Issue - meetings

Items which in the opinion of the Chair should be considered at the meeting as matters of urgency.

In accordance with the Scrutiny Procedure Rules, 5 Members of the Council (Cllrs Connett, Way, Dewhirst, Greenslade and  Brazil) have invoked the call-in procedure in relation to the decision of the Cabinet (Minute 148 of the 14 March 2018) in relation to Health and Care Integration in Devon.

This is on the grounds of Governance “and that the governance for the new proposals was a weakness. In addition, there has been a lack of consultation with the public regarding the proposals. Also the reference in the report concerning some implementation from April 2018 gives inadequate time for scrutiny through the normal committee timetable”.

A copy of the Cabinet Report (ACS/18/81) is also attached.

(An item taken under Section 100B (4) of the Local Government Act 1972)

(Councillors J Brazil and M Shaw attended in accordance with Standing Order 25 (2) and spoke to this item)   

(Councillor A Leadbetter attended in accordance with Standing Order 25 (1) and spoke to this

item at the invitation of the Committee)

(Mr N Roberts (Accountable Officer, NEW Devon CCG and South Devon and Torbay CCG), Dr S Manton, Joint Director (Strategy) North, East and West (NEW) Devon CCG and South Devon and Torbay CCG attended and spoke to this item at the invitation of the Committee)

The Chair had decided that the Committee should consider, as a matter of urgency, this issue in view of the recent call-in (as outlined below).

In accordance with the Scrutiny Procedure Rules, 5 Members of the Council (Councillors

Connett, Way, Dewhirst, Greenslade and Brazil) had invoked the call-in procedure in

relation to the decision of the Cabinet (Minute *148 of the 14 March 2018) in relation to

Health and Care Integration in Devon.

This was on the grounds “that the governance for the new proposals was a weakness. In addition, there has been a lack of consultation with the public regarding the proposals. Also, the reference in the report concerning some implementation from April 2018 gives inadequate time for scrutiny through the normal committee timetable”.

The Committee considered the Report of the Chief Executive (ACS/18/81) which had been submitted to Cabinet on 14 March 2018 and re-presented to this Committee for consideration in relation to its recommendations.

The Report outlined the national context and drivers towards integration of health and social care, the local Devon context and how it was developing its integrated working, further developments and proposals with a common set of objectives and outcomes, proposed arrangements in Devon, noting that governance arrangements would not change from 1 April 2018. 

The Chair also reported the receipt of approximately 45 representations from the public on this matter, and written representations from Councillors B Greenslade (circulated at the meeting) and S Russell. A paper from Councillor Ackland on proposals for a revised composition of the Devon Health and Wellbeing Board, which had been presented to the Cabinet at its meeting on 14 March 2018, had also been circulated to Members.

The representatives from the Clinical Commissioning Groups and the Chief Officer for Adult Care and Health responded to Members’ questions and/or commented on:

·         the benefits of further integration (the process of which had been longstanding) which included improved services, avoidance of duplication, work force efficiency and effectiveness, and greater consistency over the two CCGs and local authorities with better alignment of services; 

·         the emerging proposals which did not represent a change in accountabilities, there was no new organisation being created, and the focus was on a joined-up approach to promote independence for people where it was safe and appropriate so to do;

·         consideration of changes in the composition of the Health and Wellbeing Board and development of local boards with  ...  view the full minutes text for item 52

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  ...  view the full minutes text for item 148