Agenda item

Report ACH19008

The Committee considered a report setting out further information on proposed changes to the NHS commissioning system in Bromley, and seeking support to progress with arrangements to better integrate health and social care commissioning, including the appointment of a joint senior post to manage commissioning, contract management and brokerage for Adult and Children’s Services and for NHS community services.  The report also provided information on the progress made on ‘One Bromley’; the local health and care partnership.

The Chairman welcomed Dr Angela Bhan, Managing Director Bromley CCG, to the meeting.

In response to a question from the Vice-Chairman, the Managing Director (Bromley CCG), confirmed that the Level 2 model that was being recommended for Bromley would ensure that budgets would be kept separate and ensure that the Council was not exposed to the risks of NHS budgets.  The purpose of the proposals was building on the positive relationships that were already in place and continue to build a consensus.  A Place Based Board with joint chairmen was being proposed and protections had been built in around any votes that would be necessary concerning budgets (i.e. if a proposal had implications for only Local Authority budgets then only local authority representatives would be able to vote – the reverse would be true in the case of proposals affecting only NHS budgets).

A Member suggested that the proposals before the Committee represented a pragmatic way forward which minimised risk by allowing project based co-production and co-development.  Scrutiny processes would remain the same and the Place Based Board represented an additional interface with existing structure with 3 representatives of the CCG having seats on the Place Based Board.

In response to a question from the Chairman, the Managing Director (Bromley CCG) confirmed that the new joint commission post that was being proposed would be entirely dedicated to Bromley and it was proposed that the Place Based Director would jointly accountable to the CCG Accountable Officer and the Council Chief Executive.  A Member expressed concern that the proposed Place Based Director for Commissioning could have a conflict of interest as they would be employed by the CCG yet accountable to the Council.  In response, the Managing Director (Bromley CCG) highlighted that ‘One Bromley’ was about developing a joint approach to shaping services.  The aim of the current proposal was to try to ensure that strategy and plans were integrated without any financial exposure.  The Committee received assurances that the Council’s commissioning processes would remain the same.

Members discussed engagement with Bromley Healthwatch, noting that Healthwatch was part of the Governing Body of the CCG.  It was noted that there were some interim issues with Healthwatch which would require a collective approach.

A Member highlighted that there was a great deal of good practice in other Local Authorities and that there needed to be a mechanism to ensure that reports detailing this good practice were brought back to Members.  Going forward it would be important for Members to fully utilise the scrutiny powers that were available.

Following a discussion it was agreed that the Managing Director (Bromley CCG) would provide further clarification around the possible phasing out of Level 1 in March 2021.

In response to a concern raised by a Member concerning the open ended salary package outlined in recommendation 3, the Managing Director (Bromley CCG) and the Director of Adult Social Care provided assurances that Director-level salary bands were clearly defined and there was a maximum level that could be paid.

Turing to the recommendations, a Member suggested the following amendment to recommendation one:

“That the Executive be recommended to support the development of a borough based structure that would better integrate health and social care commissioning”

The amendment was agreed.

RESOLVED: That the Executive be recommended to:

1. Support the development of a borough based structure that would better integrate health and social care commissioning;

2. Progress with integrated commissioning at level 2 for  Bromley – Aligned Commissioning; and

3. Recommend to Full Council the recruitment and selection of a joint role between the Council and the CCG to lead commissioning on a salary package higher than £100k, pursuant to the Localism Act 2011. Previously, the plan was that this should be a Director level role but the current intention is that the post holder reports to the Director of Adult Services and to the Place Based Director who will have delegated authority and budget from the new proposed SEL CCG. The role of this post will be to:

·  Manage the commissioning, contract management and brokerage functions for Adult and Children’s services.

·  Manage the commissioning and contracting function for the NHS in Bromley.

·  Seek to gain efficiencies  and improved productivity in a joint commissioning,  contract management and brokerage team, thereby releasing resources for health and social care

·  Ensure that commissioning,  contract management and brokerage functions are aligned to gain maximum efficiency and productivity, eg in the merging of two teams.

·  Ensure that NHS and social care processes are aligned to achieve maximum value for money for the population of Bromley and commissioning organisations.

·  Seek to gain efficiencies  and improved productivity in a joint commissioning,  contract management and brokerage team, thereby releasing resources for health and social care

·  Ensure that commissioning,  contract management and brokerage functions are aligned to gain maximum efficiency and productivity, eg in the merging of two teams.

·  Ensure that NHS and social care processes are aligned to achieve maximum value for money for the population of Bromley and commissioning organisations.