Agenda item

A presentation is attached for members’ consideration detalining Brent’s vision for a local integrated care system.

Phil Porter (Strategic Director, Community Wellbeing) introduced the paper setting out Brent’s Strategic Vision for a local integrated care system and highlighted the context of the ongoing work to develop a single North West London Clinical Commissioning Group (CCG). Currently, the Council and Brent CCG deliver a number of integrated care services including the Adult community mental health team, the Community Learning disability service and the Community integrated rehabilitation and reablement service (IRRS). However, these services were integrated only in terms of delivery and there is now an opportunity to develop an integrated commissioning function for the existing, and any future, integrated services. The proposed two phase approach was detailed in the paper and described a process of transformation through to jointly managed services. With reference to the examples provided in the paper, Phil Porter highlighted several issues that could be resolved through integrated commissioning including practical difficulties and inefficiencies caused by different IT systems, referral mechanisms, performance indicators, budget constraints and even the language used across services.

Mark Easton (Accountable Officer, NWL Collaboration of CCG) stated that the proposals before the Board were entirely in line with the work to establish the single NWL CCG. It was explained that the NHS Long Term Plan, published in January 2019, set out the intent to encourage integration at every level and to move away from the 2012 model of a competitive commercial health service to one based on collaboration, working with stakeholders across the NHSE and public sector family. Reflecting this new direction, the NHS Plan suggested that the number of CCGs should accord with the number of Sustainability and Transformation Plans (STPs). Nationally this would see the number of CCGs reduced from 190 to 44, with 5 CCGs for London. The amalgamation of CCGs was a matter of national policy, but local discretion could be applied with regard to how and by when this was to be achieved. The North West London Collaboration of Clinical Commissioning Groups had previously published a document, ‘Commissioning reform in North West London – the case for change’, outlining initial proposals. A follow up document had now been published detailing the functions to be determined at borough or North West London level. This had been provided to the Chief Executive of Brent Council, the Leader of the Council and the Chair of the Brent Health and Wellbeing Board. The North West London Collaboration of CCGs was anticipating an April 2020 launch of the new CCG alignment, to reflect the intentions of the majority of London’s CCGs.

Responding to queries raised, Mark Easton explained that the anticipated structure of the North West London CCG would encompass local CCG sub-committees which would be responsible for commissioning local services. The local CCG team and local government partner would be separate from the provider Integrated Care Partnership (ICP - usually a federation of provider bodies, governed by a partnership agreement). It was envisioned that eventually the local partnership may take on a statutory form, at which point it may be possible to site commissioning staff within an ICP. Changes to services commissioned could be made at an early stage of an ICP but once established, it was likely that changes would be made by amending the portfolio of services or methods of delivery. It was acknowledged that it was important to be consulting patient groups, including Brent Patient Voice as the plans for a single North West London CCG developed.

In the subsequent discussion, Members of the Board questioned the oversight arrangements for the Section 75 Agreements that would be required for a local integrated care system. It was RESOLVED that:

i)             The proposed two phase approach to establishing a local integrated care system in Brent as detailed in the paper be agreed;

ii)             A report on the Section 75 Agreements currently in place and required to support a local integrated care system be brought to the next meeting of the Board, to support discussion of oversight and governance arrangements to be implemented in Phase 2.