Agenda item

Report of the Chief Executive (ACH/18/81) on Health and Care Integration in Devon, attached.

(Councillors Ackland, Connett, Greenslade and Shaw attended in accordance with Standing Order 25(2) and spoke to this item).

The Cabinet considered the Report of the Chief Executive (ACH/18/81) on Health and Care Integration in Devon, circulated prior to the meeting in accordance with regulation 7(4) of the Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012.

The Report outlined the national context which had been a national policy driver towards the integration of health and social care with successive governments using the term without prescribing a solution or answer. It also outlined that, in 2016, the Local Government Association, Association of Directors of Adult Social Services, the NHS Confederation of Providers and NHS Clinical Commissioners published a vision for the integration of adult social care (Stepping Up to the Place) and made a shared commitment to a collective approach to achieving integration by 2020.

Devon had been developing its integrated working and the Report outlined the proposals in the latest phase towards a fully integrated health and care system across wider Devon. It also reiterated the key milestones over the last several years which had included a Section 75 agreement for the provision of services to working age adults with mental health needs, a Section 75 partnership agreement between local authorities and the NHS for pooling resources and delegating certain NHS and local authority functions to other partners, co-location and co-management of community health and social care services and joint governance of pooled budgets, including of the Better Care Fund from 2015.

The Report then set out the way forward to bring about further health and care integration in Devon, but noting there was no proposed changes to the formal governance of health and Care in Devon as proposed.

In order to support the delivery of health and care and achieve outcomes of improving quality, lowering costs and enriching user experience, partners were planning to further develop partnership through the establishment of an Integrated Care System (ICS).  This was alongside the statutory duty of the local authority to co-operate with NHS partners of which collaboration and partnership were key features of an ICS approach. The ICS was not an Accountable Care Organisation (ACO) which had been subject to national consideration and debate. It was not about changing organisational accountability or privatisation of either NHS or council services and the local authority would remain responsible for all its existing statutory obligations.  NHS statutory obligations remained unchanged. The development of an Integrated Care System in Devon mirrored the approach being taken nationally.

The Report outlined the following actions that had been agreed in Devon;

(i)            A single integrated strategic commissioner for health and social care, primary care and specialised commissioning (plans were being developed, although the first step would see the County’s two Clinical Commissioning Groups working together to manage the overall annual NHS budget of £1.5 billion, set strategic direction, co-commission services, develop plans for the future and work more jointly with Local Authority Partners;

(ii)           A number of local care partnerships and integrated mental health; and

(iii)          Shared corporate services across Devon for the NHS (such as IT, Finance and HR).

The Report also outlined how plans and resources could start to align better and an enhanced model of partnership working from April 2018, where possible, which reflected national planning guidance for 2018/19.

In addition, the two CCG’s had been aligning their resources and executive teams and

Consultation on a single CCG executive structure was underway and due to be concluded at the end of February 2018. Also proposed were joint appointments between local authorities and the NHS. For Devon County Council, there were three positions jointly funded by DCC and CCGs at Executive Team Level (Head of Adult Commissioning and Health, Joint Strategy Director and Joint Commissioning (South Devon)).

There was also an ambition for co-location of teams, based in the Exeter area and options were currently being explored.

In terms of Governance, there was no change to legislation, statute or constitutions but options on governance of any new integrated arrangements would need to be explored. The Report highlighted that the role of Scrutiny Committees would remain a key function.

The matter having been debated and the options and/or alternatives and other relevant factors (e.g. financial, sustainability, carbon impact, risk management, equality and legal considerations and Public Health impact) set out in the Chief Executive’s Report and/or referred to above having been considered:

It was MOVED by Councillor Leadbetter, SECONDED by Councillor Hart, and

RESOLVED

(a) that the key features of an emerging Devon Integrated Care System being a single Integrated Strategic Commissioner, a number of Local Care Partnerships, a Mental Health Care Partnership and shared NHS corporate services, be noted.

(b) that the proposed arrangements in Devon as set out in paragraph 3 of the Report be endorsed, reporting to the Appointments and Remuneration Committee as necessary.

(c) that the co-location of NHS and DCC staff within the Integrated Strategic Commissioner, subject to agreement of the business case, be approved; and

(d) the Health and Adult Care Scrutiny Committee be invited to include Integrated Care System governance in its work programme.