Agenda item

Report of Staffordshire Clinical Commissioning Groups’ Accountable Officer

The Committee considered a joint report and presentation of Staffordshire Clinical Commissioning Groups’ Accountable Officer regarding the development of an Integrated Care System (ICS) in Staffordshire (schedule 2 to the signed minutes).

The meeting was attended by Simon Whitehouse (Director, Together We’re Better); Anna Collins (Head of Communication and Engagement Staffordshire and Stoke on Trent Clinical Commissioning Groups (CCGs)) and; Dr. Alison Bradley (Clinical Chair, North Staffordshire CCG).

The NHS Long Term Plan (LTP), published in January 2019, set out how the organisation intended to respond to future pressures (financial, staffing and demographic etc) in the decade ahead whilst building on the positive achievements of the past in order to ensure continued improvements in patient care and health outcomes for the general population. In response to this Plan, Together We’re Better (The Staffordshire Sustainability and Transformation Partnership (STP)) had developed a five-year Delivery Plan (FYDP) setting out their priorities and commitments going forward. In addition, the STP’s Designation and Development Plan (D&DP) outlined how the Staffordshire and Stoke-on-Trent health and care system would continue to collaborate and strengthen partnership working in order to tackle the various challenges identified in the LTP and FYDP whilst continuing to respond to the Covid-19 pandemic.

In February 2021 the Secretary of State for Health and Social Care published a White Paper entitled, “Integration and Innovation: Working together to Improve Health and Social Care For All”. The proposals sought to establish a statutory ICS in Staffordshire (and other areas) made up of an ICS NHS body and separate ICS Health and Care Partnership to bring together Partners from the NHS, Local Government and other sectors.

Having regard to the above-mentioned developments, the STP considered it necessary for the development of the ICS to seek to merge the six existing Staffordshire and Stoke-on-Trent CCGs into one strategic body. Accordingly, following a vote by all 147 Staffordshire General Practices which indicated 84% were in favour, it was agreed that the CCGs should merge. A request was made to NHS England and Improvement (NHSEI) who approved the merger in principal on 16 February 2021. However, whilst formal consultation was not required under the Local Authority Health Scrutiny Guidance 2014 the STP had agreed a detailed Communications and Engagement Plan setting out how key stakeholders were to be consulted and giving them the opportunity to comment. Subsequently, the six existing CCGs published, “Our journey to becoming a single strategic commissioning organisation” (copy appended to the report), on 22 February 2021 which, whilst not seeking stakeholder agreement to the merger, enabled them to have their say through an on-line survey.

It was anticipated that a formal application to merge would be made by the STP to NHSEI by 26 March 2021 and that an in-year merger would take place on 1 October 2021. However, this date had yet to be confirmed and the default position was that merger would be achieved by 1 April 2022.

During the full and wide-ranging discussion which ensued, the Committee emphasised the need for the above-mentioned changes to achieve real improvements in healthcare provision for local residents and sought details of how this would happen. In response the representatives of health explained the importance of a holistic approach in achieving the best outcomes for patients through delivery of services at a local level. They also outlined the national funding arrangements to be adopted for ICSs contrasting them against the piecemeal approach which had previously existed. However, it was unclear at this stage whether any significant additional funding streams would be made available to the new ICSs.

Members stressed the importance of the accessibility of local facilities to patients and communities in Staffordshire without which the benefits of integrated working in health would be undermined. They also cited the negative effects of funding cuts. In response the representatives agreed that accessibility to services was key and that the development of the ICS would help maximise the effectiveness of every Pound spent. Discussion then turned to mental health and the STP vision which included, “Give mental health equal priority to physical health and wellbeing. They queried how this would be achieved through the new arrangements. In response the representatives cited the work of the Mental Health Programme Board which sought to develop services across the County. The single integrated commissioning body would promote further joined-up working though the removal of barriers and better co-ordination so that patient pathways could be improved.

In response to a question from a member Health explained that the proposed placed based Integrated Care Partnerships (ICPs) would cover the North Staffordshire (Newcastle-under-Lyme Borough, Staffordshire Moorlands District and Stoke-on-Trent City), South-East Staffordshire (Burton-on-Trent, Lichfield and Tamworth) and South-West Staffordshire (Stafford Borough, Cannock Chase District and South Staffordshire District) areas. However, the importance of cross boundary arrangements with Health Trusts outside Staffordshire were recognised and would be maintained through joint working with neighbouring systems. Guidance regarding senior managerial appointments to the ICS was expected in April 2021 and would include single Accountable Officer and Chief Executive posts.

The Committee also sought re-assurance regarding the processes in place for managing risk as referred to in, “Our journey to becoming a single strategic commissioning organisation”. In response Health highlighted the CCGs Risk Assurance Framework and Risk Register which identified appropriate controls and mitigations. However, whilst they acknowledged the many risks facing the NHS as a whole and the additional risks associated with the above-mentioned changes at this time, they were confident that merger would help management system-wide rather than promoting risk shunting between Partners. Management of financial risks and achieving efficiencies whilst improving patient outcomes was a top priority going forward.

In response to a question from the Chairman the representatives of Health explained that they hoped to retain some of the existing national funding formula for CCGs so that areas within the new ICS system were not disadvantaged by their merger with other areas currently in greater financial deficit than themselves. Continuing they said they were confident funding of the ICPs would reflect need and ensure each received their fair share of budgets available. However, they were fully aware of the underlying financial difficulties currently existing across the Staffordshire health economy.

The Chairman then thanked the representatives of Health present for an interesting and informative presentation and looked forward to further engagement with them during continued development of the Staffordshire ICS.

RESOLVED – (a) That the report be received and noted.

(b) That the decisions of the Staffordshire and Stoke-on-Trent Clinical Commissioning Groups’ General Practices to support their merger into a single strategic commissioning body, be noted.

(c) That Health continue to engage with the Committee on the development of an Integrated Care System for Staffordshire, as necessary.

(d) That further scrutiny of health be undertaken at the appropriate time to ensure the adoption of an Integrated Care System for Staffordshire has led to tangible improvements in health care provision for residents across the County, as necessary.