Agenda item

The Sub-Committee is provided with a report on Croydon’s Integration Journey to inform its discussion.

The Sub-Committee considered a report together with an accompanying presentation on the integration journey to date for the Croydon Health Service NHS Trust (CHS) and the Croydon Clinical Commissioning Group (CCG). This was divided into three specific areas, namely the approach to integration with social care, how the integration between CHS and CCG was progressing and an update on the Integrated Community Networks. The following representatives were present at the meeting for this item:-

·         Agnelo Fernandes – Chair of Croydon CCG

·         Matthew Kershaw - Chief Executive and Place Based Leader for Health NHS Croydon CCG and Croydon Health Services NHS Trust

·         Guy Van-Dichele – Executive Director for Health, Wellbeing & Adults – Croydon Council

A copy of the presentation can be found at the following link:-

https://democracy.croydon.gov.uk/documents/s20442/CCG%20-%20CHG%20Integration%20-%20Presentation.pdf

Following the presentation the Sub-Committee was given the opportunity to ask questions on the integration journey, with the first relating to the possibility of change at a senior level within the team. It was advised that the scale of the challenge in delivering integration was recognised, but there had not been a notable increase in staff leaving on the basis of the changes. In fact it had been found that more consultants were looking to work in Croydon because of the pioneering integration work.

As it was noted that different localities across the borough faced different challenges, it was questioned how this would be managed. It was advised that the purpose of the Integrated Community Networks (ICN) was to address some of these issues. Although it would not be possible to have totally different ICNs as there were many common health issues, there will be certain services that need to be focussed in specific areas to address the need of the local population. Additionally it was also about building on existing ways of working, such as the GP Huddles which had resulted in a 15% reduction in hospital admissions.

In response to a question about delegation from the South West London CCG and whether there had been anything retained at the higher level that could be delegated to Croydon, it was advised that most decisions had been delegated. Certain specialist services needed to remain at a higher level due to workforce issues with a limited number of staff able to deliver these. Discussions were taking place about the budget being fully delegated to Croydon, which would then allow the decision to be made locally on what services were returned to the higher level. It would also allow funding to be compared with other areas and in doing so it was hoped that the funding for Croydon would be levelled up with the other areas under the South West London CCG.

Reference was made to the original integration plan from 2016, with it questioned what had not been delivered from this plan. It was advised that at present the information points were only available in Thornton Heath, but this would be expanded as the localities work progressed. There had been challenges relating to IT connectivity which impacted upon the introduction of the My Life Plan scheme which had resulted in it morphing into the Coordinate My Care Plans, with Croydon currently rated first in London for the creation of these plans.

It was highlighted that there was a deficiency in signposting patients towards the voluntary sector, with it acknowledged that there were challenges in this area. Health services currently operated a siloed system by design which needed to change in order to be able to deliver further integration.

In response to a question about the longer term vision for integration it was highlighted that the public expected there to be closer integration between health and social care. It was important to have a bold vision, with work underway to test how to align budgets between health and social care. There would also be a need to change how people work, with a move to multi-disciplinary teams to support people’s needs. Looking further forward, there would also be a need to address the wider determinates of health and wellbeing such as housing and employment.

As there had been moves towards greater integration before that had not been sustained, it was questioned whether reassurance could be given that it would be successful this time. In response it was advised that previously the NHS had operated separately from other organisations and was now part of a wider system. There was also a push towards greater integration nationally which meant that the environment for change was substantially different from when it had previously been attempted.

In response to a question about lessons learnt from the process so far it was advised that one of the key factors to progress was workforce, with it important to increase involvement to ensure that change was being delivered from the ground up. How communication with the public was managed was also important as this helped to change behaviour, with a need to work with people earlier to help improve their lives.

It was highlighted that the potential changes at Epsom, St Helier and Sutton hospitals could have a significant effect upon Croydon University Hospital and whether the possible impact had been considered. It was advised that preparatory work had been undertaken to understand the possible impact with it found that should the acute site be located at St Helier the impact would be largely neutral, if it went to Sutton it would slightly reduce demand, with the biggest impact arising if it went to Epsom requiring additional resource to build capacity. CHS would be responding to the consultation with the view that each of the three options were deliverable, but with a different level of challenge depending on where it was located. It had not been proposed to upgrade all three sites as this would not achieve the aim of delivering the infrastructure to provide a sustainable and safe clinical model.

It was confirmed that there was a principle that ICNs would have Community Reference Groups to refer to and check ideas as they progressed as having an evidence base on the various population across the borough was essential.  

At the conclusion of this item the Chair thanked the representatives for their attendance at the meeting.

Conclusions

Following discussion of this item the Sub-Committee reached the following conclusions:-

1.    The Sub-Committee felt that the work carried out to date on integration was positive and were reassured that progress was being made.

2.    The move to investigate the potential alignment of health and social care budget was welcomed, particularly in light of continued funding challenges.

3.    The Sub-Committee retained a concern that the challenge of delivering integrated software systems would be one of the key risks to the success of integration.