Agenda item

Mark Adams, Joint Lead for Combined Cumbria and North East STP will provide the Joint Committee with a verbal update on the above.

The Joint Committee received a video presentation outlining the role of Accountable Care Organisations.

 

Mark Adams advised the Joint Committee that the focus in NE and Cumbria STP areas was on developing Accountable Care Systems and looking at how organisations could work together more.

 

The approach involved the NHS working under set budgets to improve health and working together with other services such as Social Care and Public Health to achieve this. Some of this work was taking place within the Vanguard pilots which were trialling new models of delivering community based services.

 

Mark highlighted that this approach would mean that whilst patients would still see their GP and access hospital care they may receive more support and treatment at home. It might also mean that individuals might have to travel further to access hospital care.

 

Mark stated that the Joint Committee would be able to see from the video presentation that as far as STPs are concerned there has been a lot of discussion around how individual organisations come together and work in different ways. Mark highlighted that one of the key areas in our STP is the emphasis on Prevention which as the video highlighted has not always been seen in other areas. Mark stated that within this STP the key focus will be on looking at what other areas can do and working with other organisations, not just local authorities to see how the best use of resources can be achieved. Mark advised that it will be really important to make sure that the organisations that come together are rooted in local work.

 

Mark stated that the discussion around Prevention highlight the general understanding of what we want to do collectively and what works well and less well and how it is planned to make changes.

 

Alan advised that the aim was to have systems working together rather than implementing organisational change. Alan stated that where it makes sense to work at scale there are a lot of things that can be done to try and provide an equitable approach. However, Alan advised that what can be achieved locally is also important. Alan stated that an accountable care systems approach means working together in the North East to agree how we deliver care and how we want to collaborate more with partners such as local authorities and the voluntary sector to create local systems which will meet needs and improve services for local people. Alan stated that he believed there were real opportunities in progressing such an approach and in ensuring a real interface for patients at a local level.

 

Alan highlighted that some hospital services in the patch were vulnerable due to staff shortages in areas such as radiology and other areas are also under pressure so this may mean that patients have to travel further.

 

The Chair stated that on the issue of further privatisation of the NHS this was not in the interests of most people and the recent collapse of Carillion and the need for government to bail out contracts highlighted this. The Chair stated that Gateshead and Newcastle were quite far down the line in discussions on health and social care integration. However, it would be important for public accountability that whatever systems etc are set up that they are accountable to Health and Wellbeing Boards.

 

The Chair also noted that it will be important to look at how we commission using the Social Value Act. The Chair advised that Gateshead is now looking to ask those who contract with the Council to sign up to a Corporate Responsibility Pledge around wages/ workforce and health and wellbeing.

 

The Chair considered that integration would help to better deliver services and avoid duplication of effort and she considered that this approach was similar to the approach being outlined by Mark and Alan. The Chair also highlighted that it would be important for the North East to continue to attract resources from central government.

 

Councillor Hetherington supported the comments Alan and Mark had made about greater joint work across systems as a way forward. Councillor Hetherington considered that all local authorities support this ambition. However, Councillor Hetherington noted that STPs had come in on the back of a great deal of suspicion about the motivation for implementing them and without a great deal of input from the public and local authorities. In addition, Councillor Hetherington noted that Accountable Care Organisations were unfortunately linked to the US healthcare system which is linked to private medical care.

 

Councillor Hetherington also noted that this approach appeared to be in direct conflict with the Health and Social Care Act which supports competition. Councillor Hetherington queried whether there was any danger of fragmenting services if they were put out to smaller organisations.

 

Mark stated that Councillor Hetherington was right to say that the structure of the NHS was based on competition. However, Mark stated that as a result of the direction of travel under austerity, STPs were focusing on improving health and the quality of services and as a result of this had learnt that working collaboratively together achieves more and helps to keep funding here.

 

Councillor Hetherington supported the approach being adopted by Mark and Alan but expressed concern that government may try to override this approach. Dr Pilkington acknowledged that there was a risk but there would be the potential for everyone to challenge such a stance. Dr Pilkington stated that the inequalities agenda had not been tackled successfully using the NHS focus on competition.

 

Councillor Clark stated that it was good to hear that a more collaborative approach was planned but expressed concern that this might not be supported nationally.

 

Mark stated that the Joint Committee’s comments were really helpful. Whilst the methodology of Accountable Care Organisations was based on the US model the focus in this STP was on an accountable care systems approach and on how organisations work together. Mark stated that he considered that there was scope to influence government in relation to local approaches to STP delivery.

 

Councillor Clarke queried whether there was a clear vision as to what accountable care systems look like in the North East.

 

Mark advised that there is not a clear vision at the minute. It would be necessary to work together to create such a vision and understand what works best at a local level. Mark stated that there is the potential to consider other models and see what this might mean for this STP area.

 

Councillor Clarke considered that it would be good to have more information on this issue at a future meeting of this Joint Committee.

 

Councillor Temple noted that there were a lot of tensions in the system, in relation to private and public health, the spread of models and integration work and he queried how much of a challenge this represented in terms of the STP’s capacity to achieve its goals.

 

Councillor Temple also noted that he could not see any evidence of voluntary sector representation or social care providers on the Prevention Board and he queried what was planned in relation to this.

 

Alan stated that there is a need to get the governance right and get the right people involved with the right approach and this is still work in progress.

 

Dr Pilkington advised that there were challenges within the system. Within commissioning there is currently a lot of focus on split funding and health responsibilities. However, Dr Pilkington considered that there were still potentially better ways to deliver services through efficiencies and by taking collective responsibility. Dr Pilkington advised that he would be speaking to the ADASS Board about appropriate representation for the Prevention Board. Dr Pilkington stated that by working towards an Accountable Care System the aim was to take a whole population approach and encourage commissioners and providers to be part of a collective solution.

 

Councillor Schofield expressed concern that a top down approach was being progressed and she was keen to understand how the voice of the community was going to be taken into account. Councillor Schofield also considered that it would be helpful to have a clear definition of an Accountable Care System to avoid confusion and misunderstandings. Councillor Schofield also noted that the issue of transport did not appear to have been covered in any of the discussion and she felt that was an important area to take into account.

 

Councillor Mendelson considered that it is beneficial for everyone to work together and there is also a need to campaign for better funding. Councillor Mendelson queried how scrutiny would be built in to the development of the proposed Accountable Care System. Councillor Mendelson considered that this Joint Committee should scrutinise what was happening at various stages of development of the proposed system prior to decisions being made.

 

Mark acknowledged that at present there is not a collective vision/model as this is still in development. However, Mark assured the Joint Committee that whatever proposals are developed these would not cut across statutory duties to involve and consult the Joint Committee and patients. Mark considered that the views of the Joint Committee would be particularly helpful in providing a strategic steer.

 

Caroline confirmed that any significant service changes would be brought to the Joint Committee.

 

Councillor Mendelson stressed that it was important that matters were brought to the Joint Committee before decisions were made.

 

The Chair invited questions from members of the public.

 

Carole Reed from Keep Our NHS Public (Durham) highlighted that the talk about ACOs appeared to be very vague and it was unclear as to what was being proposed and who would be accountable. Carole also queried when the final version of the STP would be shared.

 

Alan stated that finalised STP would be shared once it was fully developed.

 

Carole also considered that if any reconfiguration proposals arising from the STP had taken place before the winter crisis the system would not have had the capacity to deal with this. Carole also considered that the main focus of the STP was saving money and that ACOs were the same.

 

The Chair noted that these points had been raised and considered at the last meeting. Carole stated that this was being raised again as there were concerns that ACOs would not be subject to public scrutiny.

 

Mark assured the Joint Committee that when a vision had been developed for the Accountable Care System both the Joint Committee and the public would be consulted.

 

A member of the public, who is a carer in Gateshead, expressed concern that when the issue of workforce was raised there appeared to be no mention of the “ invisible” workforce which was carers and their contribution to the prevention agenda. The member of the public highlighted the potential negative impact on carers’ mental health as a result of their caring role and highlighted the need for carers to be supported to deal with the pressures placed on them.

 

Alan acknowledged that there would need to be a to link with carers / explore support for carers going forwards and how this fits with working families as more services became more community focused.

 

The member of the public noted that it had been mentioned that the aim was to keep services as local as possible. However, the member of the public considered that there had been a 50% increase in out of borough services for mental health which had a big impact on his family. The member of the public expressed disappointment that CCGs whose funding had been increased to deliver mental health services had reduced the percentage of funding allocated to those services.

 

Alan advised the Joint Committee that investment in Northumberland Tyne and Wear NHS FT had reduced a little but mental health spend had grown overall.