Agenda item

The Board received a report which outlined how an Accountable Care Partnership (ACP) could support delivery of the aims of the Haringey and Islington Wellbeing Partnership and to provide a vehicle for delivery of the STP. The report was introduced by Rachel Lissauer, Acting Director of Commissioning Haringey CCG and was included in the agenda pack at page 57. The Board also received a presentation to accompany the report. Following the presentation, the Board discussed its findings.

The Board considered how the Haringey and Islington Wellbeing Partnership could use its organisational structure to bring about the biggest improvements in health and social care outcomes. The Acting Director of Commissioning Haringey CCG set out what an ACP looked like in practice and examples of different models being used by other authorities. The Board noted that there was a range of terminology used around Accountable Care Organisations and that a number of models that could be adopted. The Haringey and Islington Wellbeing Partnership was currently set up as an informal collaboration but was moving to a more formal collaboration model. The Board noted that an essential feature of an Accountable Care Organisation was that it involved a population based budget for either a single or a group of providers who had responsibility for achieving health and wellbeing outcomes for that particular population.

The Board noted a number of examples of different models that were being developed in other areas:

1. Northumbria was noted as an example of how shared commissioning across the council and CCG was enabling shared provision; as both organisations had came together as joint commissioners and held the budget for population services. In this example the health foundation trust held a single contract for acute services, mental health services, community services and adult social care.

2. Stockport was in the process of establishing a care trust involving the health foundation trust, GP federation, council and another provider.

3. South Somerset had developed a much more GP led Accountable Care System, which originated from groups of practices wanting to develop ownership of community services. In practice this involved a joint venture to bring GP’s in to the community health care system, but ensuring that membership for individual practices was done on a voluntary basis.  

The Acting Director of Commissioning, Haringey CCG sought to gauge the Board’s view on the degree of ambition and the pace of change that might be required. The Board was also asked to comment on the role it would like to take in the process and how it might interact with some of the other bodies involved.

The Deputy Chief Executive commented that this discussion was partly influenced by the earlier discussions around an ACO with the Royal Free and NMUH and how to build a new partnership. The Board considered that primary care in both Haringey & Islington would play a central role along with Healthwatch, the voluntary sector, the acute trust, community health provider and adult social care services. There were a number of activities already underway and it was commented that the Haringey and Islington Wellbeing partnership were effectively trying to build this from both the bottom up as well as the top down. In terms of the pace of change, the Deputy Chief Executive suggested that it was important that the partnership did not get left behind by taking too cautious an approach and should consider that the Royal Free and NMUH were seeking to move to a decision by Autumn next year.

The Leader cautioned that adopting a model which involved acute care providers absorbing greater amounts of funding seemed to undermine the idea of reorientating funding towards primary & community care, and adopting a more preventative approach. The Leader advocated adopting population based health interventions involving providers from across health and social care. The Leader also suggested targeting the small group of individuals who spent a significant amount of time using health and social care services, due to the nature of their condition/s, and targeting their support in a community setting. 

In response to a question, the Acting Director of Commissioning, Haringey CCG advised that appointing either a lead partner or adopting a joint venture seemed to be the direction that most authorities had gone with but there were other models that could be adopted. The Chair Healthwatch Haringey commented that there had not yet been an effort to explain the development of ACP/ACOs to service users and the rationale behind setting up a separate organisation.

The Chair Healthwatch Haringey also suggested that service users may have some concerns with potential conflicts of interest developing as a result of abolishing the commissioner/provider split and a wider issue of understanding who the new organisation would be accountable to. The Cabinet Member for Children & Families echoed concerns around accountability structures and suggested that the existing health and social care landscape was confusing and this process offered partners the opportunity to engage with residents and outline the direction in which the Council and partners wanted to go. The Cabinet Member advocated adopting an ambitious approach instead of smaller incremental adoption.

The Chair, Haringey CCG echoed concerns around the power of large acute trusts to pull resources towards them and that adopting an ACP/ACO model was an opportunity to adopt a more population based patient-centred focus.  The Lay Member Haringey CCG advised that the Board needed to engage with patients to explain the large amount of structural change underway but cautioned that any explanation needed to be based around patient experience. The Lay Member Haringey CCG also reiterated concerns about acute providers seeming to become even more powerful, and that this was in contrast to the strategic direction of the NHS and vision set out in the Five Year Forward Plan. The Lay Member, Haringey CCG commented that the partnership needed to adopt an ambitious approach to try and move services away from the acute sector towards community services and a preventative approach.  

The Cabinet Member for Finance & Health commented that adopting a more formalised structure was the best way to drive accountability, and advocated a more formalised ACO-type organisational structure. The Deputy Chief Executive commented that it was crucial that the top level governance structure was worked out in order to ensure that resources were not centralised through acute care providers and that the Council, CCG, GP surgeries and patient representation were enabled to be as powerful as possible. The Assistant Director of Adult Social Services advised that the partnership needed to articulate an outcome based framework, as opposed to one based on organisational structure in order to ensure that large acute care providers or social care providers did not dominate. The Chief Executive of BRT advocated adopting an organisational structure that facilitated greater influence for voluntary sector organisations.

 RESOLVED:

1. To note progress with the Wellbeing Programme and the continued work to explore how an Accountable Care Partnership can support the Wellbeing Partnership’s aims of taking a preventative approach to maintaining population health and wellbeing.

2. To discuss options on organisational form, governance and pace of change and to consider what arrangements are most likely to enable the partnership to drive efficiency and improve outcomes in the long term 

To discuss the role of the Health and Wellbeing Board in shaping the Wellbeing Partnership