Attempt at making sense of badly written Calderdale Council Cabinet paper on Integrated Care System

On the agenda of the February 12th Calderdale Cabinet meeting was an incoherent jargon-filled paper by the Council’s Chief Exec Robin Tuddenham, about the creation of  Calderdale Integrated Health and Social Care System by 2020.

The paper proposes the set up of a shadow Integrated Care System in 2018, that is to commission and provide out-of-hospital services in Calderdale – despite the fact that the out-of-hospital services proposals have been referred to the Secretary of State by Calderdale and Kirklees Joint Health Scrutiny Committee, along with the hospital cuts proposals, and the Independent Reconfiguration Panel has not yet published its review.

The paper raised more questions than it answered. Councillors however were not bothered and contented themselves with uttering platitudes, before unanimously resolving to:

  • Endorse in principle the approach to delivering a place-based health and social care system that will enable neighbourhoods to develop at their own pace
  • Endorse, in principle, the alignment of in-scope service budgets
  • Ensure shared commitment to reducing inequalities in both access and outcomes
  • Maintain clarity about the boundaries between health and social care in terms of payment and means testing, ensuring that healht remains free at the point of access
  • Invite scrutiny to consider and comment on the proposals
  • Seek to agree a memorandum of understanding between key partners which sets out the basis for our partnership approach to realise our ambitions for better health and social care in Calderdale.

As this is a Cabinet resolution, Full Council doesn’t get to debate or vote on it.

However, the People Scrutiny Committee should now call in the Cabinet resolution because the Integrated Care System proposal it endorses is a total dogs’ dinner and did not receive any sensible or informed discussion at the Cabinet meeting. Cabinet appear to have been shockingly negligent in nodding through this ill thought out set of proposals.

After reading Robin Tuddenham’s sloppy paper about 10 times, this is the best summary I can make of it.

1. Multispeciality Community Provider

This is to be set up in shadow form in April 2018 and to go live in June 2019, following a 3 month evaluation from April 2019. It will run out-of-hospital services in Calderdale.

This Multispeciality Community Provider would consist of 4 organisations (Calderdale Clinical Commissioning Group, Calderdale Council, South & West Yorkshire Partnership Foundation Trust – the mental health trust and the Calderdale and Huddersfield Hospitals Trust) that remain separate and directly employ their own staff but are bound together by an alliance agreement to deliver Multispeciality Community Provider services.

These would be delivered from locality hubs each serving a population of around 30K-50K.

It looks as if these services would be primary care, triaged planned care, urgent care and urgent care centres, Rapid access services to keep people at risk of A&E admission out of hospital, On-going Care Services “delivered through multi-disciplinary teams at scale through local access hubs forming a mutual network of care with a wider network of community based and voluntary sector services.” God know what that means, I guess a few physician associates, nurse associates and therapists basically overseeing “community assets”. High Care Need Services and an Integrated Wellness Services which is basically a behaviour change programme.

The Alliance agreement would overlay existing contracts and deal with risk and reward sharing.

Decision making by the four Providers (which four?) would be delegated from each provider to their member(s) who sit on an Alliance Provider Board and bind their organisation (Appendix 5)

This alliance model will work through pooling resources and new forms of commissioning that are aligned with the outcomes set out in the Single Plan for Calderdale – formerly known as Calderdale Sustainability and Transformation Plan (3.4)

Calderdale Cares will be an alliance (is this the same as the Multispeciality Community Provider alliance?) with the “enhanced” Integrated Commissioning Executive driving the removal of the purchaser/provider split and commissioning the provider alliance. (Strategy stage 2)

2. “Shadow year” tasks

These include

  • Full review of community assets
  • Identification of which Council and NHS services should be aligned
  • The governance arrangement (Appendix 2 is the favoured potential arrangement) will be introduced in 2018/19 in “shadow form” with a view to more formal arrangements being introduced from June 2019.
  • An “enhanced Integrated Commissioning Executive” will carry out Joint commissioning by the Council and the Clinical Commissioning Group based on “the whole population outcomes approach” that will see the allocation of budgets to integrated services on the basis of local need. They will also act as System Integrators.
  • A joint Calderdale Council/Clinical Commissioning Group commissioning team with a pooled budget will commission and monitor the neighbourhood providers based in locality hubs that each manage a budget allocated through a ‘population health’ based approach.
  • “A ‘neighbourhoods’ model will be established across the health and social care system as a basis for locality working. These areas should cover populations of roughly 50,000 and will manage whole population budgets.”
  • It looks as if GPs may have overall responsibility for the health and social care services provided by the Neighbourhood Providers in the locality hubs. (Appendix 3 diagram is headed Community Provider: Commissioning Shared Outcomes.)
3. Fully operational stage from June 2019

The enhanced Integrated Commissioning Executive will play a pivotal role in removing the purchaser/provider split and commissioning the proposed alliance of providers, and regularly monitoring performance in line with pre-determined outcomes. (p9, 4.10)

Employees’ day-to-day work will change with new roles and responsibilities for delivery of an effective preventative/early intervention/self-management service.

The services the GPs will commission for the neighbourhood hubs seem to be triaged planned care, urgent care and urgent care centres, as well as:

  • Rapid access services to keep people at risk of A&E admission out of hospital
  • On-going Care Services delivered through multi-disciplinary teams at scale through local access hubs forming a mutual network of care with a wider network of community based and voluntary sector services. God know what that means, I guess a few physician associates, nurse associates and therapists basically overseeing “community assets”.
  • High Care Need Services,
  • Integrated Wellness Services which is basically a behaviour change programme.

On the one hand p 18 says the 4 providers will go on delivering Multispeciality Community Provider services under their existing contracts with commissioners. On the other, somewhere else says a joint Calderdale Council/Clinical Commissioning Group commissioning team with a pooled budget will commission and monitor the neighbourhood providers based in locality hubs that each manage a budget allocated through a ‘population health’ based approach. And it seems that GPs will have overall responsibility for this.

As it stands, none of this makes a whole lot of sense. Answers to  these questions might make things clearer. And then again they might not. There’s only one way to find out, and this is to ask these questions at the 12th April Health and Wellbeing Board

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