Agenda item

A joint commissioning update report was presented to the Committee. The report had been written jointly by Paul Feven and Graham Mackenzie—Interim Joint Directors of Integrated Commissioning. Daniel Taegtmeyer (Interim CAMHS Commissioner) attended the meeting as an alternate for Mr Mackenzie.

The report provided an update on joint commissioning activity between LBB and Bromley CCG. It was noted that the report had been based around the work programme of the Integrated Commissioning Board (ICB); this Board was the integrated officer governance body for health and social care. The Committee noted that the aim of the ICB was to develop and strengthen the commissioning approach across the borough, to improve service delivery and to ensure value for money.

The Chairman commented that the report seemed to indicate that much contractual activity was taking place, and he asked how much of this was going before LBB’s Commissioning Board. Mr Feven responded that projects such as Bromley Well and the Dementia Hub (as jointly commissioned services) should have gone to the Commissioning Board.

In any joint commissioning venture, proposed services for commissioning would be scrutinised by the relevant governance bodies for both the CCG and LBB, and so would come before the Commissioning Board as a matter of course. Strategies for future development would also be referred to the Commissioning Board. Mr Feven stated that he was not sure if Integrated Care Networks (ICNs) had gone to the Commissioning Board, but he could confirm that they had been looked at by the Executive. 

The Chairman expressed concern that scrutiny of joint projects may not be taking place adequately. He asked Mr Feven if joint projects had been scrutinised by the relevant LBB PDS Committees. It was confirmed that joint commissioning proposals had been brought before the Health and Wellbeing Board. The Chairman asked Mr Feven for some information concerning the composition of the ICB.

It was noted that the ICB was chaired jointly by LBB’s Deputy Chief Executive and Executive Director of Education, Care and Health (Ade Adetosoye) and by the Managing Director of the CCG (Dr Angela Bhan). He explained that both Mr Adetosoye and Dr Bhan would draw on officer support from both LBB and the CCG as required. The work of the ICB was to manage a set of projects and a work programme.

The Chairman wondered where the ICB was answerable to with respect to LBB. The Director of Commissioning clarified that no reports should go anywhere until they had been looked at by the Commissioning Board. She cited the example of developing a Care Home Strategy. The strategy should be scrutinised by the Commissioning Board as the Board would have directors available who would have expertise in that area. Dave Starling sat on the Board. The Board would need to be presented with a Gateway report that would set out risk and cost implications. Only after scrutiny by the Commissioning Board could reports move on to be considered by the Portfolio Holder or by the Executive.

Mr Feven clarified that the work of the ICB was an exploration of ideas, and that there was no attempt to subvert or deviate from the scrutiny process at the appropriate time. When a project was ready for consideration it would go to the Commissioning Board. The Chairman asked if the ICB definition of ‘when it is ready’ equated to a Gateway Zero report that set out the business case or a Gateway 1 report which would be the last chance for Members to have any input. He was concerned that Members were provided with the opportunity for scrutiny.

A Member commented that the report had a lot of information concerning ‘what’ but very little information on ‘how’. It was with the ‘how’ that would come innovation and value for money. He wanted to see how things were being done, and how LBB and the CCG would arrive at their joint objectives. More of this type of information should be included in future papers. Members wanted to see how they could be involved in the process, particularly at an early stage like Gateway Zero.

Mr Feven stated that the report was meant to be a light touch document that provided Members with a sense of the scope of activity, and to illustrate how the CCG and LBB were engaged in meaningful dialogue. The ‘how’ would follow later and the relevant governance procedures would be followed. He pointed out that part of the current process was to unblock pathways so that LBB and the CCG could work together to provide better services and benefit from economies of scale. A brief discussion took place about the geographical nature of ICNs.

The Chairman was concerned that joint commissioning projects may be discussed that at the end of the day may not be affordable. The Vice Chairman asked where the work plan for the ICB originated from. He also asked what the process was for deciding if a service should be commissioned or not. It was clarified that the previous body dealing with the work programme would have been the JICE (Joint Integrated Commissioning Executive); the ICB took over from the JICE. It became clear that the work programme for the ICB was derived from the HWB Priorities and from the JSNA (Joint Strategic Needs Assessment). Going forward there could be big operational issues to deal with and so membership of the ICB may need to be expanded. This was recently the case with the addition to membership of Janet Bailey (LBB Interim Director of Children’s Social Care).

A Member asked if the individuals on the ICB just ‘ticked boxes’ or if they were ‘real’ commissioners that provided challenge when required. He asked if the ICB had any ‘heretics’ as members who would provide the necessary degree of challenge. Mr Taegtmeyer responded that the ICB welcomed challenge and guidance, and brought in experts if required. It was noted that the Director of Commissioning may be able to suggest suitable candidates for ICB membership. Mr Feven responded that the ICB was not averse to expanding its membership. The Chairman stated that as far as LBB was concerned, challenge would come from the Commissioning Board. 

Councillor Graham Arthur explained that previously there had been a divide between the CCG and the LBB, and so the plan from central government was to join both organisations together in terms of commissioning and so BCF (Better Care Fund) funding was provided to help divert money from acute care to enable LBB to provide social care. However, most of the money remained within the healthcare community. He felt that the report was helpful and informative, but hoped that at the end of the day it did not end up as a wish list that could not be funded. It was imperative that proper governance be established before any money went from LBB to another organisation.

The Chairman noted that there was no schedule or timescales in the report and this was concerning. If joint integration was the aim by 2020, what was the mechanism that would enable both parties to arrive at the required destination on time. Mr Feven responded and said that all of the projects detailed in the report had either already been completed or were a work in progress.

A Member asked what the position with respect to the alignment of contract registers was. Mr Taegtmeyer answered and explained that work on this had already commenced by a joint team. The intention was that where possible, commissioning and contract information between the CCG and LBB be aligned.

At this point the Director of Commissioning urged caution, and the need to pull back. Matters of governance had to be resolved first. Risks would need to be clarified in a business case together with who was responsible for what system. If LBB were giving the CCG access to their contracts database, the reasons for this would have to be clarified and clearly understood. 

A discussion followed around the four themes mentioned in section 3.3 of the report. The Chairman agreed that the matter of Care Homes and the mental health of children and young people should be priorities. The Chairman expressed the view that it was important that LBB was involved in the decision making process regarding priorities, as Councillors were accountable to the public. He wondered how the CCG was scrutinised. Mr Taegtmeyer responded that the CCG was accountable to the NHS and to other partners. 

The Chairman re-iterated his concerns that in an environment where over the next two years the Council had to find savings of £39m, it was difficult to see how all of the joint commissioning plans could be afforded. Mr Feven responded that to do nothing was not an option. A Member stated that in the future he would like to see a report that focused more on timescales and outcomes. The public were not interested in Boards, Committees and funding, but were simply interested in what was going to be done and when. In short they were interested in practical outcomes.

The Chairman referred to in year reductions in budgets. Would this be written into the joint contracts. LBB normally asked for continuous improvements and efficiencies. Mr Taegtmeyer replied that the CCG had quality improvement programmes in challenging financial landscapes, and this was not a foreign concept to the CCG. This has been ongoing in the CCG since April 2013.

The Chairman thanked Mr Feven and Mr Taegtmeyer for their time in attending and the meeting, and for a very useful discussion. 

RESOLVED that the joint commissioning update report is noted.