Agenda item

Report of the Chief Executive (ACH/20/123) on proposals for the Integrated Care System (ICS) Board and establishment in “shadow” form, Memorandum of Understanding and system assurance framework, attached.

(Councillors Biederman, Dewhirst, Hannaford and Greenslade attended in accordance with Standing Order 25(2) and spoke to this item).

The Cabinet considered the Report of the Chief Executive (ACH/20/123) on proposals for the Integrated Care System (ICS) Board and establishment in “shadow” form, Memorandum of Understanding and system assurance framework, 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 NHS Long-Term Plan (LTP) had set many national priorities including clinical services, learning disabilities, digital, workforce and care closer to home as well as a fundamental shift towards integrated care, placebased systems and population health. This required all organisations in each health and care system to join forces and offer well-coordinated efficient and sustainable services to those who needed them.

In Devon, the Council’s Health and Adult Care Scrutiny Committee had been engaged in the development of the Devon LTP, including a Standing Overview Group session on the 24 February that focussed on the emerging governance and architecture proposals of a Devon ICS, set out in Annexes A, B and C.

All Local Government organisations (Devon, Plymouth and Torbay) plus all NHS organisations were being asked to consider these documents and respond to the proposals so that the Devon ICS could operate in shadow form from April 2020.

The Devon Health and Wellbeing Board (HWB) would have a key role in the Devon ICS alongside the HWBs in Plymouth and Torbay.

It was important to note that an ICS was not a legal entity, rather a “partnership” of the key statutory agencies bound through a Memorandum of Understanding that worked in a collaborative manner. Each sovereign organisation maintained their own statutory accountabilities.

This was clearly highlighted in paragraph 1.7 of the MOU (Annexe B): ‘Local government’s regulatory and statutory arrangements are separate from those of the NHS. Councils are subject to the mutual accountability arrangements for the partnership. However, because of the separate regulatory regime certain aspects of these arrangements will not apply. Most significantly, Councils would not be subject a single NHS financial control total and its associated arrangements for managing financial risk. However, through this Memorandum, Councils agree to align planning, investment and performance improvement with NHS partners where it makes sense to do so. In addition, democratically elected councillors will continue to hold the partner organisations accountable through their formal Scrutiny powers.’

The Cabinet further noted Paragraph 3.1 of the MOU (Annexe B): ‘The Partnership does not replace or override the authority of the Partners’ Boards and governing bodies. Each of them remains sovereign and Councils remain directly accountable to their electorates.’

Cabinet noted that Local Authorities were not within the NHS resources definition and that resource issues with the Council continued to be governed in the same way as now.

The Council had been involved in partnership working for many years, with health and care teams collocated across Devon providing integrated care, a number of joint strategic commissioning strategies, long standing partnership agreement and arrangements and a number of joint posts across both NHS and DCC commissioning and operations.

The matter having been debated and the other relevant factors (e.g. financial, sustainability (including 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 proposal for the Integrated Care System (ICS) Board and its establishment in “shadow” form from March 2020, as outlined in Annexe A, be approved;

(b) that the Memorandum of Understanding to secure “system” working, outlined at Annexe B, be approved for signature; and

(c) that the system assurance framework as the means of ensuring effective governance of the ICS, as shown in Annexe C, also be endorsed.