Agenda item

Will Blandamer – Executive Director Strategic Commissioning Health and Care to provide a verbal update. Presentation attached.

Will Blandamer provided an update on the Greater Manchester Integrated Care System (GM ICS).

It was explained that an NHS England consultation took place in November 2020 and a White Paper was published in February 2021, proposing the disestablishment of Clinical Commissioning Groups (CCGs). The legislation was presented to the House of Commons in July 2021, subject to the legislation being approved, there will be no more CCGs in the country from 1 April 2022. There will be an aggregation of CCGs transferred into an Integrated Care System (ICS), in Greater Manchester all 10 CCGs will be a part of the GM ICS.

The Council has worked closely with the CCG, as the agency in the borough that is responsible for commissioning health and care services. There are joint appointments between the Council and the CCG to enable integration.

The ICS legislation focuses on removing barriers for integration, improving data sharing, removing competition and promoting collaboration. It has a focus on population health and health outcome values for taxpayers and refers to health inequalities. It contains new powers for the secretary of state to have direction over some hospital reconfiguration proposals.

Greater Manchester has been essentially working as an ICS for the last five years, with strong working partnerships between health and social care and the voluntary sector.  The legislation describes the balance of doing things once at a higher level such as at a Greater Manchester level and also operating locally and at neighbourhood levels.

There is a significant body of work taking place across Greater Manchester to plan for the closures of the CCGs and the creation of the GM ICS.

Key elements of the operation model were explained. At the moment, monies from the NHS services come through the CCG, in the future monies will come through the GM ICS. Bury remains committed to combine the money from the NHS and Council budget, which brings political leadership and clinical leadership together, to try and spend the health and care budget in the borough once. There is still lots to understand in terms of financial flows and what the partnership arrangements will look like in the borough. All CCG staff below board level will transfer to the GM ICS as a new organisation, most staff members will be deployed back into Bury to continue to work on transformation programmes. Bury is committed to maintain partnerships with other organisations to focus on population health and gain better service outcomes for residents.

Bury’s objectives from the locality plan was shared with the committee. The objectives outlined that the solution to making the health and care system sustainable, is to support residents to be well, independent, and connected.

A chart was shared that showed the health, care and wellbeing partnership system. A Locality Board is being created to set strategy and hold a budget for health and care.  Money will come into the Locality Board from the GM ICS and the Council. The Locality Board will feed into the Integrated Delivery Collaborative Board which will create the conditions for integrated neighbourhood working. The Health and Wellbeing Board is a standing commission to focus on health inequalities.

The timeline of the GM ICS was explained:

·         There is a process in place to recruit to the IC Board Chair and Chief Executive posts.

·         From October 2021 the GM ICS will be operating in shadow form.

·         In December 2021, all Integrated Care Board appointments will be made. This will form the leadership team for the new organisation.

·         Up until March 2022, work will continue at pace to prepare for the creation of the new Integrated Care Board and Integrated Care Partnership.

·         It is planned that staff will move into the new organisation from 1 April 2022. From April those staff that transfer will have a new employer but there is work to be done to develop the GM and locality functions. It is expected that colleagues will experience minimal changes on 1 April 2022.

Will Blandamer invited questions and comments from the committee members.

·         Councillor Pilkington questioned what the advantages or complications are for Bury, as the CCG and Bury Council have already merged operationally, operating under one Chief Executive.

Will Blandamer explained that in Bury there are joint senior leadership appointments and integrated teams which is an advantage in understanding our place and the way we work. The ability to create opportunities to build joined up teams has been positive. There is still work to be done in terms of the financial flows.  A main concern for Bury is not to lose focus on delivering integrated, quality services which focus on prevention, early intervention, and health inequalities.

·         Councillor Tegolo questioned if there would be a consultation on the locality plan.

Will Blandamer explained that the locality plan was produced in 2019 and was subject to a lot of consultation including workshops and public engagement. There has been a refreshed plan created with some of the learning which has been developed throughout the pandemic, integration, and a focus on inequality.

·         Councillor Hussain asked for the reasons why the GM ICS is being created, questioning if it was based around efficiency savings or the system being more Manchester centric.

Will Blandamer explained that it is not a Greater Manchester proposal, it is national legislation that Greater Manchester is implementing. The purpose of the ICS is to reduce some of the competition and move towards a model of collaboration; it is not about a reduction in efficiency saving. There is work being completed on the governance structure to ensure that the GM ICS has locality working at its heart, so it isn’t dominated by Manchester centric. It is important to continue to make sure the governance of the ICS plays due consideration to all localities. 

·         Councillor Grimshaw questioned what will happen with the Chief Executives for the 10 authorities, once the GM ICS is established.

Will Blandamer explained that Bury has a situation where the CCG and the Council have a joint Chief Executive, which is the same in other parts of Greater Manchester. The employment commitment for CCG staff does not include executive level roles, including the Chief Executive.

There needs to be a focal point of health and care in each locality and there is a proposal in the guidance document about place-based leads. There is further work to complete around the understanding on who the place-based lead is and what it means for staff members who are jointly appointed.   The management structure is a matter for the incoming Chief Executive of the GM ICS.

·         Councillor Brown referred to an article in a newspaper which described the system as not working in Greater Manchester, in terms of performance data on health care integration. It was questioned if the GM ICS could overcome the problems.

Will Blandamer explained that the article was referring to comments on the model of the health and care devolution. Greater Manchester was challenged on some of the key performance indicators and did not deliver as well as it should have done. Although there were some key ambitions of the health and care devolution programme where Greater Manchester did make a significant different such as public health, school readiness, mental health, and physical activity.

Greater Manchester was described as a complex health and care system, it was thought that it would be unlikely to resolve some of the endemic challenges in a short period of time. The metrics described should not dissuade Bury to drive a closer integration of health and care services, and focus on prevention, and better-quality outcomes from hospital services through Fairfield General Hospital and North Manchester Hospital.

It was agreed:

1.         The refreshed locality plan be added to the Health Scrutiny Committee work programme.