Agenda item

The Cabinet considered a joint report of the Chief Executive and the Director of Adults and Communities regarding the Councils relationship with the NHS in terms of the services already delivered in partnership and the ongoing transformation and integration of health and care in the local area.  The report also set out the current position regarding the Council’s role in the Sustainability and Transformation (ST) Plan/Partnership, (known as “Better Care Together”), across Leicester, Leicestershire and Rutland.  A copy of the report, marked ‘8’, is filed with these minutes.

The Chief Executive in presenting the report highlighted that ST Plans had been introduced by the Government as a means of reducing budget deficits and prioritising integration to reduce pressure on acute care services.  However, these had so far proved unsuccessful, largely due to a lack of medium term financial planning by the NHS.  He said it had become clear, following discussions with NHS partners, that at a local level the Council could not support the current ST Plan for Leicester, Leicestershire and Rutland due to concerns around governance, the role of local authorities, the NHS financial gap and the lack of detail on how this would be addressed.

The Director of Adults and Communities emphasised that the Council had always prioritised partnership working and had and would continue to invest in health and care integration.  However, there were concerns that the ST process could frustrate progress made on health and care integration and he set out a number of examples that demonstrated this.

Mrs. Posnett supported the recommendations and said this was a complex situation dominated by the fact that the NHS did not function in the same way as local authorities and was not subject to the same pressures or the same level of accountability.  She said NHS partners had difficulty understanding the Council’s need for more robust governance arrangements and that without this the Authority could not support the ST Plan.  

Mr. Ould said the difference in culture between local authorities and the NHS meant that a balance needed to be struck to enable matters to move forward and he agreed that the recommendations as detailed in the report did this.

Mr. Rhodes further commented on the difference in financial accountability of the Council and its members and officers compared to NHS managers, and confirmed his support for the recommendations.

RESOLVED:

(a)          That the County Council’s position that the Sustainability and Transformation (ST) Plan be published as an NHS document, with the County Council as a consultee, be confirmed;

(b)          That the respective roles of the Cabinet, Scrutiny and the Health and Wellbeing Board (as set out in the Appendix to the report) be noted;

(c)          That the County Council continue to work in partnership with the NHS in the delivery of services, where those services are already delivered in partnership, and in the transformation and integration of health, public health and social care in the local area;

(d)          That the level of resource applied to the programme for the integration of health, public health and social care be kept under close review, in the context of the Council’s Medium Term Financial Strategy, the Council’s Strategic Plan, and the Leicestershire Better Care Fund Plan/pooled budget;

(e)          That the local NHS be advised that it remains the County Council’s strong view that an external review of the governance arrangements for the Leicester, Leicestershire and Rutland ST Partnership be undertaken to provide:

(i)            clarity of decision making and accountability;

(ii)          a clear definition of the roles of the partners;

(iii)         effective engagement with democratic processes; and

(iv)         robust oversight of the delivery of the ST Plan and associated financial savings and changes in NHS expenditure;

(f)           That the County Council’s position on accountable care systems/integrated care systems be considered further once the NHS provides more information on the direction of travel nationally and any emerging local response.

REASONS FOR DECISION:

The Chief Executive wrote to the local NHS in December 2017 to advise that the County Council, as a member of the Better Care Together Partnership, would not want its name or logo accompanying the publication of a further draft ST Plan in 2018.   Specific concerns existed about the lack of detail in respect of proposals for NHS service changes and spending reductions to close the local funding gap (£400 million) and separately about the overall ST Plan and Partnership governance arrangements.  The County Council requested an externally-led review of those arrangements.

The County Council has a significant role in the delivery of care and support to citizens through its social care and public health functions and a very good track record in working alongside NHS partners to improve integrated care to date.  It should therefore remain a high priority for the Council that the areas of core business that interface with the NHS, including delivering new models of care, continue to benefit from good operational and strategic leadership, backed by appropriate governance.

The County Council’s MTFS and Strategic Plan have been refreshed for 2018/19 and programme resources and workplans for individual Council priorities are in the process of being finalised.

In September 2017 a joint letter was sent to the NHS locally from the Chairs at the time of the three LLR Health and Wellbeing Boards, setting out concerns that any proposal to develop an accountable care organisation (later called accountable care system or integrated care system) would make an already complex set of health system governance arrangements even less clear.  It is, however, expected that the three local authorities will be engaged on any further proposals, in line with the changes in the governance arrangements for the ST Partnership as a whole.