Agenda item

Report to follow.

Lara Sonola, Transition Programme Director at NCL CCG, introduced the transition element of this item, noting that the target date for the establishment of Integrated Care Systems (ICS) had been moved from 1^st April 2022 to 1^st July 2022, subject to the passing of the Health and Care Bill through Parliament.

Lara Sonola explained that the key work on developing the NCL ICS had focussed on recruitment to Executive posts, including the Chair designate Mike Cooke and the CEO designate Frances O’Callaghan. Three further appointments had also been made and it was hoped that all Executive appointments would be completed in the next few weeks. This would include a Chief People Officer role to tackle workforce challenges. There was a focus on improving outcomes, as opposed to a targets-based mentality, strengthening working together at Borough level, sharing best practice across Boroughs and benefiting from economies of scale where possible. The ICS constitution was in development and would need to be approved by NHS England.

On working with communities, Lara Sonola said that building co-production/co-design into the practices of the ICS would be facilitated by a number of emerging fora. These included a Community Partnership Forum, established in October 2021, which was chaired by Mike Cooke and brought together representatives from Healthwatch and community/voluntary services groups. There was also a Quarterly Partnership Council and a Steering Committee which were already operating in shadow form before the ICS was formally established.

Lara Sonola and Sarah Mansuralli then responded to questions from the Committee:

• Cllr Tomlinson asked whether the Councillors representing their local authority at ICS meetings would be able to nominate substitutes to attend on their behalf if they were unable to attend. Lara Sonola said that details such as this were still being worked through and so a response on this point would be provided at a later date. (ACTION) Asked by Cllr Clarke about the effectiveness of elected representatives on ICS bodies, Sarah Mansuralli agreed that this was an issue that the JHOSC may wish to monitor. She added that the approach was to bring in views from other partners and aim to avoid a health-only perspective.
• In response to a question from Cllr Clarke about non-executive members of the Board, Lara Sonola said that the role would be an independent one, working with the executive members on a part-time basis. Advertisements for the recruitment to these positions were already out. Cllr Clarke about whether representatives of private corporations could be appointed to the Board, Sarah Mansuralli confirmed that this was not allowed, noting that the recruitment process was prescribed at national level.
• Asked by Cllr Connor which body the Community Partnership Forum would report into, Lara Sonola said that it would not report in anywhere but would work collectively alongside the Integrated Care Board (ICB) and the Health and Care Partnership. She reiterated that the Community Partnership Forum was chaired by Mike Cooke who was also the ICB chair. Sarah Mansuralli added that she was required to take all her papers through the Community Partnership Forum, as well as the other bodies, and to take on board their feedback. The ICB members were expected to attend all meetings and to actively engage with the different fora and with wider partners.
• Asked by Cllr Connor about the membership of the ICB, Sarah Mansuralli said that this wasn’t yet available and so hadn’t been included in the report. Lara Sonola added that there would be six partner members (including elected representative members) and two non-executive members. Cllr Connor requested that further information to be provided to the Committee at future meetings should include full details of the ICB membership. (ACTION)

Sarah Mansuralli introduced the finance element of this item noting that, as the ICS evolved and matured, the financial strategy would evolve as well to take those changes on board. She said that she would like to see the population health strategy and outcomes framework start to drive the financial strategy as this was not the case currently. The demand curve, the focus on early intervention/prevention and the approach on working better together also needed to be taken into account through the financial strategy.

The strategy had been beneficial in bringing providers together around an agreed framework with the various NCL Chief Finance Officers (CFOs) meeting fortnightly. The NCL was a net importer of activity which created additional complexity with patients attracted from outside of the NCL area. Moving forward, it would be necessary to consider further how best to resource delivering population health across the NCL area.

Sarah Mansuralli then responded to questions from the Committee:

• Cllr Clarke asked whether the arrangements for joint NCL ICS and Council funded projects, as described in the second supplementary agenda pack, would remain in place. Sarah Mansuralli said that everything would roll forward on 1^st July but when the integration White Paper was developed further then there would be potential for joint arrangements to change. However, jointly delivered work would always be necessary when tackling issues such as the wider determinants of health, for example.
• Cllr Connor said that concerns remained over the debt within the CCG and the risk to service provision relating to this if the debt was not decreasing. Sarah Mansuralli said that the statutory responsibilities of the CCG would transfer to the ICS which would be working as a system to address these issues as they emerged and ensure that due process was followed. While this wouldn’t change, there would be a focus with the new arrangements on managing money together differently as a system. However, there were still costs in excess and so it would not be possible to come in at financial balance currently. There would be considerable discussion about addressing this which was a ‘work in progress’. Cllr Connor observed that a particular concern was the risk of selling off assets to reduce the deficit.