Agenda item

This report provides a high level summary of the work to date in developing an integrated care system across Kent and Medway and in particular the development of a single CCG and the Medway and Swale Integrated Care Partnership (ICP). This report will be accompanied by a presentation on the health and care system transformation and a presentation on the ICP.

The Health and Adult Social Care Overview and Scrutiny Committee considered an update on the development of a single Kent and Medway Clinical Commissioning Group on 20 August 2019. The Comments of this Committee are set out in section 3 of the report. The Health and Wellbeing Board is asked to note and comment on the proposals.

Discussion:

The Board was provided with a detailed presentation on new ways of organising health and care services in Kent and Medway. This included further details on Primary Care Networks (PCNs), Integrated Care Partnerships (ICPs) and the System Commissioner which would form the Integrated Care System (ICS).

A Member expressed the view that retaining coterminosity with the unitary authority was his preference. He noted that the Health and Wellbeing Board covered the footprint of Medway which he attributed to its success. With respect to the Medway and Swale ICP, it was explained that Swale had been included to reflect clinical and social care flows to Medway. To support the integration of social care services across the proposed footprint, the Director of People – Children and Adults Services explained to the Board that he was pursuing further discussions with Director of Adult Services at Kent County Council regarding the possibility of delegating social care functions to the Partnership.

With reference to the recent decision in relation to the provision of stroke services in Kent and Medway, some Members expressed concerns in relation to the voice of Medway, allocation of funding for Medway and more generally whether Medway would lose out under the new arrangements. The Board was advised that the ICP comprised of Medway and Swale commissioners and providers, which included Medway Council. Decisions on the strategic development of services at ICP level would be undertaken with Medway as an equal stakeholder. It was also explained that funding for each locality was set at a national level by the Department for Health utilising a funding formula. The ICP would be awarded most of this funding and the spending decisions would be made by the partners. However, the amount of funding for Medway would be comparable to current arrangements.

The representative of the Local Medical Committee further assured the Board that with respect to primary care, funding and the services provided as part of the core contracts would remain the same, with the contracts remaining outside of the ICP. It was anticipated that the PCNs would deliver additional benefits in terms of funding and enhancing services.  

A Member expressed concern that there was no certainty on the improvement of services. Local issues of concern included the shortage of GPs and waiting times to access GP services. In response, an assurance was given that the CCG was working hard to improve access to GPs. It was recognised that nationally there was a shortage of GPs. In Medway, as demonstrated in the latest GP access report, progress had been made, however it was recognised that more needed to be done. Improvements had been made primarily as a result of the improved access clinics and the walk-in centre provided by Medway Community Healthcare.

The senior sponsor for the Medway and Swale ICP recognised the concerns raised. He considered that the ICP would enable more streamlined commissioning, delivering more local care. At present there were ongoing discussions in relation to the governance and assurance processes and a case was being made for more decisions to be delegated locally. He considered that under the new model, the Medway and Swale ICP would have a greater voice being one of four ICPs.

In response to a concern in relation to private providers such as Virgin Care, the Board was advised that Virgin Care were one of a number of providers within the ICP. Underpinned by the Joint Strategic Needs Assessment, all of the providers were engaged within the ICP to consider how best to design and deliver services to best meet the needs of the population over the next five to ten years. It was considered that by carefully defining the desired population outcomes, utilising certain providers ought not to be a risk as all providers would be part of the solution.

Recognising the challenges on the Peninsula, a Member considered that opportunities might be borne from the inclusion of the Isle of Sheppey within the Medway and Swale ICP. In addition, there was general support for PCNs.

It was confirmed that upon the outcome of the vote among GP Members of the eight CCGs, if, for example, one CCG voted against the proposal to form a single CCG, it was likely that NHS England would intervene.

With respect to which level of the system the armed forces and criminal justice provision would be commissioned, it was confirmed that these services were currently commissioned at a regional level. Subject to agreement of the proposed health system changes, there would be a future discussion on whether this would be changed. In relation to the criminal justice provision, it was noted that regardless of who the commissioner or provider was, under the ICP arrangements there was already a discussion taking place about meeting the needs of the local population, including individuals within the criminal justice system.

It was added that the Director of People – Children and Adults Services and the Director of Public Health had raised the issues of criminal justice provision with the NHS Medway CCG Chief Nurse, who undertook to confirm arrangements with NHS England. The initial view was that it would remain a specialist commissioning function rather than something that would sit locally.

Decision:

The Health and Wellbeing Board:

a)    noted the comments of the Health and Adult Social Care Overview and Scrutiny Committee; 

b)    noted and commented as set out within the minute on the update; and

c)    requested a workshop with Board Members to further discuss health system transformation.