Agenda item

This report from the Integrated Care Board (ICB) provides an update on the procurement of adult and children’s community services. The update is attached at Annex A to the report.

Discussion:

A number of representatives from NHS Kent and Medway Integrated Care Board (ICB) introduced the report by providing a short presentation which included information about the background to the issue, engagement and communication undertaken and a financial overview of the proposals.

Members then asked a number of questions and comments, which included:

• Mitigate disruption – in response to a question about plans to mitigate any disruption caused from potential changes in provider, it was explained that built into the procurement was a six month transition period to ensure smooth transitional arrangements.
• Staffing – in response to a question about how the ICB were working with providers to address vacancies within the workforce, it was explained that the ICB took a supportive role in developing and bringing staffing groups and networks together and raised the profile of working for Kent and Medway to help address the shortage which was a national issue. In addition, the ICB worked with chief people officers across providers to develop a collaborative strategy for recruitment, including working with universities.  It was recognised this would be a continual challenge.
• Needs analysis – it was asked if there was more detail about the needs and impact on communities such as specific needs of neurodivergent children or children with disabilities or particular needs and how such groups had been specifically communicated with. It was explained that at this stage engagement had been broad and more specific and targeted consultation would occur as the transformation process progressed over the course of the contract.
• HASC involvement post procurement – clarity was sought as to how HASC could be involved and have a voice on transformation of service once contracts were agreed. The ICB confirmed that there would be a number of service change proposals that would be brought back to the Committee for co-development and full involvement as the transformation plans progressed, but the ICB did not know at this stage what the specific changes would be. Change was needed to improve the delivery and quality of some services and to deliver care in different ways and HASC would be consulted on changes as they were identified and developed.
• Discrepancy in transition pathways – reference was made to the discrepancy in transition between children’s and adults services, which for some children’s services was 18 in Kent and 19 in Medway.  It was asked how this impacted both in terms of finances and transition between the two. It was confirmed that through the new contractual arrangements the ICB would ensure consistency across Kent and Medway, recognising that this issue caused frustrations for patients who also welcomed a consistent approach.
• Substantial Variation (SV) status – reference had been made to the difference in opinion between the Committee and the ICB around whether the re-procurement of community services was an SV or not. The ICB were asked how, within the remit of an SV, could the two work together to move forward as it was accepted that continued improvement was needed.  The ICB acknowledged that the Council had determined the procurement was a substantial variation and reiterated that as and when proposals were developed they would each be brought to the Committee for discussion, but that at the current time, there were no detailed plans to discuss with the Committee outside of the Ambitions Document, which was attached as Appendix 2 of Annex A to the report.
• Transparency – The point was made that without understanding more detail about the implications of the transformation that would be built into the contract, it was difficult for the Committee to be able to effectively scrutinise and have any possible influence and the concern was that, if this was done post contracts being let, the opportunity to influence would then be lost or greatly diminished. It was suggested that in order to be ready to go out to tender for the community services contract, the ICB must have had more detailed scope and timescales around the transformation. Clarity and transparency was needed from the ICB in order for the Committee to be able to carry out its health scrutiny function and it was not considered that this was being provided. The ICB referred to their Ambitions Document, which would be provided with the invitation to tender. This document set out the aspirations for the transformation but did not provide specifics as these would need to be worked through with the providers once contracts had been awarded.
• Lord Darzi report – reference was made by the ICB to the Independent Investigation of the NHS in England by Lord Darzi which recognised the needed direction of travel for health services to focus more on prevention rather than treatment and to focus on delivery of services in the community rather than in hospital. It was therefore anticipated that the forthcoming NHS 10 Year Health Plan would provide further direction in relation to the structures of health care provision and providing more focus on community based services, which in turn would feed into the transformation as it is progressed.
• Framework of engagement – the ICB offered to provide the outline framework of how the ICB would work with HASC and communities to develop service specifications together.
• Finances – the ICB explained that the budget for community services was fixed for five years with no expectation of funding reductions. There would be an element of levelling up and it was explained that currently funding for Swale was probably higher than that of Medway.  It was also anticipated following the Darzi review that more funding would likely be made available for community services and so in line with this, the ICB was committed to looking at opportunities to shift more funding from acute to community/out of hospital provision.
• Direct award option – in response to a question as to whether the ICB had considered using direct award as an option for procurement, given the new legislation around procurement and the opportunities provided under award process ‘c’ of those arrangements, it was explained that based on legal advice and advice from NHS England, the proposed approach to go out to full competitive procurement was the most appropriate option, as direct award could leave the ICB at risk of challenge.

It was reiterated that there was a collective understanding that change was needed and the opportunity to develop services to achieve improvement was welcomed.  The difficulty the Committee had was the approach in how this was undertaken and it was suggested that the Chairperson, Vice-Chairperson and Opposition Spokespersons of the Committee meet with lead officers and lead ICB representatives to develop a way through in an informal meeting and then report back to this Committee.

Decision:

The Committee agreed for the Chairperson, Vice-Chairperson and Opposition Spokespersons of the Committee to meet with lead officers and lead ICB representatives to develop a way through in an informal meeting and then report back to this Committee on the way forward.