Agenda item

At previous meetings the Committee received briefings on the development of an Integrated Care System (ICS) across Kent and Medway and the establishment of a single Kent and Medway Clinical Commissioning Group (CCG) from April 2020.  This briefing provides a summary update on the CCG establishment.

Discussion

The Accountable Officer of the Kent and Medway Clinical Commissioning Group (CCG) introduced the report. The single Kent and Medway CCG had been established on 1 April 2020 with the focus so far having been responding to Covid-19 and co-ordination of the multi-agency response. One of the corporate objectives of the CCG was the establishment of an Integrated Care System (ICS). The new executive was almost fully in place with only the Director of Digital Transformation yet to be appointed. A staff consultation on the new organisational structure had recently closed. Engagement had also taken place with the Primary Care Network (PCN) Clinical Directors in relation to the proposals. The Clinical Chair of the CCG said that having a single CCG in place had made co-ordination of the multi-agency response to Covid easier. He advised that work was being undertaken looking at vulnerable groups and the BAME population to identify how their Covid risk could be reduced with work also taking place to ensure that elective and emergency services would be able to continue effectively over the winter period.

Members raised a number of questions, which included:

Funding, risks, services and staffing – concern was expressed that the new arrangements would be too costly and it was emphasised that Medway needed to retain a fair and equitable share of funding in view of the prevalence of health inequalities. It was also asked how risks would be managed effectively, how it would be ensured that provider changes did not adversely impact patients and whether significant staff redundancies or redeployments were expected.

The Accountable Officer said that there were no plans to reduce Medway’s share of funding and disadvantaged communities may have more resources targeted at them. The development of the ICS would see more joint working between organisations to promote integrated care. Service delivery had not been impacted by the merger of CCGs with existing contracts being maintained. A risk-based approach would be used to drive organisational change. The development of the digital agenda had been a significant step. There had been a small number of redundancies so far with expressions of interest invited for some further voluntary redundancies. The number was expected to be small with many staff transferring to new roles.

Funding and Healthy Living Centres – It was questioned whether service reconfiguration involving some services being centralised and therefore no longer being provided in Medway would affect funding for the Medway population. It was also asked whether the CCG still aimed to develop GP services at Healthy Living Centres. The Accountable Officer said there were no plans to reduce funding available for treatment of Medway residents. The Integrated Care Partnership established for Medway and Swale was committed to working at a local level to redesign and improve services.

Commissioning, use of digital and engagement and BAME communities – it was asked how lessons were being learned from previous commissioning activity and how relationships would be built with the voluntary sector. It was also asked how digital engagement had been utilised, whether participation figures were available and how the patient voice would be taken into account. It was also asked what work was being undertaken to reduce the Covid risk amongst BAME communities.

The Accountable Officer said that a significant engagement process had been undertaken ahead of the new CCG having been developed. It was anticipated that a single CCG would deliver the scale benefits of a large organisation while retaining a local focus. Significant work was being undertaken to ensure resilience of services, including to prepare for winter and the EU Exit process. A detailed review of decision making was being undertaken to ensure that lessons were learned to avoid recurrence of previous issues. It was recognised that there was a need to ensure meaningful engagement was undertaken with the voluntary sector. In relation to BAME communities, significant engagement was being undertaken to communicate the increased risks that some of these communities faced in relation to Covid and to ensure that risk assessments were undertaken of patients in high risk groups. Regarding the use of digital services, a survey would be undertaken to get service user views. GPs had increasingly been using video conferencing and telephone engagement. It had not been possible to undertake as much community engagement as expected due to Covid. Plans for this were under development and would be reported back to the Committee.

The Clinical Chair said that partnership working between commissioners and providers would be central to the ICP and PCN delivery. Links were being made to the voluntary sector, including the development of social prescribers and care navigators. Work was taking place with Public Health leads in Kent and Medway on a six-point action plan in order to communicate and mitigate the Covid risks to the BAME community. The Director of Public Health said that a bespoke needs assessment was being developed in relation to this and that it was due to be completed in the days following the Committee meeting. This would inform social marketing and engagement activity. Bespoke local testing sites would be established in areas with a high BAME population. A comprehensive work plan had been developed to prepare for a second wave of Covid, including the development of a local Outbreak Control Plan and it was considered that Medway was well prepared for a second wave. Healthwatch would be assisting with engagement activity.

Engagement and contract monitoring – concern was expressed that there was insufficient evidence of public engagement regarding development of the single CCG and associated structures, including that insufficient information had been provided in the report. It was also suggested that contracts should make performance targets explicit, with effective penalties and rewards in place and that these should be linked to the needs identified by public engagement.

The Accountable Officer recognised that the NHS was not as good at engaging with communities as it should be, either locally or nationally, and that further information could be provided to the Committee in future. Following a further question, it was agreed that concerns about potential conflicts of interest, should Committee Members participate in certain CCG events, be considered further outside the meeting.

Budgets and BAME Communities – in response to a question asking whether existing public health budgets were at risk and whether there were mechanisms to prevent members of the BAME community being racially profiled, the Director of Public Health said that funding was considered to be secure. Previous funding had been received in the form of a ring-fenced grant from the Department of Health and Social Care and there was no indication that the establishment of the Institute for Public Health Protection would impact on funding. The engagement Public Health was undertaking with BAME communities was to provide reassurance that help was available to help mitigate their risk of Covid-19 and to give them the confidence and knowledge to access care and support. The Clinical Chair said that given that a black person with a pre-existing illness was twice as likely to die from Covid as a white person, there was a need to acknowledge this, engage with communities accordingly and offer appropriate support.

Benefits of a single CCG – it was asked what the benefits were of a single CCG and what challenges had been encountered. The Accountable Officer said that as the focus had been on the Covid response since the establishment of the single CCG it was hard to draw any firm conclusions from experience so far. However, it was anticipated that there would be efficiencies and more specialisation within the new CCG than could have been achieved by the smaller CCGs it had replaced. A challenge facing the new system would be ensuring that its work retained a local focus. Structures were being put in place to ensure this was achieved.

GP Numbers – it was questioned whether a successful model of GP provision would be one that had more or fewer GPs available than at present. The Accountable Officer said that success could not be determined simply in terms of GP numbers as GPs were increasingly working as part of multi-disciplinary teams using innovative models of care which were not reliant on there being the same number GPs available as previously. The increased use of digital working made it increasingly viable to utilise GPs who did not live in Kent and Medway with new technology attracting people to the workforce. The Clinical Chair added that although the number of GPs in the workforce was reducing there would be reduced demand as more services were delivered by other health professionals without there always being a need for a patient to first see a GP. It was also considered that the new CCG would be able to make decisions more effectively as it had a single governing body rather than there being the eight separate governing bodies as previously.

Voluntary sector resilience – concern was expressed that many of the voluntary sector organisations that would be able to support the social prescribing model currently faced existential challenges. It was asked what plans there were to support these organisations. The Accountable Officer said that voluntary sector fragility had been identified as a risk. Specific commitment could not be given to provide funding but as a general principle, it was acknowledged that a small investment could deliver significant future benefit.

Decision

The Committee:

i)        noted and commented on the report.

ii)      requested that a briefing note be provided to the Committee in relation to digital engagement/consultation, including numbers participating and a summary of groups unable to participate, with a view to a future update being added to the Committee Work Programme.