Agenda item

The Cabinet considered a joint report of the Director of Health and Care Integration, Director of Adults and Communities and Director of Public Health regarding a number of the high-level commitments in the NHS Long Term Plan, notably those which were likely to have implications for the County Council.  A copy of the report, marked ‘8’, is filed with these minutes.

 

Mrs Posnett CC said that the services commissioned by the Council’s Public Health Department had been improved and outcomes enhanced at no extra cost.  It was vital that local authorities were allocated sufficient funding.

 

RESOLVED:

 

(a)      That the overall level of ambition of the NHS Long Term Plan, having a large number of complex deliverables and milestones that will be challenging to deliver, nationally, locally, and financially be noted;

 

(b)      That the initial analysis of the implications of the NHS Long Term Plan for the County Council be noted;

 

(c)      That the definition of ‘place’ as described in the NHS Long Term Plan, as an Upper Tier Authority area be welcomed;

 

(d)      That the importance of the role of the County Council in the delivery of improvements to health and wellbeing outcomes within the Leicestershire population, which relies on effective partnership working across the public sector, at neighbourhood, place and system levels be noted;

 

(e)      That the County Council’s ongoing commitment to work alongside the NHS in the further integration of health and care, both operationally and as a strategic commissioner of services is confirmed;

 

(f)       That the Directors of Health and Care Integration, Public Health and Adults and Communities, following consultation with the relevant Cabinet Lead Members, be authorised to explore with the local NHS the development of an Integrated Care System across Leicester, Leicestershire and Rutland and determine the involvement and role of local authorities in this regard, including where further progress and efficiencies can be made via integrated commissioning and pooled budgets;

 

(g)      That the Cabinet notes:

                   

(i)       the commissioning, service design innovation and partnership working local authority public health has undertaken that has resulted in 80% of health outcomes improving, or staying the same, since 2013

 

(ii)      the decline in performance of NHS England’s public health responsibilities, relating to vaccination and immunisation and screening programme coverage, over the same time period;

 

(h)      That accordingly the Cabinet notes, with concern:

 

(i)       The uncertainties regarding the future funding arrangements for the Public Health Grant

 

(ii)      The lack of clarity in the commentary in the NHS Long Term Plan around the NHS’ future role in the planning and commissioning of health visiting, school nursing and sexual health services, currently commissioned by the County Council’s Public Health Department;

 

(i)       That this report and the County Council’s initial analysis of the Plan be drawn to the attention of the local NHS and, in respect of concerns about the funding of Public Health and NHS England’s intentions, to the Local Government Association.

 

REASONS FOR DECISION:

 

The NHS Long Term Plan includes a number of areas which are likely to have an impact on the County Council in terms of joint working, operationally in the delivery of care, and as a strategic commissioner of services. In particular the Plan refers to a continued support to the “blending of health and social care budgets where councils and CCGs agree that this makes sense.”  The County Council has a number of existing pooled budget arrangements including the Better Care Fund.

 

The NHS Long Term Plan states that each local area will become an Integrated Care System (ICS) organised into three ‘tiers’: system, place and neighbourhood.  The place level is defined as equating to the area covered by an upper tier local authority.  There is a clear expectation that local authorities will wish to participate in ICSs.

 

NHS financial deficits are expected to be eliminated by 2023/24, which will present a major challenge to local NHS organisations.  The NHS will also move away from organisational financial controls to system level controls.  Full integration with the local NHS system would make the County Council vulnerable in this regard. 

 

In addition to the challenging level of financial ambition in the NHS Long Term Plan, the stated expectation around digital developments is an example of another area which sets out a far greater level of ambition than currently set out in the Leicester, Leicestershire and Rutland digital roadmap.  Similarly, without adequate resources, the renewed focus on prevention will be unachievable.

 

The NHS Long Term Plan indicates that the NHS has a desire for a greater role in the planning and commissioning of health visiting, school nursing and sexual health services, all of which are currently commissioned by the County Council’s Public Health Department.  However, there is a lack of clarity nationally regarding what this role will entail.  There is also a lack of clarity regarding the future of the Public Health Grant, expected to be resolved by the Comprehensive Spending Review.