Issue - meetings

To consider a joint report of the Executive Councillors (Adult Social Care) and (Health)

The four Providers of Health and Social Care in Stockport have reached a milestone in the Joint commissioner led procurement process to identify the potential organisational form of a Multi-speciality Community Provider (MCP) in Stockport. The purpose of this document is to present the options that have been considered by Providers, including the relevant information required to support members of each partner provider organisation (Stockport NHS Foundation Trust, Stockport MBC, Viaduct Health and Pennine NHS Foundation Trust) in identifying a preferred option.

This document provides an overview of the strategic context in the development of a MCP in Stockport and outlines the appraisal undertaken by providers leading to a recommendation of a preferred option for the MCP form.

·         It is the recommendation of this options appraisal that the option to form A New Neighbourhood Led Accountable Care Trust should be considered by all providers for approval to progress to a Full Business Case (FBC) including legal agreements, regulatory and financial due diligence (and subject to the final outcome of the Joint Commissioning Procurement process and regulatory approval by NHS England and NHS Improvement)

·         In addition, as outlined in section 4 in relation to support services, it is recommended that Stockport MBC and Stockport NHS FT:

·         Develop a specification for a structured programme that results in an option for an integrated support services;

·         Adopt the design principles and next steps identified in section 4 above to inform this programme;

·         Focus in the first instance upon support services in Stockport Foundation Trust and Stockport MBC;

·         Adopt a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·         Develop a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

Officer contact: Keith Spencer / Holly Rae, 0161 474 3014, keith.spencer@stockport.gov.uk / holly.rae@stockport.gov.uk 

A joint report of the Executive Councillors (Adult Social Care) and (Health) was submitted (copies of which had been circulated) inviting the Executive to consider the outcome of an options appraisal undertaken by partners on possible organisational forms of the proposed Multi-Speciality Community Provider for health and social care services in Stockport. The option being proposed to take forward for further investigation was a Neighbourhood Led Accountable Care Trust.

The Executive Councillors (Adult Social Care) and (Health) emphasised the financial challenges facing the Council and health partners and that the Stockport Together programme, which this proposal was a development of, were the response to those challenges. Executive councillors also stressed that the proposal at this stage was to develop a full business case on the option of a Neighbourhood Led Accountable Care Trust, which would be subject to a further decision about whether to proceed to create such a Trust and would then be subject to full public consultation.

Executive councillors stressed that this option would only be proceeded with if, after the completion of the Full Business Case and legal advice, the proposal was in the best interests of residents and the Council.

RESOLVED – (1) That the recommendation of the options appraisal that partners form a new Neighbourhood Led Accountable Care Trust be noted and that approval be given to progress this option to a Full Business Case, including legal agreements, regulatory and financial due diligence (and subject to the final outcome of the Joint Commissioning Procurement process and regulatory approval by NHS England and NHS Improvement).

(2) That in relation to Section 4 of the Appraisal Document relating to Support Services, that approval be given to

·           developing a specification for a structured programme that results in an option for an integrated support services;

·           adoption of the design principles and next steps identified in section 4 of the report to inform this programme;

·           focussing, in the first instance, upon support services in Stockport Foundation Trust and Stockport Council;

·           adopting a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·           developing a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

To consider a joint report of the Interim Provider Director; Director of Services for People (SMBC); Deputy Chief Executive (SFT); Medical Director (Pennine NHS FT); Interim Chief Executive (Viaduct)

The four Providers of Health and Social Care in Stockport have reached a milestone in the Joint commissioner led procurement process to identify the potential organisational form of a Multi-speciality Community Provider (MCP) in Stockport. The purpose of this document is to present the options that have been considered by Providers, including the relevant information required to support members of each partner provider organisation (Stockport NHS Foundation Trust, Stockport MBC, Viaduct Health and Pennine NHS Foundation Trust) in identifying a preferred option.

This document provides an overview of the strategic context in the development of a MCP in Stockport and outlines the appraisal undertaken by providers leading to a recommendation of a preferred option for the MCP form.

The Scrutiny Committee is recommended to consider the proposed recommendations to the Council’s Executive:-

(1) It is the recommendation of this options appraisal that the option to form A New Neighbourhood Led Accountable Care Trust should be considered by all providers for approval to progress to a Full Business Case (FBC) including  legal agreements, regulatory and financial due diligence.

(2) It is important to stress that the completion of the FBC is part of the much larger procurement and regulatory process described above, the timescales for completion of which have yet to be confirmed.  Once approved by Provider governance processes, the FBC would therefore also be subject to the final outcome of the Joint Commissioning Procurement process and would require regulatory approval by NHS England and NHS Improvement.

(3) In addition, as outlined in section 4 in relation to support services, it is recommended that Stockport MBC and Stockport NHS FT:

·                Develop a specification for a structured programme that results in an option for an integrated support services;

·                Adopt the design principles and next steps identified in section 4 above to inform this programme;

·                Focus in the first instance upon support services in Stockport Foundation Trust and Stockport MBC;

·                Adopt a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·                Develop a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

Officer contact: Keith Spencer / Holly Rae, 0161 474 3014, keith.spencer@stockport.gov.uk / holly.rae@stockport.gov.uk 

A joint report (copies of which had been circulated) of the Interim Provider Director; Director of Services for People (SMBC); Deputy Chief Executive (SFT); Medical Director (Pennine NHS FT); Interim Chief Executive (Viaduct) was submitted.

The four Providers of Health and Social Care in Stockport had reached a milestone in the Joint commissioner led procurement process to identify the potential organisational form of a Multi-speciality Community Provider (MCP) in Stockport. The purpose of the document was to present the options that had been considered by Providers, including the relevant information required to support members of each partner provider organisation (Stockport NHS Foundation Trust, Stockport MBC, Viaduct Health and Pennine NHS Foundation Trust) in identifying a preferred option.

The document provided an overview of the strategic context in the development of a MCP in Stockport and outlines the appraisal undertaken by providers leading to a recommendation of a preferred option for the MCP form.

The Leader of the Council (Councillor Alexander Ganotis) and the Executive Councillor for Reform & Governance (Councillor David Sedgwick) attended the meeting to answer members’ questions.

The following comments were made/ issues raised:

·         The governance arrangements for the new Neighbourhood Led Accountable Care Trust to ensure it was accountable was critical to its success.

·         The Scrutiny Committee noted the challenge of bringing together different accountancy practices together to the satisfaction of the External Auditors.

·         The Equality Impact Assessment (Appendix 1 to the Options Appraisal of Organisational Form) needed to reference the impact of the proposals on disabled staff.

RESOLVED – (1) That the Executive be recommended to approve option 2, to form A New Neighbourhood Led Accountable Care Trust subject to consideration and approval by all providers to progress to a Full Business Case (FBC) including  legal agreements, regulatory and financial due diligence.

(2)          That this Scrutiny Committee agree that It is important that the completion of the FBC is part of the much larger procurement and regulatory process described in the report and note that the timescales for completion of have yet to be confirmed.  Once approved by Provider governance processes, the FBC should also be subject to the final outcome of the Joint Commissioning Procurement process and be subject to regulatory approval by NHS England and NHS Improvement.

(3)          That this Scrutiny Committee note that as outlined in section 4 of the report in relation to support services, it is recommended that Stockport Council and Stockport NHS FT:

·         Develop a specification for a structured programme that results in an option for an integrated support services;

·         Adopt the design principles and next steps identified in section 4 above to inform this programme;

·         Focus in the first instance upon support services in Stockport Foundation Trust and Stockport MBC;

·         Adopt a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·         Develop a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

To consider a joint report of the Interim Provider Director; Director of Services for People (SMBC); Deputy Chief Executive (SFT); Medical Director (Pennine NHS FT); Interim Chief Executive (Viaduct)

The four Providers of Health and Social Care in Stockport have reached a milestone in the Joint commissioner led procurement process to identify the potential organisational form of a Multi-speciality Community Provider (MCP) in Stockport. The purpose of this document is to present the options that have been considered by Providers, including the relevant information required to support members of each partner provider organisation (Stockport NHS Foundation Trust, Stockport MBC, Viaduct Health and Pennine NHS Foundation Trust) in identifying a preferred option.

This document provides an overview of the strategic context in the development of a MCP in Stockport and outlines the appraisal undertaken by providers leading to a recommendation of a preferred option for the MCP form.

The Scrutiny Committee be recommended to consider the proposed recommendations to the Council’s Executive:-

(1) It is the recommendation of this options appraisal that the option to form A New Neighbourhood Led Accountable Care Trust should be considered by all providers for approval to progress to a Full Business Case (FBC) including  legal agreements, regulatory and financial due diligence.

(2) It is important to stress that the completion of the FBC is part of the much larger procurement and regulatory process described above, the timescales for completion of which have yet to be confirmed.  Once approved by Provider governance processes, the FBC would therefore also be subject to the final outcome of the Joint Commissioning Procurement process and would require regulatory approval by NHS England and NHS Improvement.

(3) In addition, as outlined in section 4 in relation to support services, it is recommended that Stockport MBC and Stockport NHS FT:

·                Develop a specification for a structured programme that results in an option for an integrated support services;

·                Adopt the design principles and next steps identified in section 4 above to inform this programme;

·                Focus in the first instance upon support services in Stockport Foundation Trust and Stockport MBC;

·                Adopt a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·                Develop a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

Officer contact: Keith Spencer / Holly Rae on 0161 474 3014 or email: keith.spencer@stockport.gov.uk / holly.rae@stockport.gov.uk 

A joint report of the Interim Provider Director, Director of Peoples Services (Stockport Council), Deputy Chief Executive (Stockport NHS Foundation Trust, Medical Director (Pennine NHS Foundation Trust ) and the Interim Chief Executive (Viaduct Health) was submitted (copies of which had been circulated) providing the an update on the process for identifying the preferred organisation form for the new Multi-speciality Community Provider (MCP) in Stockport, including an assessment of the options available.

A presentation was also made to the Scrutiny Committee, summarising the background to the development of the MCP and highlighting the key issues to have arisen through the Options Appraisal process.

Keith Spencer (Interim Provider Director), James Sumer (Deputy Chief Executive, Stockport NHS Foundation Trust) and Councillor Wendy Wild (Executive Councillor for Adult Social Care) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/ issues raised:-

·         Concern was expressed in relation to the potential weight of bureaucracy associated with the proposed governance arrangements for the ‘Neighbourhood Led Accountable Care Trust’ outlined in the report.  In response it was stated that a Trust was legally required to have a Council of Governors, but that it was correct that the size of the Council needed careful consideration to avoid being so unwieldy as being difficult to engage with. 

·         In response to a question about the timescale for the creation of any new Trust, it was suggested that the earliest possible date would be in September 2017.

·         In relation to the suggestion that the procurement of the MCP would be based on the registered GP list, it was commented that there was a significant minority of people that were no registered with a GP.  In response it was stated that the concept was based on developing services at a the most local level, and was not intended to be exclusive of those residents who were not registered with a GP.

·         It was commented that the provision of local health services did not function properly across local health service boundaries within Greater Manchester, and that this needed to be rectified.

·         The Scrutiny Committee reiterated its view that the delivery of these vital services needed to be done from within the public sector.

RESOLVED – That the report be noted.

To consider a joint report of the Interim Provider Director; Director of Services for People (SMBC); Deputy Chief Executive (SFT); Medical Director (Pennine NHS FT); Interim Chief Executive (Viaduct)

The four Providers of Health and Social Care in Stockport have reached a milestone in the Joint commissioner led procurement process to identify the potential organisational form of a Multi-speciality Community Provider (MCP) in Stockport. The purpose of this document is to present the options that have been considered by Providers, including the relevant information required to support members of each partner provider organisation (Stockport NHS Foundation Trust, Stockport MBC, Viaduct Health and Pennine NHS Foundation Trust) in identifying a preferred option.

This document provides an overview of the strategic context in the development of a MCP in Stockport and outlines the appraisal undertaken by providers leading to a recommendation of a preferred option for the MCP form.

The Scrutiny Committee be recommended to consider the proposed recommendations to the Council’s Executive:-

(1) It is the recommendation of this options appraisal that the option to form A New Neighbourhood Led Accountable Care Trust should be considered by all providers for approval to progress to a Full Business Case (FBC) including  legal agreements, regulatory and financial due diligence.

(2) It is important to stress that the completion of the FBC is part of the much larger procurement and regulatory process described above, the timescales for completion of which have yet to be confirmed.  Once approved by Provider governance processes, the FBC would therefore also be subject to the final outcome of the Joint Commissioning Procurement process and would require regulatory approval by NHS England and NHS Improvement.

(3) In addition, as outlined in section 4 in relation to support services, it is recommended that Stockport MBC and Stockport NHS FT:

·                Develop a specification for a structured programme that results in an option for an integrated support services;

·                Adopt the design principles and next steps identified in section 4 above to inform this programme;

·                Focus in the first instance upon support services in Stockport Foundation Trust and Stockport MBC;

·                Adopt a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·                Develop a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

Officer contact: Keith Spencer / Holly Rae, 0161 474 3014, keith.spencer@stockport.gov.uk / holly.rae@stockport.gov.uk 

A joint report of the Interim Provider Director, Director of Peoples Services (Stockport Council), Deputy Chief Executive (Stockport NHS Foundation Trust, Medical Director (Pennine NHS Foundation Trust ) and the Interim Chief Executive (Viaduct Health) was submitted (copies of which had been circulated) providing the an update on the process for identifying the preferred organisation form for the new Multi-speciality Community Provider (MCP) in Stockport, including an assessment of the options available.

Keith Spencer (Interim Provider Director) Dr Stephen Watkins (Director of Public Health) Dr Donna Sager (Deputy Director of Public Health) and Councillor Tom McGee (Executive Councillor (Health)) attended the meeting to respond to questions from the Scrutiny Committee.

A presentation was also made to the Scrutiny Committee, summarising the background to the development of the MCP and highlighting the key issues to have arisen through the Options Appraisal process.

The Executive Councillor (Health) emphasised that the Executive and partners unanimously were of the view that the MCP arrangements should avoid, as far as possible, any private sector involvement. He further stated that, with the exception of Viaduct Health, all other partners would be considering and deciding upon these proposals in public, although no date had yet been fixed for a final decision on the MCP form as each partner organisation needed to seek separate legal advice.

The following comments were made/ issues raised:-

·         On page 45 of the document (58 of the agenda pack) there was reference to ‘market opportunities’ and assurances were sought that this was in accord with previous assurances given about the MCP remaining a public sector body. In response, the Executive Councillor (Health) restated the commitment of partners to ensure the MCP remained a publically owned form, although he could not give a categorical assurance as future government policy may impact on this. It was further commented that the Health & Social Care Act prevented a distinction being made between public and private organisation in tendering process, supported by European Procurement rules, which prevented the possibility of private sector involvement ever being ruled out. However, given the nature of the services being tendered for, it was unlikely a private provider could successfully tender for this contract.

·         Clarification was sought on when the delivery of new models of care would begin. In response it was acknowledged that the delivery of care was the area of real importance. Investment from the Greater Manchester Transformation Fund was enabling changes to be made to services to deliver these new models, and from November the neighbourhood model would begin to be rolled out over the following 12 months. There had been a desire to ensure that the process of change and improvement in delivery was not dependent on progress with organisational change.

·         The report made little reference to the impact on wider health and care workforce of the options, but the turbulence of change was likely to negatively impact staff morale. In response it was accepted that the discussion of organisation form would cause worry for some staff, but the model being proposed would have the least impact on staff of all the options. It was further commented that consideration was being given to seconding staff into the MCP, rather than transferring staff via TUPE, as this would allow partner organisations to maintain control over their staffing.

·         Concerns were expressed that within the model being proposed, there was a danger of dominance by GPs. What was being done to ensure that there was a balance between different groups to ensure input was equally valued. In response, it was stated that as part of the development of the governance arrangements for MCP, consideration would be given to ensure wider engagement of stakeholders. It was commented that Foundation Trust status required involvement of others non-doctors in the governance arrangements. Comment was made that as part of the preventative work stream within Stockport Together, a lot of effort has been made to  ...  view the full minutes text for item 5

To consider a report of the Corporate Director for People.

The report provides an update on the procurement for the Multi-speciality Community Provider for health and social care.  The commissioning of this new type of organisation will enable the new models of integrated health and social care that have been developed by the Programme over the last 12 months to be most effectively implemented across the Borough.

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Andrew Webb on 0161 474 3808 or email: andrew.webb@stockport.gov.uk

The Corporate Director for People submitted a report (copies of which had been circulated) providing an update on the procurement for the Multi-speciality Community Provider for health and social care.  The commissioning of this new type of organisation would enable the new models of integrated health and social care that had been developed by the Programme over the last 12 months to be most effectively implemented across the Borough.

The Leader of the Council (Councillor Alex Ganotis) attended the meeting to respond to councillors’ questions.

The Scrutiny Committee requested that the report to the next Meeting of the Scrutiny Committee should include the full Options Appraisal Paper although it was noted that the full implications of the preferred option would still be being considered and therefore not included in the report.

RESOLVED – That the report be noted.

To consider a report of the Corporate Director for People.

The report provides an update on the procurement for the Multi-speciality Community Provider for health and social care.  The commissioning of this new type of organisation will enable the new models of integrated health and social care that have been developed by the Programme over the last 12 months to be most effectively implemented across the Borough.

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Andrew Webb on 0161 474 3808 or email: andrew.webb@stockport.gov.uk

The Corporate Director for People submitted a report (copies of which had been circulated) providing an update on the procurement for the Multi-speciality Community Provider for health and social care.  It was reported that the commissioning of this new type of organisation would enable the new models of integrated health and social care that have been developed by the Programme over the last twelve months to be most effectively implemented across the Borough.

The Executive Councillor for Adult Social Care (Councillor Wendy Wild) attended the meeting to answer councillors’ questions.

The following comments were made/ issues raised:-

·         It was confirmed that the project was on target to meet the timetable for stakeholder engagement detailed within the report.

·         There was no template which could be picked up from elsewhere and adopted wholesale due to the complex and comprehensive set of services that were within the scope of the Multi-Speciality Community Provider.

·         There were benefits and pitfalls associated with each of the organisational form options proposed within the report.

·         A further report would be submitted to a future meeting of the scrutiny committee detailing the outcome of an options appraisal undertaken in respect of the options contained within the report.

·         In response to a suggestion that the roles currently undertaken by individuals within the various organisations should not significantly change as a result of this process, it was stated that there was areas of overlap in staff undertaking similar roles in different organisations which could be rationalised as a result of this process.

·         It was stated that work had been done to strengthen project management although there had been resource and time difficulties within the workforce and IT.

·         It was important to empower members of staff and to enable front line workers.

·         An element of the transition fund would be used to increase resources at a GP level to improve care within neighbourhoods and to avoid unnecessary trips to the hospital.

·         Greater recognition needed to be made of the importance of understanding and managing population change when planning health care provision within localities.

RESOLVED – That the report be noted.

To consider a report of the Corporate Director for People.

The report will update the Scrutiny Committee on the procurement for the Multi-speciality Community Provider.

Officer contact: Andrew Webb, 0161 474 3808, Andrew.webb@stockport.gov.uk

The Corporate Director for People submitted a report (copies of which had been circulated) providing the Scrutiny Committee with an update on the development of the Multi-speciality Community Provider (MCP) for health and social care and providing an opportunity for the Scrutiny Committee to comment on the possible models of the organisational form of that provider.

James Sumner, Deputy Chief Executive of Stockport NHS Foundation Trust, and Keith Spencer, Provider Director, also attended the meeting to answer questions from councillors.

The report set out the approach partners were taking to determining the best organisational form to support innovative, integrated, wrap-around provision to meet the needs of older adults with complex needs, and to do so within the context of increasing demand outstripping resources. Progress had already been made in improving service delivery through innovation and further improvements would come to fruition without any need for changes to the organisational form. Partners were committed to the development of an MCP as they believed this was the best way to address cost and demographic pressures, and realign resources.

The options set out in the report had been developed based on an assessment of the services in view of the Stockport Together programme. All services, regardless of the final organisational configuration, would remain subject to external oversight and inspection through NHS Improvement, the CQC and others. Each partner organisation would also be seeking legal advice to inform the discussions on what the preferred option would be.

The Executive Councillor (Health) (Councillor Tom McGee) stated that these proposals were the result of lot of work from all partners, and within a challenging financial context. The Council, as a democratic organisation, created an added level of complexity in the process but it was important to engage councillors and other stakeholders in these discussions and final decision given the scale of the proposals. He stated that no decisions had been taken, and that all the options would be considered, although he would not favour options that could lead to a loss of public ownership of the services in question.

The following comments were made/ issues raised:-

·           Clarification was sought about the risk of the provider eventually leaving public ownership, and assurances were sought about the there being appropriate governance arrangements to provide oversight and control over service delivery and financing. In response, it was stated that partners working on the MCP had no mandate to change the public nature of the services in question. Each model would have its own governance arrangements and implications, and these would be a part of the considerations in developing the proposal further.

·           Stockport Together and the current proposals were the result of hard work by all organisations over a number of years, and that had been recognised by the interest from NHS England and others, as well as through the success in accessing funding to support the programme. It was commented that partners in Stockport had shown good leadership in putting the wider public interest ahead of individual organisational interests in developing the programme. The various regulators involved with individual partners had also indicated they were supportive of the programme.

·           Further information was requested about patient input, and ensuring the correct balance between the views of professionals and those of patients. In response it was stated that the current consultation with stakeholders related to organisational form, whereas there had been greater drive to involve patients and service users in the development of the models of care. Depending on which model emerged as the preferred model, this may trigger a further formal consultation stage as a NHS service change. Whatever the future organisational form, there would continue to be mechanisms for public and patient engagement in service improvement. It was further commented that many members of the public were more likely to engage with consultation about care and services than organisational issues.

·           Was there wider public consultation, and consultation with other  ...  view the full minutes text for item 5