Agenda item

The NHS Long Term Plan sets an expectation that Integrated Care Systems will be established by April 2021. Work has commenced across Kent and Medway in designing an integrated system including changes to existing organisational forms, functions and the anticipated benefits that these changes will have in better meeting the health needs of the population. 

This paper sets out:

-       Progress to date in developing an integrated model; 

-       Outputs from two co-production workshops held across the system on future organisational forms and functions;

-       High level timeline for transition to a shadow form and end state by April 2020; and

-       Key next steps.

Discussion

The development of a Medway System Commissioner was a clinically led piece of work. The Case for Change for the Kent and Medway Sustainability and Transformation Plan (STP) had identified a number of challenges. It was noted that, left unchecked, health budgets would need to grow at around 5% each year to provide the full range of services, with only 1.5% of this being attributable to population growth. Key themes for the STP included intervention, prevention, addressing health inequalities and the health of the population. While there was lots of expertise in the healthcare system, this was not always used as effectively as it could be. In order to address the challenges there needed to be a cultural shift. The framework of the current system was based on the development of internal markets for health services and was therefore not suited to increased partnership and integrated working.   Four integrated care partnerships would be created across Kent and Medway as well as constituent primary care networks working under these. None of these bodies, nor the System Commissioner had a statutory basis. The statutory bodies remained NHS England and the Kent and Medway clinical commissioning groups. Integrating the budgeting and commissioning of health and social care would be challenging and the timeline specified by NHS England, which required Integrated Care to be established across STP footprints by April 2021, was considered ambitious.

A Committee Member said that the fact that healthcare was free of charge to the end user, while social care was not, would make integration and pooling of budgets difficult. The Kent and Medway STP representatives said the requirement for Integrated Care Partnerships to be in place by 2021 did not necessarily mean that health and social care would be integrated at that point. Integration was an aspiration but not a requirement. The Assistant Director of Adult Social Care said that social care was working with health colleagues in order to facilitate more collaboration between the two systems, but that there was significant work required for full integration to be achieved. Social care teams were participating in Integrated Locality Reviews to consider how to achieve better integration. Enabling providers to work together more effectively was an alternative to full scale integration. Publication of the Government Green Paper on Adult Social Care had been delayed a number of times. It was anticipated that this would set out expectations for integration of health and social care.

The STP representatives said that better collaboration could enable users of health and care services needing to use fewer organisations in order to be provided with their full range of services. An example highlighted was of a service user visited in their home by representatives of five organisations within a short space of time. It was suggested that better collaboration could reduce the number of organisations providing a direct service to this individual while the service user could benefit from more personalised service provision.

A Committee Member said that strengthening links and cooperation between health and social care required there to be trust between elected representatives and the NHS. The Kent and Medway Stroke Review was highlighted as having damaged this trust. Processes needed to be communicated clearly and honestly in order to rebuild trust. The Committee was advised that the creation of a single Kent and Medway CCG was under consideration.

Decision

The Committee noted and commented on the update provided.