Agenda item

(1)       The Chairman submitted a report inviting the Shadow Health and Wellbeing Board to comment on the development of a robust infrastructure which enables the Board to operate effectively to deliver its designated responsibilities of:

• Ensuring that a Joint Strategic Needs Assessment (JSNA), a Pharmaceutical Needs Assessment and a Joint Health and Wellbeing Strategy (JHWS) are produced;

• Ensuring that the commissioning decisions of the Clinical Commissioning Groups (CCGs) and the local authority, for public health, meet the priorities identified in the JSNA and the JHWS; and

• Promoting the integration of commissioning of health and social care services.

(2)       The infrastructure needs to be able to inform the Board on technical matters such as commissioning and integration of service delivery as well as ensuring that appropriate relationships are fostered with key partners, especially the CCGs and District Councils.

(3)       Communicating effectively with patients in Kent and the wider population will be key.

(4)       Commissioning will be a key area of activity for the Board to understand and influence.  The issue for service commissioning is what degree of integration is necessary to achieve the greatest added value.  The report proposed that groups are established for Children and Young People, Older People with a Disability and Mental Health with appropriate Directors and other senior managers from the Primary Care Trust cluster and Kent County Council as well as lead GPs representing CCGs and members as appropriate.  Each group will review existing arrangements within their respective area and agree outcomes to be achieved.  Each Group will produce a report for the Strategic Oversight Board and CCGs setting out the priorities and how integration can be evaluated.  The combined priorities will form the basis of the Joint Health and Wellbeing Strategy.

(5)       Possible models of engagement with districts and CCGs at a more local level are being considered as part of the current Kent Health Commission work.

(6)       The report proposed that an Integrated Commissioning Executive comprising the PCT Cluster Chief Executive, the Corporate Director of Families and Social Care, Kent County Council and their Directors as well as the GPs representing the CCGs is established to oversee the work of the three groups. The Integrated Commissioning Executive will decide where decisions need to be brought; to the CCG Board, KCC Cabinet or the Health and Wellbeing Board.

(7) The report also proposed the establishment of a Health and Commissioning Board to:

• Provide robust and comprehensive commissioning and de-commissioning arrangements to meet the needs identified through the JSNA and aligned with the Health and Wellbeing Strategy;

• Ensure the outcome of the framework for public health, NHS and social care are embedded in commissioning for health improvement;

• Support integrated commissioning of services across health and social care and link with other community services;

• Complement the other commissioning groups in one integrated structure;

• Ensure effective relationships with the Health and Wellbeing Board, Kent Forum, CCGs, Districts and Kent County Council;

• Review and evaluate the performance of commissioned services; and

• Deliver measurable improvements to health and wellbeing and reduce health inequalities in Kent.

(8)       Regular reports from the Health Improvement Commissioning Board will be provided to the Health and Wellbeing Board, Strategic Oversight Board, Kent County Council Clinical Commissioning Groups, Integrated Commissioning, the Kent Forum and the emerging Locality Boards.

(9) Attached as an appendix to these minutes is a proposed structure to support the Health and Wellbeing Board to discharge its commissioning related responsibilities. Meradin Peachey informed the Board that if this infrastructure had the support of the Shadow Health and Wellbeing Board it would streamline some of the infrastructure.

(10) An important issue which remained outstanding that the Board were asked to consider is how the links with the Districts and CCGs would operate at a local level.

(11)     During the debate which followed the following themes emerged:-

• The infrastructure should reflect where accountability is best executed

• Guidance is required for all partners around the future direction of Public Health

• Acknowledged that every iteration of the Coalition Government on the creation of the Health and Wellbeing Boards had strengthened the role of the Board

• The Shadow Board acknowledged that the role of the Board was strategic leadership and strategic oversight

• There was an inevitable focus on integrated commissioning and provision

• There was an inherent tension between the County Council, District Councils and partners which needed to be overcome. One of the pre-requisites had to be avoiding duplication.

• The emphasis being placed on Locality Boards would be disruptive for some of the CCGs where there was not co-terminosity with District Council boundaries

• The CCG for the Dover area, Dover District Council and Kent County Council were working well on how they would integrate commissioning – a second facilitated session with representatives of the Department of Health was due to take place shortly

• Concerns were expressed about CCGs capacity to serve the infrastructure in the appendix to these Minutes effectively.

• There had always been tensions around accountability – it should be about local mobilisation to solve problems

• The infrastructure suggested adds to the complexity. Should build on the existing infrastructure.  It was about the coming together of willing partners

• There was an opportunity to look at the structure in a more thematic way

(12)     The Board resolved that it should think again on the appropriate way forward. The Chairman indicated that that he would welcome Members sharing their views with him on an informal basis.