Agenda item

5.1  The Chair  welcomed for this item:

  Marie Gabriel CBE (MG), Chair of NEL ICS

  Zina Etheridge (ZE), Chief Executive, NHS NEL

  Henry Black (HB), Chief Finance Officer, NHS NEL

5.2  Members gave consideration to briefing papers on: Update on North East London Health and Care Partnership, NEL Financial Strategy and Working with People and Communities Strategy.

5.3  Zina Etheridge (CE) gave a presentation on NHS NEL, the organisation that has replaced the CCGs on 1 July.  Cllr Maureen Warmby (Barking and Dagenham) and Mayor Philip Glanville (Hackney) will be the two local authority reps on the ICB.  The wider body, the ICPB, has also been set up and will set the Strategy that the ICB must have regard to. Marie Gabriel (MG) explained that with the ICPB the aim was not to duplicate arrangements but build on what they all do already and she detailed the 4 aims of the System. Most of the work would take place at the Place level and not at the board itself.  Henry Bock (HB) stated that 22/23 would be a transition year for finances and full delegation would take place in 2023/24. He described how ICS’s finances will focus on a stewardship of resources approach rather than a pure contracting and commissioning approach as in the past.

5.4  The Chair outlined for newcomers the background to the creation of the ICS.

5.5  The Chair asked how the financial flows will work from the centre to the ‘place based areas’. HB  explained that certain aspects of funding will still sit with the ‘provider collaboratives’ and they will ensure there are no conflicts of interest involved. HB explained how each ‘place’ in NEL will receive allocations for its out-of-hospital activity and will see the notional budget for the total NEL. There won’t be a contractual relationship between the ‘place’ and the provider as this wouldn’t work in the new context.  So there will be an attempt to move on from the old rules of commissioning which had been very contractual.  ZE explained that the overall aim was to move beyond the old commissioner-provider model and the conversation at place level then needs to be about what are the outcomes that we are jointly trying to achieve.

5.6  Cllr Deakin asked why it was the Group CEO and not the Chair of Barts Health-BHRUT who will sit on the ICB and about how the VCS reps are selected. MG replied that this is what emerged from the conversations that had taken place with the relevant stakeholders in the process and that the view as that they needed to have the Chief Execs there so there could be a direct focus on delivery and so they can be held to account more directly. The VCS orgs are going through their own similar processes to select their reps for ICB and ICPB, she added.

5.7  Cllr Masters asked about the scheme of delegation and in relation to a large number of small contracts. HB replied that the contracting organisation would be ICB but the decision making would sit at ‘place’ level.  The Chair asked whether there would be a role veto of a Place decision and HB replied there would not. The expectation would be that the decision making would happen at Place.

5.8  Cllr Akram asked about the impact of ICS on changes to primary care registration i.e. moving GP Practice. ZE replied there would be no change as to how primary care registration worked. She referenced the Fuller Review on the importance of integrated local care at local level e.g. using the PCNs.

5.9  The Chair asked HB for an illustration of the financial scheme of delegation and how it has changed from the old CCG system. HB replied that the principles (as set out on p.150) where budgets include in-patient or acute services, that Provider Collaboratives are best to hold those budgets but for everything else the aim should be that budgets be held at Place level.  The Chair asked who was making the decisions during the interim/shadow year. HB replied that the shadow year should enable them to enact the new system and test it and each Place Based Partnership was at a different level of maturity.  ZE added that they were still awaiting guidance from NHSE about how all these processes can work.

5.10  Cllr Adams asked about the process to select the 2 Local Authority members from the 8 authorities onto the ICB. MG replied that they had asked the LAs to nominate the two members and they weren’t party to that.  The Chair asked whether the ICPB membership (c. 40 people) and frequency of meetings had been finalised yet.  MG replied that there would be an executive steering committee of the ICPB and that membership would be clear shortly.  It was a work in progress. The big partnership will meet 4 times a year and the smaller steering group will meet bi monthly.

5.11  The Chair asked about Hackney’s concerns at not having CE of Homerton on ICB and on the risk of a conflict of interest with just one secondary care lead on it and not the other.  MG replied that the approach to working with the acute sector generally was going to be via the Provider Collaboratives.  And the Acute reps would have to act on the ICB on behalf of the sector and not just their own Trust.  ZE added that they have identified, as required, ‘Place Leader’ for each of the Places within NEL and in City and Hackney it would be Louise Ashley who is the incoming CE of the Homerton.  The Executive Cttee will also comprise the key Executives of each of the Trusts. 

5.12  The Chair asked what support was being given to PCNs who will be key to success of ICS at the Place level. ZE replied that there was a lot of learning across the ‘places’ within NEL, for example in City & Hackney, to make integrated locality working a success so that this can be mainstreamed.  NEL is unusual as a system in setting up a Primary Care Collaborative so that there is a clear support for them.

5.13  Cllr Masters asked how they would ensure that culturally each part of the system will come together. MG replied that a lot of work has been done on signature behaviours and design principles for the partnership. There is also a legal duty to collaborate and regulators will judge the partnership on that. 

5.14  The Chair thanked officers for their detailed paper. He added that as the ICS was now bedding in there wasn’t a need for updates on this at the same frequency and thanked officers for their contributions on this over the period of the development of the ICS.

RESOLVED:

  That the reports and discussion be noted.