Agenda item - Update on the STP/Brighton & Hove Caring Together/Health & Social Care Integration

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Agenda item

Update on the STP/Brighton & Hove Caring Together/Health & Social Care Integration

An update from Brighton & Hove CCG on recent activity in terms of regional and local strategic issues (copy attached)


6.1       This item was introduced by Dr David Supple, Chair of Brighton & Hove CCG. Dr Supple outlined recent developments in the Sustainability & Transformation Partnership (STP), the Central Sussex & East Surrey CCG Alliance, and in local health and social care integration.


6.2       Dr Supple told members that progress on the STP has continued to be slow. However, a new governance structure is being introduced, the new STP Chair is now in place and a clinical case for change is being developed. The CCG Alliance is coming together at pace. We are already seeing better relationships with providers since multiple commissioners have been superseded by a single commissioning relationship. This will help the local health and care system plan for winter pressures. Health and social care integration has been complicated by the emergence of the Alliance and progress has effectively paused until there is more clarity on the precise roles of the CCG going forward. The CCG also has significant budget pressures which need to be fully understood.


6.3       In response to a question from Cllr Janio on the impact in delays in developing the STP, Dr Supple told members that there had been no significant impact as the CCG Alliance has delivered parallel improvements to those that might have been expected from a more developed STP.


6.4       In answer to a question from Cllr Janio on whether the integration shadow year may need to be extended, Dr Supple responded that it was too early to say, but that it was possible that the shadow year would need to be extended by some months.


6.5       In response to a question from Cllr Greenbaum on the availability of material explaining the STP governance changes, Dr Supple agreed to forward information to members.


6.6       In answer to a question from Cllr Greenbaum on integration, Dr Supple told members that this was proceeding at a different rate in different areas. For example, East Sussex has progressed much further than Brighton & Hove via the East Sussex Better Together programme. There is no requirement for integration to happen concurrently across all areas and no local integration plan will be slowed down to allow other areas to catch up.


6.7       In response to questioning from Cllr Allen on CCG funding, Dr Supple informed the committee that BH CCG has not yet finalised its plans to make in-year efficiencies, but will do soon and will share these with the HOSC once they are in the public domain. The forecast of an increased budget gap this year is essentially due to growing activity. Although CCGs across the Alliance all need to make in-year efficiencies, each CCG is a sovereign body and there is no sharing of deficits. The savings targets will be challenging, but it is important to stick to them because of the offer to write-off other deficits if the Alliance area achieves its control total.


6.8       In answer to questions from Cllr Marsh on the recent announcement of additional NHS funding, Dr Supple told members that the funding does not commence until 2019-20, so will not impact on this year’s spending. The additional funding will be helpful, but will not solve all local NHS financial problems. However, the CCG is confident in its budgeting this year because it has an agreement in place with Brighton & Sussex University Hospitals Trust which should help manage in-year costs.


6.9       In response to questions from Cllr Morris about the Alliance, Dr Supple explained that merging posts reduced the number of senior staff and made the posts more attractive to high calibre applicants. Previously the individual CCGs had struggled to recruit to a number of important posts, but this is expected to improve. Dr Supple stressed that the scaling-up of CCGs is going on across England; if CCGs do not coalesce voluntarily it is likely that they will eventually be made to do so.


6.10    Fran McCabe questioned where the strategic oversight on local healthcare issues was located, noting that recent announcements on city primary care, including GP practice closures, the decision to end the walk-in centre contract and uncertainty about Urgent Care Centres, seemed indicative of a lack of grip. Dr Supple agreed that it was important to establish which issues would remain local and which would be held at Alliance level. It seems certain that GP commissioning will remain a local activity, however.


6.11    In response to a question from Cllr Hill on in-year efficiencies, Dr Supple told members that the CCG has developed a plan to make in-year savings. This has yet to be approved by the CCG Governing Body, but will be shared with the HOSC once it has been.


6.12    Cllr Janio noted that, whilst some members characterised these savings as cuts, the position was actually that CCGs in the Alliance were being required to reduce their combined overspending. If they were successful in meeting their control total, they would be rewarded with significant additional money from Government. Dr Supple agreed that this was correct, although the impact on Brighton & Hove will be a reduction in the baseline 18/19 budget.


6.13    In answer to a question on public engagement from Colin Vincent, Dr Supple acknowledged that engagement on the STP had been flawed. However, the CCG does lots of engagement in Brighton & Hove and has plans to engage with the public on its financial planning and on Clinically Effective Commissioning.

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