Agenda item

Mr Dominic Cox (Deputy Chief Commissioning Officer), Mrs Claire Robson (The Company Secretary of the Kent and Medway Integrated Care Board) and Mrs Rebecca Fox (Director of Quality and Deputy Chief Nurse),

1)    The Committee received the report outlining the structural changes to the NHS Kent and Medway ICB Mr Cox introduced the item, which included the following key points:

a)    The purpose of the structural change was to enable a more strategic approach to commissioning services at both national and local levels. The revised structure would aim to support a more proactive and outcome-focused approach in the future.

b)    A greater consideration would be given to inequalities and population needs, and how these would be addressed with the move towards a more clinically led model of commissioning.  There would be increased engagement with partners. 

c)    The new model created more opportunities for joint working between the NHS and councils, including commissioning arrangements.

d)    The transition involved organisational and restructuring changes  providing opportunities for staff to move to different organisations, supporting an improved integration of services, staff would be supported throughout the changes.  

e)    Members were advised that some elements of the transition (including shared services such as procurement and digital) would not be fully established by 1 July. 

f)     The programme had operated as a transitional initiative but would now become the general operating model. Appropriate oversight would be maintained through the Integrated Care Board governance arrangements.

2)    In response to questions and comments from Members, the following points were noted:

a)    Further clarification was sought regarding the extent to which integration with local authorities had been considered within the proposals, as the report had referenced only limited collaboration.

b)    Members discussed issues relating to inequalities, noting that in addition to health inequalities, there were wider inequalities that required consideration. Clarification was sought on how the organisation intended to manage and reduce these inequalities.

c)    Additional questions discussed the approach to collaborative working with local authorities. Concerns were expressed about the current approach, including previous experiences of joint working, the pooling of budgets, and instances where there had been a lack of clarity over responsibilities. Additional points raised discussed how accountability would be maintained and whether sufficient safeguards would be in place before progressing further pooled budget arrangements.

d)    Mr Cox acknowledged the points raised and outlined that partnership working with local authorities remained an important priority. Work would be ongoing to address inequalities through collaboration, although the specific approaches and arrangements discussed would continue to develop over time.

e)    Referring to the development of neighbourhood health arrangements across Kent and Medway, Mr Cox outlined a proposed model and how it would be structured around different layers of care of delivery.

f)     Mr Cox outlined the proposed commissioning structure within the model, noting that this would include arrangements for primary care. He explained that single neighbourhoods would comprise groups of general practices operating within defined geographical areas, while multi-neighbourhood arrangements would cover larger populations of approximately 250,000 residents or more. It was further discussed that the final tier of the model related to acute care services.

g)    In response to further Members questions, aspects such as neighbourhood working would be central to tackling health inequalities and wider determinants, with local authorities already progressing related work and collaboration essential for effective delivery.

h)    The approach aimed to shift services towards prevention, early intervention and community-based provision, in line with longstanding ambitions to reduce reliance on acute care. In response to earlier queries, the Mr Cox confirmed that a commissioning policy had been developed with a renewed emphasis on joint commissioning.

i)     Members were advised that partners would review previous arrangements to identify effective practice, improve future joint working and any potential opportunities through the Better Care Fund. The importance of maximising the impact of shared resources and the commitment to ongoing partnership working to support delivery of the strategic approach was discussed as a priority.

j)     Mr Cox acknowledged that, historically, some processes had not been undertaken as effectively as intended, particularly in relation to engagement and commissioning timelines. Members were advised that a revised approach would be implemented to ensure earlier and more proactive engagement with partners, providers, local authorities and communities took place.

k)    In addition, Mr Cox explained that the new approach would enable commissioning discussions to begin significantly earlier and allow greater opportunity for collective input and challenge. It was further highlighted that this represented the clear expectations from senior leadership and the Board.

l)     In response to concerns regarding governance and accountability, Mr Cox clarified that the Integrated Care Board operated within a formal accountability framework, with oversight from NHS England and, following national changes, continuing accountability to the Department of Health. He emphasised that the organisation was subject to clear lines of scrutiny and could not act independently without accountability.

j)     Mr Cox acknowledged that neighbourhood plans had been submitted to meet national deadlines before full engagement had taken place, noting that these were not final and would continue to develop. Presenters confirmed that there would be further opportunities for collaboration and that the improvement of engagement with partners and communities remained a priority as the plans would continue to develop.

k)    Members raised concerns regarding the scale of historic financial pressures and referred to previous discussions where deficits in excess of £40 million had been identified. It was questioned how the current report addressed the prevention of any similar financial positions arising in the future.

l)     It was acknowledged that the financial position had related to previous historic discussions and Members were assured that work was underway between the Integrated Care Board and the Council to resolve and rectify the situation. It was agreed that the comments and concerns raised would be recorded in the minutes as was the request that future reports for greater financial clarity.

m)  Questions were raised on the lack of patient experiences captured within the paper with additional concerns raised on the benefits and dis-benefits that could possibly occur. Mr Cox responded that the changes had been driven by national requirements and would result in a reduction in headcount however, the primary intention would be to change the way services operated in the future, with a focus towards a more integrated delivery withing teams.

n)    Additionally, Mrs Fox highlighted that the move to a more strategic commissioner model would enable an improved and greater understanding of the patient’s experience, including accessibility and the quality of care provided.

o)    A key role of the quality team would be to monitor the experience of individuals accessing the service and to ensure providers would be held to account for delivering high-quality care and Mrs Fox confirmed that the current process for assessing patient experience and holding providers accountable would continue.

p)    Mrs Fox confirmed that, while there had been a requirement to reduce headcount within the ICB, staff who had been transferred out of the organisation had done so under protected employment arrangements and would not be at risk of redundancy. It was highlighted that individual provider organisations would manage their own workforce processes separately.

RESOLVED that the Committee  note the report.