Agenda item

To receive a presentation and discuss an update on the Integrated Care System (ICS).

The Director of Strategy Croydon Health Services, Neil Goulbourne, presented the update. He explained that the transition to the new arrangements in April 2022 would be managed through the One Croydon Alliance structures.

There had been a round of significant organisational changes to the NHS circa 10 years ago and Clinical Commissioning Groups (CCGs) were introduced. Their creation brought greater competition for services and a collaborative approach was encouraged, which differed to previous reforms. He noted that a progress had already been made in Croydon towards integrated working, more so than other regions, which was reflected in the white paper.

The purpose of the white paper, and the legislation to follow, was to encourage development in those collaborative approaches, to remove further of the barriers to integration and to formalise agreements where consensus was identified.

The guidance sets out that services should be delivered locally where possible, closer to patients and their communities.  He informed the Board that the white paper was relatively silent on social care and was primarily NHS and acute care focused. The government had set out an assurance that there would be further reform of social care, but it was not addressed as part of these papers. He added that the white paper was also notably light on Public Health, however  it was clear they would have a role to play.

A Partnership Board would be introduced at Integrated Care System (ICS) level, which would have an advisory role and would create a long term strategy bringing together the NHS and partner. Additionally, there was a newly introduced requirement of a duty to collaborate placed on the NHS and local authorities; however that would not bring a material effect to Croydon as those systems were already in place.

The role of Health and Wellbeing Boards was still seen as important entities, and although it was left to local discretion as to the Boards involvement, it was repeatedly acknowledge that they should be integrated into the developments.

There were three elements to the ICS:

·       ICS Level Body – This would comprise of a board, a partnership board, an executive team and a significant number of staff. Strategic planning would be carried out and the focus would be on inequalities.  There was a disproportionate level of need within Croydon and for which funding was note reflected and should be adjusted accordingly.

·       Place – In SW London there were 6 ‘Places’, Croydon being the largest by population. 

One Croydon Alliance closely matches how Place should operate, as outlined within the white paper. There would need some changes to be made to enable Place to form a contract with the ICS, through which it would have delegated powers.

·      Provider Collaborative – There was a SW London Acute Provider Collaborative which brought together the four Acute Provider Trusts.  Using those systems, there were collaborated share back services and clinical pathways providing mutual aid to manage waiting times. 

The white paper and guidance presented an enhanced role for all collaboratives with a suggestion they should do more to reduce inequalities and challenge providers to improve performance.

Croydon was already well placed for achieving the white paper objectives by having a defined transition team with representation from the various partners.  The transition would take place through the One Croydon governance.

There were a number of to complete over the next few months ahead of the transition.  A plan had been developed including to decide the organisational form, outcomes which could be achieved and the basis of the contract with the ICS.

The Chair thanked the Director of Strategy Croydon Health Services for his presentation and invited questions and comments from the Board.

The Healthwatch CEO, Edwina Morris, stated that they had carried out work seeking local residents’ views when CCGs were merged into the SW London CCG.  Concern was raised about decision making becoming more remote away from Croydon. She stated that she was pleased to hear that Croydon Place would be a strong entity, but expressed concern about how delegation to Croydon would be achieved. It was positive to see the new guidance making reference to the role of Healthwatch, the voluntary community and the social enterprise sector as being strong in representing local views at the Croydon Place level. However, she added that it was less clear about how they would be represented at the SW London level.

Councillor Hopley said there was clearly significant change ahead and she had several constituents asking what this meant for them.  She had concerns regarding the disproportionate level of need within Croydon and the governance arrangements regarding outcomes for Croydon and the role of Public Health.  Councillor Hopley asked how Croydon councillors would be involved in the work and the role of GPs.

The Director of Strategy Croydon Health Services responded that locally and nationally there was buy in to the principal of subsidiarity.  Discussions with colleagues across SW London would take place with the key element being the ICN+ model and how health and care services build within localities.

The Vice Chair, Dr Agnelo Fernandez, responded that there was a patient forum across SW London already and that He and Councillor Campbell attended the Health and Care Partnership Board where the patient and voluntary care voice was heard. He stated that Croydon had a greater population and diversity and it was a key element that appropriate funding for Croydon be put in place. He explained that going forward that the NHS Board would have the executive and non-executive board members but also one local authority person, one GP (not representing general practice) and one member from the hospital trusts, as well as the Chief Executives of the trusts. The key element was to make sure subsidiarity was enabled with the structures of One Croydon Alliance being robust. Further guidance on the Partnership Board was pending.

The Director of Operations (Croydon Council), Annette McPartland, added that it was very important that the local authority was represented within all groups. The long awaited reforms for social care would come into force and it was essential that funding reached the right places.

The Director of Public Health talked about the pandemic, which was still prevalent and a threat, and expressed her condolences to anyone who had been impacted. 

Having spoken with colleagues across SW London regarding the amount of people who had vaccinations within Croydon and the inequalities and demographics experienced within the Borough, the Director or Public Health stated that the local authority retained Public Health and there would be a further paper regarding the future of Public Health England. She said a an update would be presented to a future Board.

Councillor Fitzpatrick asked for elaboration on accountability in the ICS, who the accountability would be to and what preliminary thinking had been done to improve the accountability of health providers. In response, the Director of Strategy (Croydon Health Services) responded that there was the aspiration to foster partnership regardless of organisational boundaries and to blur the lines of accountability and responsibility. He stated that this had been an initial discussion and the white paper was a drawing from earlier in 2021, the guidance was now available and the legislation would follow, together with further discussions through the One Croydon Alliance.