the Associate Director Community Health Services, Barts Health NHS Trust and the Deputy Chief Officer, Tower Hamlets Clinical Commissioning Group at the meeting on 3 September 2013 about the redesign of health services in the borough over the next two years.  The intended plan would be to relocate some services away from hospital setting to community settings, in GP surgeries, and in people’s homes.  She advised this work had evolved into the Integrated Care Programme and this had itself evolved and expanded to encompass neighbouring East London Boroughs of Newham and Waltham Forest to become a one of the 14 designated Department of Health Pioneer sites.   The WELC Pioneer programme was about developing care pathways for older adults.  The three local authorities were part of the programme of change and in this connection the following was to be noted:

• Transfer of some social care into these community-based services was proposed - although the timing of these changes had yet to be established.
• Local authorities would need to consider which services and staff would be most appropriately redeployed into the programme. 
• It was felt that the single point of access and co-location of services was best method to deliver co-ordinated care.  This would have implications for the workforce for example one consequence may be a requirement for home care workers to be up-skilled. 
• Participation in the Pioneer programme did not attract additional funding but there was access to expertise.  This advice has already been accessed to help resolve information governance issues
• There was ongoing work on financial modelling of the impact of the service redesign on activity flows, with the aim of ensuring that funding followed the activities. 
• Funding for these developments would be in the Better Care Fund but this is not new money into the system but one fund into which several pre existing funding steams have been merged.  Funding in 2014-15 was a centrally determined allocation. However for 2015-16 a proportion of the grant would only be paid if targets were met therefore the Partnership of the CCG and Council were considering which targets were most appropriate to measure.

The Panel was informed that:

• The first draft of the plan for the use of the Better Care fund had to be submitted by 14^th February and therefore the Health and Well-being Board was required to consider this matter at its meeting on 6^th February.
• There were risks around the programme for those involved and there were potential cost pressures.  However the Council's focus should remain “better care for residents".  Learning could be drawn from previous integrations which showed a need for significant input of formal programmes of organisational development 
• The duration of the programme was expected to be three years and there would be regular progress updates made to Health Scrutiny Panel
• Carers Breaks funding would be located in the CCG base budget but would not automatically be passed to carers

In discussion the Panel noted the following information:

• A future scenario being thought about was that local authorities might not provide fieldwork social work but would be the commissioners of services whilst the NHS would act as the provider.  This raised issues about differences in the ethos of service cultures between the social care model and the medical model. 
• Additionally some governance issues were expected since the NHS was not a democratically accountable body. 
• Concerning financial modelling for the changes, the Panel was advised that there was an expectation that monies in the Better Care Fund would be pooled from 2015-16 onwards.

The Chair noted that there would be challenges for local authorities and NHS bodies in terms of trust and transparency of issues.  However the work previously been done by the NHS into collaborative working by GP networks would provide a useful reference.  The Panel was informed that there were plans for a savings pool to be used as an incentive for providers to work together in an integrated way.

The Chair noted that it would be necessary to consider the impact of the reduction for Barts Health service provision therefore a review was necessary to examine which clinical services should be continued and which should not.

RESOLVED:

That the update to be noted