Agenda item - Brighton & Hove Caring Together, CCG Alliance and NHS & Social Care Integration Update

Presentation from the city council and the CCG on B&H Caring Together, the CCG Alliance and local health and social care integration (some slides are attached for information)

30.1    This item was introduced by Dr David Supple, Chair of Brighton & Hove CCG; and by Rob Persey, BHCC Executive Director, Health & Adult Social Care.

CCG Alliance

30.2    Dr Supple explained that the alliance represents the coalescing of four Sussex CCGs (Brighton & Hove, High Weald Lewes Havens, Horsham & Mid Sussex, and Crawley), which will formally take place in January 2018. CCGs are coming together in this way across the country and it seems likely that those that do not jump will end up being pushed into closer working arrangements. The changes make sense in terms of realising efficiencies via unified back-office teams and scaled-up commissioning; and also in terms of the creation of a local Accountable Care System (ACS). The move will also ease workforce pressures as the new model should hopefully prove easier to recruit to.

30.3    Cllr Allen commented that, whilst he could see how the alliance could potentially save money by commissioning on a larger scale, the savings are nothing like those required to be made locally in order to meet national NHS targets. The CCG needs to start talking frankly about the kinds of service changes that will be required to meet these targets. Dr Supple agreed that there are difficult decisions to be made – for example, via the Clinically Effective Commissioning initiative. To date decisions have been limited to changing thresholds for referral or intervention, rather than decommissioning services.

30.4    In response to a question from Fran McCabe on who will be in charge of the alliance, Dr Supple told members that Adam Doyle will be the Accountable Officer across the four CCGs. A Managing Director for the south of the patch will provide additional managerial grip. Governance arrangements are a work in progress, and will be further developed in the coming months. However, individual CCGs will remain the accountable bodies.

30.5    In answer to a question from Ms McCabe on Accountable Care Organisations (ACO) and Accountable Care Systems (ACS), Dr Supple told the committees that ACOs are organisations that provide a wide range of health and care services for a defined population. ACOs are potentially incentivised to focus on prevention and early intervention given the likely longer term financial benefits of this approach. The use of this model should significantly reduce commissioning and contracting costs. An ACS is a way of existing organisations working together to achieve similar outcomes. It is much quicker to set up than an ACO. Rob Persey noted that there has been no real local discussion of ACS to date and it is important that this happens so that we can reach agreement on what we mean locally by an ACS.

Brighton & Hove Caring Together (Cato) and Integration

30.6    Rob Persey explained that the local population is growing and is living longer, but unfortunately many people are living longer in poor rather than good health, with the prevalence of long Term Conditions (LTC) increasing. Services need to work differently to reduce and better manage demand. Prevention and early intervention will be key.

30.7    Dr Supple added that the NHS was not set up to deal with this level of LTC and will need to adapt to manage these new demands. Cato is intended to drive this change. There are five care programmes which each have a number of work-streams. These are currently being discussed with providers, with a report to the January 2018 Cato Programme Board outlining the next steps.

30.8    Integration of local NHS and social care services is an integral part of this. This will enable NHS commissioners to better influence the broader determinants of poor health such as housing. The council and the CCG will also work much more closely together to understand and utilise local date. The announcement of the CCG alliance complicates, but does not threaten to de-rail integration plans. Governance arrangements for the shadow year (April 18-19) leave the CCG and the council as separate organisations, and there is no pre-determined view on the ultimate governance model.

30.9    Commenting on the governance chart in the papers, Cllr Allen noted that an arrow was missing from HOSC to Full Council representing potential referrals. Mr Persey agreed that this should be included.

30.10  Jo Ivens asked whether the CCG and the council are sighted on the Early Action Commission work undertaken by Lambeth and Southwark councils. Mr Persey answered that they are aware of this work; the Public Health team is also working on a Prevention Framework.

30.11  In answer to a question from Colin Vincent on whether any areas had already integrated, Mr Persey told members that the furthest advanced area was probably Manchester. However, no area is there yet and there is no single template for integration. There is emerging best practice and we are using this to plan our approach.