Agenda item

The Board was provided with an update on the integrated commissioning arrangements for health and social care services in Oldham and an overview of the future direction of travel.

Following the co-location of Council and CCG health and care commissioning functions in April 2018, work had been ongoing in relation to activities around learning disability, mental health, care home and care at home commissioning, dementia, continuing health care, and safeguarding strategy and policy work identified in a Section 75 Agreement between the Council and the CCG.  In addition, teams had been realigned across the partners to ensure more joined up work and leadership.

Work was progressing at a strategic level.  For example, the Market Position Statement published in 2017 sets out the anticipated demand and current market position in relation to a range of needs and services:  this was due to be refreshed and is included in the commissioning service plan for 2019/20, and production of the Managing Provider Failure Policy and Procedure, a statutory duty of the local authority in relation to provider failure and continuity of care, now goes further than the statutory requirement in recognition of the joint commissioning arrangements.  The report further considered commissioning activity and quality initiatives being undertaken, alongside matters progressing at the Greater Manchester level.  Further reference was made to the integration of Adult Social Care teams with NHS community health staff, and of the recent transfer of those NHS staff from Pennine Care to the Northern Care Alliance, and the work to develop new service specifications to improve efficiency and effectiveness, including the potential to empower local staff to commission services within a budget.

Looking forward, a comprehensive blueprint for the future of integrated commissioning has been developed and agreed within the system. This blueprint envisages a move beyond excellent service commissioning to Commissioning for Outcomes and Communities of Identity with a focus on social value.  The Council and the CCG would form an Integrated Commissioning Function (ICF) with a breadth of responsibilities creating the conditions for a high quality partnership for providers of health and social care services.  The goal was to use the discipline of commissioning to develop the culture and mindset of the Oldham system, being guided by the core principles of the integrated commissioning framework.  

A Member noted that staff were to be gathered in ‘hubs’ and queried whether this meant that people with, for example, a mental health issue would get picked up quicker.  The Board was advised that it was not possible to say that people would be picked up quicker, but services were developing in a more co-ordinated or co-operative manner with an absolute commitment to improvement which should see patients/clients seen within timescales. 

Considering funding implications, the Board was advised that the extent of the funding gap depended on the formula used, but the gap could be said to be in excess of £60m meaning that it was essential to redesign the what and how of services.  The situation was complicated by the fluid nature of health and social care budgets, with budgets being dependent on government announcements of grants, on precepts etc.  These positions meant that it was not possible at this time to progress the proposed local budgets.

Other issues considered by the Board were –

·         staff turnover in care homes was in the order of 20% and through commissioning it was needed to consider an approach to stabilise the position and develop an equitable approach;

·         it was acknowledged that changes in population profiles, or within particular communities that might also be hard to reach, or in circumstances where gender issues might arise, meant that services needed to be planned accordingly; and

·         the differing recording and operating systems used by social care and health staff were considered, and work to develop a tool to allow systems to talk to each other and with GP systems thereby allowing exchange of records with patient/client approval was in development.

It was acknowledged that elected Members made contacts and highlighted challenges to, and gaps in, services and that a developed relationship with Councillors needed to be built.  It was suggested that a directory, or a working definition of services as they evolve, could be provided so Councillors could be sure that statutory duties were being fulfilled.

Noting the complicated governance diagram within the submitted report, it was acknowledged that communications about, for example, what the jointly commissioned services were trying to achieve in a complicated operating environment and that the first port of call to access social care would be through a GP surgery was key.  Simplifying the message was a challenge and would be considered in the next report to the Board.

RESOLVED that

1.            the Board receive a further update report at the meeting to be held in March 2020;

2.            a Members’ workshop be held to consider the issue of what details of services could be shared with/provided for elected Members.