The Director of Adult Services will present on the work taking place in Havering to establish an Accountable Care Organisation.
Minutes:
The Director of Adult Services explained that the Accountable Care Organisation (ACO) encompassed the boroughs of Havering, Barking Dagenham and Redbridge, the three local CCGs, BHRUT and NELFT. The ACO had been set up in response to the large challenges in the local health economy such as reduced Government funding for both the Council and Havering CCG.
It was possible that the ACO could serve as a pilot for the rest of London. The ultimate decision on the ACO was for the Treasury although NHS England also had an involvement. The Sustainability and Transformation Plan (STP) was also being worked on and the CCG Chief Operating Officer felt this would lead to more work taking place at the North East London level. The latest STP submission had been completed in the last week and NHS England had recently announced that there would not be any more consultation on STPs at present as Ministers wished to reflect on the programme.
The STP work had impacted on work on the ACO and it was noted that NHS Transformation money was available via the STP. Better Care Fund monies remained separate and were administered by the Health and Wellbeing Board.
The former Council Chief Executive – Cheryl Coppell had been part of the ACO team but was expected to leave this position shortly. The future format of officer work on the ACO was in the process of being agreed.
The ACO had been established in response to rising demand for health services locally due to an increasing population and a rise in the number of long-term conditions. It was expected that population of three BHR boroughs could rise by 19-28% by 2030. Officers agreed that this meant that the population figures in the previous Health for North East London review were not accurate but there would be any additional funding to accommodate this. It was agreed that Havering was not funded to the correct levels for this work.
The first bid document for the ACO had been submitted in December 2015 and a Strategic Outline Case had to be submitted in the next 3-4 weeks. The Director would confirm the precise schedule for this. Governance of the ACO was the responsibility of the Democratic and Clinical Oversight Group which covered all 8 organisations involved.
It had also been agreed to deliver an Integrated Care Partnership with joint commissioning functions although the exact arrangements for delivering this were still to be confirmed. It was hoped that this work plus the development of a Locality Delivery Model would produce substantial savings for both health and social care. Details of this proposal were expected to be ready in March or April 2017.
The ACO would avoid disputes over funding etc and the CCG had started engagement on this with local GPs. It was hoped that the development of an Accountable Care System and locality working would allow better sharing of resources between the organisations involved in the ACO. It was accepted that GPs were currently confused by the new system but there was a wish to bring GPs into networks to work together. There were also plans to combine back office services for some GP practices. It was anticipated that there would be 8-15 GPs in a network. GP networks could also organise the sharing of certain medical services such as stitch removal. The Chair of Havering CCG and colleagues would be meeting with local GPs in November to discuss the networks concept.
Under the Locality Delivery Model, the locality, rather than the hospital, would be at the centre. It was felt important that health conditions within communities were understood and that GPs should start working together. There were currently 6 GP clusters in Havering but it was anticipated that this would reduce to 3 localities. It was emphasised that the local population would be at the centre of the model.
It was also wished to have more hospital services delivered in the community. Each locality would have a community hub that could be shared in order to facilitate this. It was accepted that it was vital to ensure that separate IT systems used plug-ins etc in order to communicate with each other. The CCG also wished to educate people to look after themselves better. Being able to see a patient’s records and care plan would be a great help with this.
Havering would test a new model for working with children. This would take place in the north of the borough where there were higher incidences of deprivation, children with child protection plans etc. The Director added that the recent OFSTED inspection had found that the Council needed to do more work on children leaving care and the Council could house these young people up to the age of 25.
The CCG was looking at how people could be treated more in the community as this would help reduce delays to treatment at the hospital. This could be piloted in central Havering with conditions such as diabetes where enhanced support in the community could avoid the need for hospital admissions. It was confirmed that the DAFNE course for people with diabetes was still available. It was felt that Councillors could be involved in the community treatment model and a Member suggested that health advice could be put in the Council’s Living magazine.
The Director emphasised that the locality work was not just about social care but also included areas such as housing, benefits advice, helping people back into work, parks and open spaces. It was therefore necessary to work in a more cohesive way. Interviews re the locality model and what people would like included within it had been carried out with 1,000 residents in each of the local boroughs.
The CCG Chief Operating Officer was confident that GPs would support the plans. It was hoped that a road map to the new model would be available by Aril 2017. It was AGREED that a further update on the ACO and locality work should be given at the next meeting of the Sub-Committee.