Agenda item

To receive an update on the work underway across West Yorkshire and Kirklees to prepare for the changes set out in the Health and Care Bill.

Contact: Richard Parry, Strategic Director for Adults and Health and Carol McKenna, Chief Officer

Carol McKenna, Chief Officer and Richard Parry Strategic Director for Adults and Health updated the Board on the Health and Social Care Bill.  In summary, the Board was informed that the legislation is focused on establishing Integrated Care Systems (ICS) as statutory bodies from the 1^st of April 2022.  This will mean that the functions that currently sits within Clinical Commissioning Group's (CCG) will transfer into ICS’s and CCGs will be dissolved after the 31^st March 2021.

There are a number of dimensions that it just be helpful for the Board to consider.  The Health and Social Care Act will establish:

1)         Integrated Care Partnerships (ICPs) - which is a broad alliance of organisations and representatives, and that is very, very similar to the Partnership Board that is now operating across West Yorkshire and Harrogate ICS

2)         Integrated Care Boards (ICB) - which will bring together the NHS bodies to improve population health and care, and that is a statutory body that will be accountable for funding and performance

3)         Place-Based Partnership (PBP) – will remain as the foundations of Integrated Care Systems building on existing local arrangements and relationships.  This will be an important element of the new arrangement

ICS exist to achieve four aims:

-             Improve outcomes for population health and healthcare

-             Tackle inequalities in outcomes, experience, and access

-             Enhance productivity and value for money

-             Help the NHS support broader social and economic development

West Yorkshire and Harrogate have been operating as an informal ICS for several years now and it is fairly well developed.  However, the changes required by the Act will see the current voluntary partnership move to statutory arrangements.  The intention remains that collaborating as an ICS will help health and care organisations tackle complex challenges that are beyond the scope of individual organisations.

The Board was informed that in the early drafts of the Health and Social Care Bill social care got very little mention, but there are two key changes:

-             from 2023 the CQC will start to inspect local authorities social care functions, in addition to existing inspection of care providers

-             the government being able to pass funding to directly fund social care providers, rather than money flowing into local authorities then to social care providers,

As the development of the Act moved through various stages there has been more focus on social care, for example, the Health and Social Care Act will establish a requirement to create a workforce plan for the effectiveness of the health and care workforce.  There is also the potential complexity of some announcements around the future of social care funding and who pays for their own care, and the pricing structure for things like residential care, with further detail to follow on that. There is also talk of an integration white paper later this year.

The Board was informed that there are five place-based partnerships within the West Yorkshire ICS.  The potential activities and approaches of place-based partnerships include:

-       Health and Care Strategy and planning at place

-       Service planning

-       Service delivery and transformation

-       Population health management

-       Connection support in the community

-       Promote health and wellbeing

-       Align management support

Provider Collaboratives – partnership arrangements involving at least two trusts working at scale across multiple places, with a shared purpose and effective decision-making arrangements to:

-       Reduce unwanted variation and inequality in health outcomes, access to services and experience

-       Improve resilience for example by providing mutual aid

-       Ensure that specialism and consolidation occur where this will provide better outcomes and value

It is very much expected that the ethos of provider collaboratives will be the spirit of collaboration and cooperation rather than competition.  The way the partnership has worked over the past 18 months in Kirklees to respond to the pandemic and deliver the vaccine program has been about collective teams and communities working together to address specific need.

The place-based partnership will take on delegated authority for some elements, from the ICB, in terms of funding and performance. The expectation at the moment is that the level of resource delegated back into place will be quite significant to continue to make decisions locally on matters that are relevant to each place under that delegated authority.

The expectation is that the Health and Wellbeing Board will continue into the new arrangement and will still be responsible for setting the overall strategy within which the rest of the system will operate.

With CCG's no longer being in place, there will no longer be governing bodies made up predominantly of GPs.  The aim will be to create a multi-professional multi-disciplinary, clinical, and professional reference group who can provide advice and leadership and guidance into the system and ensure that the decisions that are made are clinically sound.

Timeline and next steps

September 21         ICS Chair and Chief Executive appointment (currently

                               underway)

Oct/Nov 21             ICS shadow form

November 21          PBP Shadow form

December 21          Place lead appointed

March 22                 CCG transition complete

April 22                   ICS and PBP live    

-         The Integrated Health and Care Leadership Board and Design Team will continue to develop Kirklees PBP model and structures

-         Continue to test back with NHSE and West Yorkshire (WY) ICS

-         Develop plan to be shared with WY team in November

-         West Yorkshire refining functions using once or five times model and developing structures

RESOLVED

That Carol McKenna and Richard Parry be thanked for providing an update on the Health and Social Care Bill