Agenda item

To receive a report on the proposals for collaboration between the North Central London Clinical Commissioning Groups (CCGs). 

The Board received the report and presentation from Paul Jenkins, CCG Chief Officer containing an overview of the work of the North Central London Collaboration Board. 

1.               North Central London Collaboration Board

Paul Jenkins presented the report to the Board highlighting the following: 

·       The collaboration board have considered the options for working collaboratively, supporting the case for change with the aim of improving health and reducing health inequalities.

·       The North Central London boroughs have been investigating ways of working collectively together in a similar way to other groups of boroughs in other parts of London. 

·       The boroughs are hoping to put together a streamlined and systematic health care offer, linking in the outcomes from Carnell Farrar Review, all working against the backdrop of significant financial challenge.  Together the bodies are facing a deficit of between £400m to up to £1 billion across North Central London by 2019/20.  

·       This area includes a very large population - 1.4m residents. 

·       Staff recruitment and retention issues are variable, but all need to be able to attract and retain the highest calibre individuals to deliver future plans. 

·       It is a very complex health and social care landscape. 

·       The full report will be made available. 

·       Across the region life expectancy and clinical outcomes vary.  Adults with long term conditions and mental health illness account for significant proportions of the money spent.   The majority of money is spent on acute hospital care, followed by mental health, community and primary care. 

·       All the five CCG’s are in the highest quartile nationally for prevalence of mental health.

·       North Central London is facing significant clinical and financial challenges.  If nothing is done and the organisations continue to work individually, the cumulative challenge would be £891m by 2019/20.  This would be a significant increase in costs with no increase in outcomes or delivery. 

·       Priorities have been investigated and seven areas for joint improvement have been identified: a programme which looks to realise the opportunities through working with local authorities and other provider colleagues. 

·       The collaboration board had been set up to support the collective endeavour, making a case for change and setting out strategic objectives. 

·       Four programme work-streams have been prioritised, based on strategic objectives and the case for change.  They are: optimising the use of the estate; prevention and self-care; care for those with chronic complex needs; care for those in child and adolescent mental health services (CAMHS). 

·       Four programmes have the potential to start immediately:  These are redesigning acute services with an immediate focus on urgent and emergency care managing patient expectations and improving infrastructure, mental health with an immediate focus on transforming inpatient care, care pathways with an immediate focus on primary care, system wide enablers with an immediate focus on estates. 

·       Various governance models are being considered by partners and stakeholders.  Options include everything from a full federation of sovereign CCGs to a formal joint committee.  If a new entity were to be created, GP practices will need to be part of the process. 

2.       Questions/Comments

2.1     A very successful meeting had been held in September, involving all the partners.  This has created a good platform to build upon.  The clinical case for change will need to be articulated, before any more can be done, alongside a financial piece of work.   Both will be needed. 

2.3     Other authorities have more money than Enfield, but not significantly better outcomes.  It is important to think about how we can meet the standards of the future and there will be a need for consolidation.  Personal fiefdoms will not be possible when considering what is affordable.  The future will bring different challenges.

2.4     There is likely to be a convergence of funding across the five authorities. 

2.5     There is some very successful collaboration in North West London and in Hertfordshire.  Where parties are in serious financial difficulty it will be necessary to find a way forward. to find a strategic solution with the commissioners and providers, working closer together, sharing knowledge and ideas.  This is beginning to happen.  It is important that people are honest and frank.  

2.6     Public Health has a strong role to play. 

2.7     Before a governance model can be decided upon, the evaluatory framework will have to be considered and key principles identified.  Clear principles are essential to ensure transparency when decisions are made in collaboration. 

2.8     A voting mechanism will be necessary for conflict resolution.

2.9     There is some growth in the NHS budget but there is no growth in the local government budget.  It will be necessary to understand what the reductions in funding will mean in reality.

2.10    There is some concern about special interest groups.  Officers are stretched to attend all the various groups and there needs to be some consideration as to whether the groups are doing what they need to do.  Are they strategic or operational? 

2.11    The appointment of the programme director has to be considered.  An experienced interim has been appointed, Janet Soo Chung, who is based in Camden, but all parties would want to be involved in a substantive appointment. 

2.12    Governance issues are important to ensure that decisions can be taken at an appropriate level, without unnecessarily slowing down processes.  Everyone will need to work differently in the future.

2.13    Ruth Carnall, author of the review, had said that it would not be possible to make major changes, without resources, but there are no resources.  

2.14    There is a growing demand for services in primary care, but a decreasing capacity.  There will be no new money, but it will be possible to change the application of commissioner spend resources between different areas. 

2.15    There are multiple layers of groups and decision makers across the five boroughs including several system resilience groups.  There is now an opportunity to improve what we currently have and to make systems more efficient and effective. 

2.16    The same report on the procurement of the 111/Out of Hours service went to all five Health and Wellbeing Boards.  There is already a joint health overview and scrutiny committee and with the right delegation and structure it could be possible to create one body covering all areas to deal with cross borough issues.  

2.17    The aim is that final collaboration proposals will be fully developed and ready for decision in November 2015, but there is a need for further discussion both locally and across all the organisations involved.  Special meetings may be necessary to sign off decisions.

AGREED to note the progress achieved towards the collaborative working of the North Central London clinical commissioning groups.