Agenda and minutes

To elect a Chair for the Health and Commissioning Board for the 2016/17 year.

Resolved: That J Crombleholme be appointed as Chair for the 2016/17 year.

To elect a Vice-Chair for the Health and Commissioning Board for the 2016/17 year.

Resolved: That Councillor McGee be appointed as Vice-Chair for the 2016/17 year.

Board Members to declare any interests which they have in any of the items to be considered as part of the agenda.

Doctor Gill declared an interest in Item 9 – Multi Speciality Community Provider Update, the nature of the interest being that as a General Practitioner operating as a Provider in Stockport he had an interest in the procurement outcome.

Doctor Johnson declared an interest in Item 9 – Multi Speciality Community Provider Update, the nature of the interest being that as a General Practitioner (GP) operating as a Provider in Stockport he had an interest in the procurement outcome. He also noted that he had been appointed by Viaduct, the federation representing GPs in Stockport as the Lead for his Neighbourhood.

To note any apologies submitted from Members of the Board.

There were none on this occasion.

To consider and respond to any questions submitted by Members of the Public related to the remit of the Health and Care Integrated Commissioning Board no later than 24 hours prior to the meeting. Questions should be submitted in writing to laura.latham1@nhs.net

*Any questions requiring detailed response will be shared with the Board and responded to following the meeting in writing.

There were none on this occasion.

To note the governance arrangements and terms of reference of the Board.

M Cullen, Borough Treasurer presented a report outlining the governance arrangements for the operation of the Health and Care Integrated Commissioning Board and the Section 75 Agreement. He explained that the document would guide the Board in its work and highlighted in particular the integrated commissioning principles by which the Board would lead the system.

Resolved: That the report be noted.

To consider a report detailing the finances of the Pooled Budget and the related performance indicators and measures.

M Chidgey, Interim Chief Finance Officer and Director of Provider Management provided an overview of the integrated performance report. He noted that the intention had been to provide a strategic overview of how the resources available in the totality had been used to improve outcomes and deliver high quality health and care in Stockport. Elements around accident and emergency performance, delayed transfers of care and care home capacity and admission rates were highlighted as particular challenges. He noted the systems thinking approach which had been underway.

M Cullen, Borough Treasurer provided an overview of the pooled budget finances as at Quarter 1 and noting that alignment of the integrated presentation to points of delivery to ensure the impact could be monitored against key outcomes and service performance. He outlined the end of year forecast deficit within the pool as at £1.64m and the options being investigated to bring the pool back into balance by year-end.

A discussion took place regarding the NHS Funded Nursing Care cost increases as communicated by the Department of Health and the risks posed to the pool and the impact on both commissioning organisations. M Cullen noted that work was underway and a more detailed paper on the risk flow through the economy would be presented to the Board at its November meeting. The procurement decisions of the CCG Governing Body were highlighted for the Board’s endorsement.

The Board provided positive feedback on the content and presentation of the report, in particular the focus first on outcomes followed by finances. It was clarified that the re-assignment of monies between the Children’s and Adult’s Directorates of the Council for Out of Hospital care for children was technical adjustment within the Council and not a change in service.

The challenges of Quarter 2 performance were discussed by the Board and it was noted that a Tripartite on urgent care performance had recently taken place. It was noted the emergency department and delayed discharge remained significant challenges within the Stockport economy. The Board noted the additional pressures of the upcoming winter period and the need to ensure continued system wide review and management of strategic and operational performance. G Mullins noted that the Stockport Together Programme had been undertaking significant work which it was anticipated would begin to impact on performance in Quarter 4 of the 2016/17 year and included both supporting people more flexibly and robustly within the community and improving the acute system flow. The Board noted the need to balance short term investment to solve immediate problems with medium / longer term investment in support of transformation. The detail of future changes within the key Stockport Together work streams would be presented via a series of service specific business cases from October 2016 onwards. The importance of linking into Greater Manchester initiatives was noted.

In response to a question regarding the all age all-cause mortality rate for women in deprived areas, R Gill noted that a key focus of the neighbourhood work would be active case management and find and treat initiatives. In addition he explained that lifestyle choices had a significant impact and work needed to be continually undertaken to ensure people made informed choices on order to reduce health inequalities in Stockport.

A discussion took place regarding financial risk within the pooled budget. M Cullen noted that for the 16/17 year it had been agreed that risks would sit as far as they can within individual organisations within the pool. The ambition was to develop the risk share in future years to move to a situation where funds were truly integrated within the pool.

Resolved: That the Board:

1. Approves the reduction to the value of the pool (SMBC contribution of £0.224m)

2. Notes the financial position as at Quarter 1 illustrating a deficit of £1.6m and that the relevant Section 75 Agreement processes have been instigated.

3. Endorses the procurement decisions approved  ...  view the full minutes text for item 7.

To receive an update report of the Director of Integrated Commissioning.

The Board received an overview of the report of the Director of Integrated Commissioning. G Mullins, Director of Integrated Commissioning highlighted the key elements of work which had been undertaken in recent months, noting in particular the MCP (Multi-Speciality Community Provider) Procurement activity, governance work in establishing the Health and Care Integrated Commissioning Board and work to develop an integrated commissioning function. She explained that Stockport had been accessing additional national support and expertise as an MCP Intensive Support site.

A high level discussion took place regarding the MCP procurement work underway. G Mullins noted that information had recently been shared by the national team regarding the process and timescales for the new National Gateway Assurance Process for regulatory approval of MCPs. This was being discussed through the Stockport Together Programme with a view to aligning local processes and timescales.

The Board was informed that Provider Organisations had begun a process of stakeholder engagement to discuss the type of organisational form the MCP would select as its preferred option. A Webb, Director of Services for People, provided an overview of the approach which would be taken by Providers and how the preferred option would be tested to ensure it met the needs of individual organisations, commissioners and was able to meet regulatory requirements.

The opportunities in future to utilise the Integrated Service Solution to both re-design and integrate services and to identify and fill known or emerging gaps were noted to be significant. It was acknowledged that whilst the MCP organisational form was being developed and the procurement process underway, it would not stop provider organisations developing a single organisational culture and continuing with work to align and integrate frontline services and teams.

The Board acknowledged the ambitious timescales which had been set for the work and the challenges in maintaining pace. It was requested that the Board be kept updated on the development of the integrated commissioning function and the governance arrangements which would underpin the proposals developed.

Resolved: That the report be noted.

To receive an update on the progress of the procurement of the Multi-Speciality Community Provider.

S Robson, Director of Procurement provided an update on the procurement of the Multi-Speciality Community Provider. She outlined the process which had been agreed by commissioners and was underway and the legal and statutory underpinnings of the procurement approaches governing both organisations. She explained the timeline and current position of the activity and the proposal that when the procurement had been concluded, a negotiated approach would be pursued to move towards the agreement of the MCP Contract. NHS England had indicated that a draft of the contract would be available in September.

The benefits of the establishment of an MCP were highlighted and in particular the opportunities to completely re-shape and re-design the commissioning and provision of health and care services in Stockport. It was noted that external legal advice had been taken to support the procurement approach and in particular how any risks could be mitigated and managed.

The assessment process of the Provider Responses was noted to be underway and had been aligned to the content as shared with Providers of the National MCP Framework issued in July 2016.

The Board acknowledged the importance of balancing transformation at a sustainable pace to ensure the continuation of high quality health and care services in Stockport.

Resolved:That the report be noted and a further update be provided at the next Board Meeting.