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Agenda item

Joint Commissioning for Health and Social Care

Report of the Executive Director, People Services.

Decision:

9.1

The Executive Director, People Services submitted a report providing an update on progress to date on delivering the Sheffield City Council (SCC) and Sheffield Clinical Commissioning Group’s (SCCG) integrated commissioning agenda and sets out a proposal for enhancing the governance arrangements. These enhanced arrangements are designed to ensure that commissioners have a truly joint approach to commissioning in a way that secures the transformational change that is required to realise our ambitions.

 

 

9.2

RESOLVED: That Cabinet:- 

 

 

 

(a)

notes the progress made to date on joint commissioning and the proposals for future joint commissioning; and

 

 

 

 

(b)

endorses the objectives, principles and priorities for joint commissioning set out in the report.

 

 

 

 

·         RESOLVED: That the Deputy Leader agrees to the amendment of the existing Better Care Fund partnership arrangements under s75 NHS Act 2006 to establish a joint committee to:

·         take responsibility for the management of the partnership arrangements;

·         lead on shaping the development of joint health and care commissioning; and

·         provide advice and guidance on ways in which the partnership arrangements could be strengthened and developed and on appropriate engagement of all relevant stakeholders, this should include guidance on specific areas of service improvement.

 

 

 

9.3

Reasons for Decision

 

 

9.3.1

Learning from other authorities suggests that significant progress can be made against downstream outcomes,  at the same time as having a measurable impact on overall budget positions, by adopting different approaches to governance, management models, commissioning arrangements and delivery priorities, focussing on early intervention and prevention, by taking an asset-based approach.

 

 

9.3.2

The health and social care system in Sheffield must create a shift towards delivering better outcomes for people, via a more preventative approach that supports individuals to remain as well as possible within communities, and reduces the population need for acute care, with a particular emphasis on reducing inequalities in acute need.  The recommended approach will provide the basis for this shift.

 

 

9.4

Alternatives Considered and Rejected

 

 

9.4.1

Do Nothing

The Council is forecasting increasing funding pressures in the short-term, and longer term forecasts predict a £61m funding gap by 2023 for SCC. Without social care, hospital discharge will suffer dramatically, beds will become unavailable for those who need them and NHS costs will rise. Business as usual is, therefore, not a realistic option, although it is important to recognise that it will be the default position unless we take action. The aim of developing joint risk sharing is to ensure there is a shared approach to risk and benefit sharing, recognising that doing nothing also carries financial risks, and these are set out below.

 

 

9.4.2

SCC Delivers statutory responsibilities only

A second option would be for SCC to focus solely on statutory responsibilities, removing discretionary support (such as STIT, People Keeping Well etc.) in order to address the immediate financial challenge. This would have dramatic effects on the people of Sheffield, leaving its most vulnerable residents unsupported. The impact on partner NHS organisations would rapidly lead to financial failure and then, inevitably, to very poor outcomes for individuals, which would include avoidable deaths.  It would also lead to subsequent failure for SCC, as our budgets became more and more focused on dealing with more and more acute demand for services.

 

 

9.4.3

Alternative Joint Commissioning Model

The possibility of a model where one provider had responsibility for all provision was considered.  However, it is not recommended that this option is actively considered at this time.  The legal and structural changes that would be required to facilitate this model mean that progress would be much slower than with the proposed arrangements.  In addition, there is a risk that structural integration – where separate organisations merge to form a new organisation – could become the main focus rather than better coordination and integration of services.

 

 

9.5

Any Interest Declared or Dispensation Granted

 

 

 

None

 

 

9.6

Reason for Exemption if Public/Press Excluded During Consideration

 

 

 

None

 

 

9.7

Respective Director Responsible for Implementation

 

 

 

Jayne Ludlam, Executive Director, People Services

 

 

9.8

Relevant Scrutiny and Policy Development Committee If Decision Called In

 

 

 

Healthier Communities and Adult Social Care

 

Minutes:

9.1

The Executive Director, People Services submitted a report providing an update on progress to date on delivering the Sheffield City Council (SCC) and Sheffield Clinical Commissioning Group’s (SCCG) integrated commissioning agenda and sets out a proposal for enhancing the governance arrangements. These enhanced arrangements are designed to ensure that commissioners have a truly joint approach to commissioning in a way that secures the transformational change that is required to realise our ambitions.

 

 

9.2

RESOLVED: That (a) Cabinet:- 

 

 

 

(i)

notes the progress made to date on joint commissioning and the proposals for future joint commissioning; and

 

 

 

 

(ii)

endorses the objectives, principles and priorities for joint commissioning set out in the report; and

 

 

 

 

·         the Deputy Leader, acting in the absence of the Leader, agrees to the amendment of the existing Better Care Fund partnership arrangements under s75 NHS Act 2006 to establish a joint committee to:

 

(i) take responsibility for the management of the partnership arrangements;

 

(ii) lead on shaping the development of joint health and care commissioning; and

 

(iii) provide advice and guidance on ways in which the partnership arrangements could be strengthened and developed and on appropriate engagement of all relevant stakeholders, this should include guidance on specific areas of service improvement.

 

 

 

9.3

Reasons for Decision

 

 

9.3.1

Learning from other authorities suggests that significant progress can be made against downstream outcomes,  at the same time as having a measurable impact on overall budget positions, by adopting different approaches to governance, management models, commissioning arrangements and delivery priorities, focussing on early intervention and prevention, by taking an asset-based approach.

 

 

9.3.2

The health and social care system in Sheffield must create a shift towards delivering better outcomes for people, via a more preventative approach that supports individuals to remain as well as possible within communities, and reduces the population need for acute care, with a particular emphasis on reducing inequalities in acute need.  The recommended approach will provide the basis for this shift.

 

 

9.4

Alternatives Considered and Rejected

 

 

9.4.1

Do Nothing

The Council is forecasting increasing funding pressures in the short-term, and longer term forecasts predict a £61m funding gap by 2023 for SCC. Without social care, hospital discharge will suffer dramatically, beds will become unavailable for those who need them and NHS costs will rise. Business as usual is, therefore, not a realistic option, although it is important to recognise that it will be the default position unless we take action. The aim of developing joint risk sharing is to ensure there is a shared approach to risk and benefit sharing, recognising that doing nothing also carries financial risks, and these are set out below.

 

 

9.4.2

SCC Delivers Statutory Responsibilities Only

A second option would be for SCC to focus solely on statutory responsibilities, removing discretionary support (such as STIT, People Keeping Well etc.) in order to address the immediate financial challenge. This would have dramatic effects on the people of Sheffield, leaving its most vulnerable residents unsupported. The impact on partner NHS organisations would rapidly lead to financial failure and then, inevitably, to very poor outcomes for individuals, which would include avoidable deaths.  It would also lead to subsequent failure for SCC, as our budgets became more and more focused on dealing with more and more acute demand for services.

 

 

9.4.3

Alternative Joint Commissioning Model

The possibility of a model where one provider had responsibility for all provision was considered.  However, it is not recommended that this option is actively considered at this time.  The legal and structural changes that would be required to facilitate this model mean that progress would be much slower than with the proposed arrangements.  In addition, there is a risk that structural integration – where separate organisations merge to form a new organisation – could become the main focus rather than better coordination and integration of services.

 

 

 

Supporting documents: