Agenda item

The Board was informed that the report had been a collaboration between the report author, Dr. Bhan and Clive Uren.

In June 2013 the Bromley CCG Chief Officer and London Borough of Bromley Executive Director of Education, Care & Health commissioned a piece of work to assess the benefits of greater integration of commissioning arrangements across the two organisations. This work explored, with existing lead commissioners, clinicians and other key leads what LBB and CCG currently commissioned and how the commissioning functions were organised. In addition, the drivers and objectives for integration were assessed and a number of other health and social care economies visited in order to consider how they had approached integration and what they considered to be the benefits, risks and opportunities.

The Board considered a briefing paper that summarised the conclusions of this work and outlined a set of proposals for integrated commissioning in Bromley. Officers explained that Mental Health Services would be used as a “test” service as it was a relatively small budget.  The Board was informed that the Chancellor had announced a “pooled” budget of £3.8bn to drive forward integrated commissioning.  The Health and Wellbeing Board would be able to draw on this budget.

Integration between Health Authorities and Local Authorities had been the aim of successive governments.  In order to further the integration in Bromley a number of local Health and Social Care economies had been approached to discover how they dealt with integrated commissioning in practice.  There were varying levels of integration with some boroughs having all or some services integrated to others that had a joint CCG Chief Officer/Director of Adult Social Care, accountable for both management and commissioning of all CCG and LA Services.  In all areas both GPs and Councillors were happy, and signed up to the arrangements, agreeing the mutual benefits of the economy of scale and the opportunities for efficiency, saving and community based improvements.  There were still some issues to overcome such as different cultures and approaches generally.

Officers then outlined the proposed approach for Bromley; the Bromley CCG Chief Officer and London Borough of Bromley Executive Director of Education, Care & Health believed that mental health should be the first area of focus as integration was not a new agenda for mental health services. Many steps had been taken by both organisations to move in this direction over the past few years.

The Board expressed concerns that the report did not fully clarify the role of the HWB nor outline the efficiencies. It was agreed that further reports would be submitted to the board outlining the model for delivering mental health services and giving detailed outcomes.

The Director explained that there were still a number of other issues, not just financial, such as clinical governance.  Integration would force a solution to some of the issues that had not yet been concluded. The Board also requested a structure chart for the integrated services. 

Councillor Ellis felt that the integrated service caused concern for some in relation to grants.  Integration would mean they would no longer receive grants from both the Local Authority and Health Authority therefore partners needed to be reassured that this would not be detrimental to patients. With mental health there were joint contracts between the voluntary sector and the CCG.