Agenda item

4.1  The Chair stated that one of the issues which as caused some concern over the period of the development of the ICS was how the new body, NHS NEL, will work vis a vis the old CCG system and in particular the need to preserve valuable local knowledge from ‘Place’ level in the new, more centralised commissioning structure. He had invited the CE of NHS NEL therefore, to give a briefing on this.

4.2  Members gave consideration to a briefing paper - Understanding staff at place level.

4.3  The Chair welcomed Zina Etheridge (ZE), Chief Executive Officer, NHS NEL,  who took Members through the briefing which covered: Background, Place partnership principles, and staffing. 

4.4  ZE explained that the new structure would go live on 1 July and that any matter involving staffing was sensitive to the individuals involved which therefore limited the amount of detail she could give at this stage.  She reiterated that Place was fundamental to their work collectively and in partnerships.

4.5  The Chair asked whether there would be an anchor level of staffing at Place level. ZE stated that it had not been agreed yet as the current contractual arrangements of staff varied quite widely The aspiration was that staff working at Place would spend some of their time in that Place.

4.6  The Chair asked if there would be delegation of finances to the Place based structures and what attempts were being made to retain staff with local knowledge in broadly the same roles.  ZE replied that local knowledge of Primary Care would be the cornerstone of the model going forward. They already had a Primary Care Improvement Lead and a Primary Care Clinical Lead in each Place. On financial delegation she stated it was their intention that Places would have a very real role in setting the objectives for their communities.  She added that the leadership team all recognised this aspiration and acknowledged the concerns and so were, for example, updating the Terms of Reference for the Place Committees so that more delegation would be put in place from April.

4.7  Cllr Brewer asked whether NHS NEL had the balance right for resourcing staffing at Place level. ZE replied that the ICB budget was made up from a number of sources, some Programme Funded costs and some other costs.  The answer on the size of the budget depended on which elements you included. On staff numbers in the structure, she was not able to confirm any of that as yet because it had not yet been set out for staff.

4.8  Cllr Masters expressed concern that previous promises about subsidiarity appeared to be fading and asked about how best practice programmes on reducing inequalities were operating. ZE explained that the Population Health and Integration Cttee chaired by Marie Gabriel was key here and Place Committees sit within that structure. They have a series of pieces of work focusing on reducing health inequalities driven by what was set out in the recently published Integrated Care Strategy.  They look at inequality through a lot of different lenses.  Acutes look at waiting lists, mental health acutes look at it via the various improvement programmes they have in place.  Place, being at the heart of local communities, then will feed into this work. She gave the example of the ‘Health Spot’ in Poplar,which she had just visited and which provided access to primary care to young people by linking with youth provision.  This  focus on young people and teens accessing primary care was innovative as this had been an under examined area. 

4.9  The Chair asked about the different pressure points on NHS NEL including presumably a requirement to deliver savings but added that the reference in the paper to “System and Place are one” didn’t exactly point to an ethos favouring delegation. ZE apologised if subsidiarity was not coming out strongly enough.  They were committed to Pace being the most important unit in terms of tackling health inequalities. There would  continue to be a need for central functions as well as the need to work closely within the Provider Collaboratives. Both approaches are needed, she added, to tackle unwarranted variations in health outcomes across the patch. At the System Level the intention is to do, and only once, at that level what needs to be done at that level. She explained that there is a whole range of functions and statutory duties and their associated regulations that they have to meet and that needs to be delivered within a budget envelope set by NHSE.

4.10  The Chair asked if it has been nationally mandated that admin spend must be less than under the old system. ZE replied that when looking at their current restructure plans part of the exercise was to explore a range of alternative scenarios where they’d be required to deliver against different financial envelopes. The Chair stated that the Committee was appreciative of the efforts by ZE and colleagues to avoid a ‘one size fits all’ approach across NEL, thus recognizing that different localities have different constraints on them. Cllr Kennedy, the Cabinet Member for Health from Hackney, added that he was grateful to ZE for allowing City and Hackney to retain the jointly funded Director of Delivery, as it had worked very well for them.

4.11  The Chair asked if the new staff structure would be in place by 1 July. ZE replied that staff had to be consulted first adding that the timeline had slipped. Once these were agreed she undertook to provide a written update for the Committee. She added that a restructure was complex and included a consultation process which would take time. The Chair commented that while City and Hackney for example was pleased with its Clinical Lead in Primary Care for example, they would still prefer there to be a core local admin lead on Primary Care who was not clinical but had the in-depth local knowledge.

  ACTION:

CE of NHS NEL to provide an update to the next appropriate meeting on the agreed staffing structure, the ‘Local Accountability Framework’ and the ‘Financial Framework’. 

  RESOLVED:

  That the report be noted.