Agenda item

This report provides the Joint Board with an opportunity for discussion on the position of the Joint Board in response to emerging national views on system wide leadership and governance. It focuses on the Care Quality Commission’s reviews across 20 Health and Social Care systems and explores recommendations made by CQC following their critical review of wider partnership working in other areas. The report also sets out changes expected in the immediate future that may impact on the work of the Joint Board.

Discussion:

The Policy and Relationships Adviser (Health) at Kent County Council presented the Joint Board with the findings from a number of recent national reviews of progress made towards integration of Health and Social Care systems in England. As well as progress made, these reviews examined the challenges of integration, ways in which national and local bodies were managing these challenges and the consequential impacts on service users. The Joint Board’s attention was drawn to the conclusions and recommendations from the following three key reports:

1.    The Care Quality Commission (CQC) report ‘Beyond Barriers: How Older People Move Between Health and Care in England’;

2.    The National Audit Office report ‘The Health and Social Care Interface’; and

3.    The report compiled by NHS Providers ‘Key Questions for the Future of Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICSs).

The Joint Board was advised that one of the conclusions drawn from these reviews was a need for system wide leadership, either through a Health and Wellbeing Board (HWB) or a Sustainability and Transformation Partnership (STP) Programme Board. The CQC report also noted that within the Health and Social Care systems it had reviewed, it was difficult to identify where system leadership came from and that, in general, Health and Wellbeing Boards were not fulfilling their potential and were underused where Sustainability and Transformation Partnership footprints did not align. However, these bodies could be effective in bringing together local leaders to plan and deliver services.

Across the Kent and Medway footprint it was explained that system leadership had developed and, in particular, the Kent and Medway STP Programme Board was strong and inclusive, with representation from both Local Authority areas and on each of the component workstreams. In addition, the Kent and Medway Joint Health and Wellbeing Board had been established and had a programme of work in place that broadly reflected the recommendations made by the CQC and set out within the report.

In relation to the vision expressed by the CQC, a Member commented that neither the Joint Board nor the STP Programme Board was empowered to make decisions on behalf of the health and social care system. He added that in this respect it made it very difficult for health and social care to come together in decision-making. In response, the Joint Board was advised that, in the context of the current national planning and regulatory frameworks, local systems have had to find workarounds. NHS Providers have expressed this concern in their report, particularly owing to the expected scale and pace of integration required. However, it was added that whilst it was not within the gift of the Local Authorities’ Health and Wellbeing Boards, the Joint Board or the STP Programme Board to make decisions on behalf of the system, Kent and Medway were in a strong position if there were any future changes in legislation or national guidance.

With reference to recent decision-making on a key decision for Medway by one part of the system, a Member expressed the view that it was appropriate that this joint Board and the STP Programme Board could not make decisions on behalf of the health and social care system in Kent and Medway. It was added that he was in favour of a consensus-based approach and that moving to a more formal decision-making structure should only occur when joint working had matured and confidence built.

A Member expressed support for the Joint Board undertaking the CQC recommendation set out at paragraph 5.2.1 of the report, a joint plan for older people. In response, the Joint Board was advised that a joint plan exists through the Case for Change supported by the work programme for the local care workstream. In Kent, the Adult Social Care Strategy was being refreshed and there would be merit in joint working to meet the requirements of the CQC. It was added that Medway’s Adult Social Care Strategy was approved in 2016 and that one of six strategic themes within the Strategy was integration, and so Kent and Medway were well placed to enable joint working through the Local Care workstream.

Referring to the Canterbury, New Zealand Model, a Member commented that system leaders could learn a lot from this and other models of integrated working in health and social care. In response to a question regarding national examples of good practice, the Joint Board was advised that examples of good practice included Manchester and Frimley. With respect to Frimley, it was explained that their integrated care system was considered outstanding and that they had established a Memorandum of Understanding (MOU) between partners to achieve this. It was noted that the extent to which the Local Authority was involved in these areas differed and that full integration in these areas had not been achieved. It was also outlined that Manchester had recently submitted a report on the barriers to integrated working to the Public Accounts Committee. One of the primary barriers was the need to use intricate arrangements to work around current legislation.

Members acknowledged that a common factor in more advanced integrated health and social care systems was that partners had been working together in an integrated manner for long periods of time. Moreover, it was suggested that the preferred starting point in these successful models was to build relationships, trust and common agendas ahead of determining the structure of a model. A Member added that in some instances, such as in the Canterbury, New Zealand Model, adversity had forced a move to an integrated model.

The Joint Board was advised that representatives of Canterbury, New Zealand Model had visited Medway to share their experience and lessons learned. The Team considered that integrated working would have advanced more quickly, if the first steps taken were to embed a common information system and invest in falls prevention.

The Managing Director of the East Kent CCGs advised the Joint Board that there was a Frailty Group working across Kent and Medway, which had drawn lessons from the experience of Canterbury, New Zealand and New South Wales.

Referring to the outcome of the recent NHS Kent and Medway review of urgent stroke services in Kent and Medway, a Member emphasised the importance of information sharing and transparency. 

A Member also stressed the importance of accountability in any health and social care system to ensure the quality of provision for service users and to maintain confidence in the system.

Decision:

The Joint Health and Wellbeing Board noted this report and the contribution that the Joint Board makes to system wide leadership across Kent and Medway Health and Social Care.