11.45
The will be a verbal update including
· An outline of the Integrated Care System which will include Oxfordshire
· Timescales for implementation of the ICS
· Implications for residents of Oxfordshire and plans to involve them in its roll out.
Minutes:
Louise Patten, CEO OCCG, gave a presentation on progress and plans with the Integrated Care System. This is a way of working regionally. It is not creating new organisations. For planning and commissioning the level of population makes sense. The counties share the characteristics of additional population growth and an aging population.
Integrated Care Partnerships, involving health and social care, are certainly at the best level of population for commissioning and provision. For example, with discharge from hospital we need to look at the cost of everything and then see is there a way of working differently to change the provision at a cost that works. A budget would be delegated to Oxfordshire and local accountability would remain.
With ICS the partnership at this scale makes sense for dealing with workforce, digital and prevention issues. It is all a bit empirical at this stage but she can provide examples of how it is working elsewhere.
There is a certain inevitability of the CCGs merging. It will free up money for services. The process includes consultation – an engagement document has been drawn up with the initial thoughts. The timescale is being worked on.
From April 2020 it will shadow the ICS but will have more form at that stage and it will be clearer how it relates to HOSCs and the Health and Wellbeing Boards.
At the request of the Chairman, Louise Patten AGREED to share the maturity assessments.
Anita Higham asked where the patient voice would be in this. Louise Patten responded that Patient Participation Groups are the patient voice in primary care. They can vary greatly in how they operate. There will be a contracting group for a PCN rather than for individual practices. The commissioning process will set expectations for PCNs and will need to state that they are expected to have the patient voice represented.
Councillor Laura Price asked to what extent the ICS is a Sustainability and Transformation Partnership (STP) rebranded. The language is the same: it’s a way of working not a body. She also asked how the different financial positions are being managed and what the relationship will be with Adult Social Care.
Louise Patten said that the STP is a difficult concept to communicate. They will only work together where it adds value and makes efficient use of NHS resources. There are many overlaps and much learning that can be shared. At this higher level the scale is enough to have our own Special Commissioning Board. People locally can sit on that and influence it. There is more form on ICS than before, but the statutory organisations still exist. Different providers such as OUH and Royal Berkshire Hospital are starting to work together on common issues to support choice and outcomes for people. With regard to different financial positions, all have got challenges and they can be better tackled by working together. There is an aspiration to bring together health and social care. This will be developed further with outcomes-based work.
Dr Alan Cohen said that the difference between purchaser and commissioner was not clear. There appeared to be more movement towards commissioning. He asked, if there is going to be closer working between health and social care, what the role of the CCG will be and could it be a case of getting rid of the CCGs?
Louise Patten responded that what CCGs did was to engage clinicians and that engagement must not be lost. Historically commissioning described what we want and they bid. Now it works on describing the outcomes, setting up frameworks so patients get a better experience as they go through the system. Some commissioning functions are not needed anymore. What is needed is analysis, planning and making sure the outcomes are being achieved. Some commissioning needs to happen at scale, in particular special commissioning such as Mental Health. It’s not about CCGs getting bigger. The role is changing.
District Councillor Paul Barrow asked what the estimated savings would be over five years and how they will be distributed. Louise Patten stated that each CCG has to achieve a 20% reduction in running costs - including the cost of clinicians and services bought from Commissioning Service Units. The money is expected to be recycled into clinical services. There may be a single management team with more money put back into the front line.
Anita Higham asked what the governance arrangements will be in a CCG merger. Louise Patten noted that no decision has been made to merge but where they have, there is a single board with the same representation as currently. There will be an engagement exercise to go through.