Agenda item

The Executive Director of Communities, Sheffield City Council and the Director of Business Planning and Partnerships, NHS Sheffield Clinical Commissioning Group (CCG), submitted a report providing an overview of progress on the Integrated Commissioning Programme (ICP), which was a joint commissioning programme between NHS Sheffield Clinical Commissioning Group and Sheffield City Council and supported the delivery of the Better Care Fund of £270 million.

The report was presented by Joe Fowler, Director of Commissioning, Sheffield City Council, and Liz Howarth, Programme Director of the Integrated Commissioning Programme. It highlighted progress to date and future milestones. Challenges and risks to the programme were outlined, which related to financial challenges, the approach to commissioning and System Governance. The Board was asked to consider some of the challenges and risks to support the achievement of change for the benefit of the people of Sheffield. Four work streams had been established in the areas of Independent Living Solutions, People Keeping Well, Active Support and Recovery and Ongoing Care and further work streams might be established to meet the aims the programme.

The Board was also asked to consider if it would be supportive of a wider review of system governance arrangements, to ensure that the ICP is properly aligned with other major pieces of work such as the Prime Minister’s Challenge Fund.

The scale of the programme was ambitious given the amount of systems change and redesign across health and social care. The focus was on adults, although discussion was being held in children’s services with regard to transitions.  A strategic review had been commissioned, one of the recommendations of which was to develop the involvement of provider input to the programme, which had been addressed in the design of solutions and governance.

Members of the Board made comments and asked questions, as summarised below:

There was a commitment between the CCG and the Council to focus on the future and work as one virtual organisation to achieve the change required. Discussions had taken place with commissioners to agree principles and ensure value for money. Workshops had been held with providers and it was intended to hold an integrated commissioning ‘summit’ in September to enable people to confirm and challenge the proposed approach.

The Council and CCG would take decisions within their existing decision making structures and rules and there was a role for the Council’s Health Scrutiny Committee. With regard to governance, there was currently no existing structure for joint decision making and commissioning, although that was the aspiration. The Health and Wellbeing Board’s present role was to ask for work on the model for health and social care but it was yet to be seen whether this Board would be the appropriate governance body for the City.

It was not clear where the citizen was as part of what was a large scale transformation. There had been some open sessions for people. However, it was difficult to engage people in what was, at present, a conceptual model. Healthwatch Sheffield was represented on the Programme Board and could assist in respect of public engagement.

Increasing demand was a further challenge which should be considered, together with how to converse with the public about creating better value services, with less money and achieving better outcomes. This should form part of a wider policy discussion, including consideration of the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy.

Systems design should begin with the citizen and their needs and engagement was required to ascertain what those needs were and understand the various connections.  Previous incremental change may have led to a fragmented system of care, whilst the alternative was more substantial systems change.

Resolved: That the Health and Wellbeing Board:

1.     Notes the progress made to date with the Integrated Commissioning Programme (ICP);

2.     Recognises the continued ambition for joint working across health and social care;

3.     Recognises the scale and pace of change required in the challenging financial climate; and

4.     Supports further work to be carried out on the partnership governance arrangements.