Accountable Officer for Health & Care Strategic Commissioning Function (SCF) & Pooled Fund Bolton Locality. Wirin Bhatiani, Chair

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1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 9 Date of Meeting: 30 th November 2018 TITLE OF REPORT: AUTHOR: PRESENTED BY: PURPOSE OF PAPER: (Linking to Strategic Objectives) Accountable Officer for Health & Care Strategic Commissioning Function (SCF) & Pooled Fund Bolton Locality Tony Oakman, Chief Executive, Bolton Council Su Long, Chief Officer, Bolton CCG Wirin Bhatiani, Chair In July 2017 the GM Health and Social Care partner organisations approved the GM Commissioning Review. In July 2018, Bolton CCG Board, Bolton FT Board and Bolton Metropolitan Council Cabinet approved a paper that established a high level Health and Social Care Integration model. The report recommendations approved: The strategic approach Agreed milestones which establish the Strategic Commissioning Function and the Integrated Care Partnership. Further detailed updates on specific pieces of work which underpin the implementation of an Integrated Health and Care system. The report proposes an approach for a single accountable officer for Bolton, with the aim of ensuring we retain the strong partnership and sense of ownership from each statutory organisation within a place-based system. This would achieve a key milestone in our plans for delivering integration. LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): Deliver Year 3 of the Bolton Locality Plan. Ensure compliance with the NHS statutory duties and NHS Constitution. Deliver financial balance. Regulatory Requirement. Standing Item. 1

2 RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) The Board is asked to approve the approach as outlined in section 4 of the report. The development of the Strategic Commissioning function (SCF) and Integrated Care Partnership (ICP) is being led by the Bolton Strategic Partnership Board. Updates on progress will continue to be provided to Bolton CCG Board regularly. COMMITTEES/GROUPS PREVIOUSLY CONSULTED: CCG Board Development Session November 18 REVIEW OF CONFLICTS OF INTEREST: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: OUTCOME OF EQUALITY IMPACT ASSESSMENT (EIA) AND ANY ASSOCIATED RISKS: Conflicts of interest have been reviewed throughout the development of this report. Patient views are not specifically sought as part of this report but are being gathered as part of the ongoing work to join up services in Bolton. EIA reviewed and confirmed no issues at this stage in the process. 2

3 1. Introduction In July 2017 the GM Health and Social Care partner organisations approved the GM Commissioning Review. A recommendation of this review that is now being implemented is development of Strategic Commissioning functions as follows: Local Authorities and Clinical Commissioning Groups must come together to form a single, small and strong Strategic Commissioning Function (SCF) with a breadth of responsibilities. The SCF must support the LCO to strengthen its existing Neighbourhood Leadership Systems to include clinical and political leadership, personalised care, asset-based community development, and citizen and community engagement The SCF must deliver a significant pooled budget across health, social care and wider public services, enabled by a risk-sharing agreement The SCF must adopt an investment-led approach to commissioning and decommissioning, and support the move away from hospital and residential care services to investment in prevention, early intervention and community voluntary sector In July 2018 Cabinet with partners approved a paper that established a highl level Health and Social Care Integration model underpinned by a Memorandum of Understanding. In Bolton, these steps are being overseen in partnership by the Bolton Shadow Partnership Board. As part of these reports there is a clear expectation that in each locality there is the establishment of single accountable officer for the pooled budget for health and social care; a person who: Is accountable within the locality for the pooled commissioning programmes for health and care Provides a leadership role to the developing SCF Is accountable to the GM partnership for the delivery of the commissioning priorities/ outcomes for health and social care as relevant This paper proposes an approach for a single accountable officer for Bolton, with the aim of ensuring we retain the strong partnership and sense of ownership from each statutory organisation within a place-based system. The model also builds on current operational requirements in Bolton: Maximise the strengths of the economy and organisational capability Need to minimise clinical risk and engagement of clinicians Maximise strategic focus on outcomes Pick up pace and therefore consolidate capacity & capability in respective organisations Respect sovereignty arrangements which currently exist Effective deployment of resources for the Bolton Population It also is consistent with the GMCA Public Service Model. 3

4 2. GM models for single accountable officer There are already several examples of single accountable officer for health and care commissioning in GM which range as follows: a) CCG Accountable Officer taking responsibility for joint heath and care commissioning as a standalone entity, separate from the Local Authority (Manchester) b) Local Authority Chief Executive replacing CCG Accountable Officer and undertaking both roles (Tameside) While both of these extremes provide a single accountable officer for NHS and social care commissioning, they do not reflect the situation in Bolton where there is a strong partnership ethos between a high performing Council and CCG, each with strong leadership. It is also important to note the models highlighted have been based upon relationship development and this takes time. New leadership arrangements have been in situ in Bolton for approximately 10 months. The key message is Bolton s approach build on strengths, capabilities and assets not differences and is much shaped from the front line as it is strategically. Via the MOU and Partnership board and partnership arrangements this approach will evolve and consolidate over the coming 24 months. 3. Proposal It is proposed that the Accountable Officer of the CCG takes on the role of Accountable Officer for heath and care commissioning outcomes /programmes within Bolton on behalf of the CCG and Council. As the Accountable Officer the post holder will provide a single leadership focus for Coordinating and overseeing the programmes of activity across Bolton. This will also include a direct responsibility for CCG investment and providing a unified view on all aspects pertaining to Health and Social Care expenditure. This proposal reflects that the statutory role of the Accountable Officer of the CCG already has accountability for delivering best health outcomes from effective commissioning of services with the 450 million NHS commissioning budget in Bolton. This is an integrated approach with a place-based accountability ultimately via the Chief Executive of the Council through to the Leader of the Council, Chair of CCG and the, Bolton Partnership Board and Health & Wellbeing Board. This also builds on the Accountable Officer role undertakes as Senior Responsible Officer for the Locality, which involves: Responsibility for ensuring the locality plan meets its objectives and delivers identified benefits (agreed locally and with GM in the accountability agreement with GM H&SC) Reporting to the Bolton Health & Wellbeing Board Acting as the locality voice for Bolton, reporting to GM and communicating key locality messages to GM and vice-versa Ensuring stakeholder commitment, brokering agreement between stakeholders on objectives and benefits and how they will be delivered / implemented. 4

5 Decisions on pooled health and care budgets will be made collectively through the agreed decision-making governance and supported by Section 75 agreement. The role and accountabilities of the Accountable Officer are outlined in section 4, below. It is important to note that statutory responsibilities of current organisations and individuals will be protected, namely: Deputy Director of People (Director of Adult Services BMBC) (DASS) Director of People (Director of Children s Services BMBC) (DCS) Director of Public Health (BMBC) (DPH) S151 Officer (BMBC) Chief Finance Officer (BCCG) Chief Accountable Officer (BCCG) Day to day oversight will be achieved via joint leadership and programme management activity and governance processes. The commissioning programmes and activity of all of the above will be held accountable via the Bolton Partnership Board. Planned Co-location of commissioning functions will greatly benefit this approach. The model is proposing integrated arrangements; integrated programmes of commissioning and service improvement which are overseen by the Bolton Partnership Board. Opportunities to develop integrated line management will develop over time. This is in recognition of the requirements of the current arrangements as outlined in section Role and accountability Chief Executive / Accountable Officer The Chief Executive will lead and work in partnership with the Accountable Officer to ensure strategic direction is consistent with 2030 Vision and aspirations of Taking Charge Locality Planning etc. There will be a reporting line from the Accountable Officer to the CEO. This will be subject to review via a three-way appraisal process with the Chair of the CCG. The Chief Executive will provide strategic oversight and direction to all roles to underline the place-based leadership role. The Accountable Officer will via the Chief executive and Chair and Board of Bolton CCG ensure politicians and clinicians are sighted on key strategic risks, challenges and opportunities and provided every opportunity to set strategic direction and influence represent Bolton health and care commissioning both within the locality and outside as a single entity, representing the partnership within Bolton not organisational interests develop the Strategic Commissioning Function, making proposals for partnership agreement of its scope and form, establish programmes of activity and secure the appropriate resources and capacity to deliver 5

6 account to the Bolton Partnership Board and Health & Wellbeing Board for delivery of locality plan objectives and outcomes through implementing the health and care Commissioning Strategy for the local population with programme support, ensure provision of papers/ data to the Bolton Partnership Board to enable effective decision making work as a member of the Bolton Council core leadership team, reporting to the Council Chief Executive in their leadership of the place-based vision and strategy provide assurance on the delivery of safe, effective health and care services in Bolton that support the Council and CCG to meet regulatory and statutory requirements of all commissioned services in conjunction with the relevant statutory officers coordinate the annual health and care budget agreed with CCG and Council in consultation and partnership with the relevant statutory officers DASS, DCS, DPH. Provide reporting, risk management and delivery of prioritisation and savings process provide leadership and ensure effective relationships with all local health and social care providers so as to ensure their active support in delivery of commissioning intentions represent Bolton health and care commissioning at the GM Joint Commissioning Board, alongside political and clinical representatives Work with the commissioning decision making body and in partnership with statutory officers to ensure: - decisions are taken with regard to securing the best use of public money; - the voice of Council and CCG members is heard and the interests of the public and the community remain at the heart of discussions and decisions; - decision making is responsive to the views of local people and promotes self-care and codesign - decision and recommendations of the pooled budget and commissioning are taken in partnership with the relevant statutory officer: DASS, ECS, DPH Statutory Accountability to NHS England (via CCG Board & GM) ensure the CCG commissions the highest quality services with a view to securing the best possible outcomes for their patients within their NHS resource allocation and maintains a consistent focus on quality, integration and innovation; ensure the CCG, when exercising its functions, acts with a view to securing that health services are provided in a way which promotes the NHS Constitution duty to exercise CCG functions effectively, efficiently and economically; duty to meet financial obligations, obligations relating to accounting and auditing; and duty to provide information to NHS England, following requests from the Secretary of State. Accountability to CCG Board via CCG Chair The post holder will also need to be accountable/report to Chair of CCG for the post holder s health statutory functions. The Chair of the CCG will importantly still meet on a regular basis about specific issues arising from matters pertaining to the CCG such as: delivery of statutory accountabilities above organisational development of the CCG to meet strategy 6

7 ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the governing body) of the organisation s ongoing capability and capacity to meet its duties and responsibilities All of the above is part of a wider place-based system promoting a wider determinant of heathbased approach and consistent with the GMCA Public Service Model The post holder will recognise and take account of the differing statutory roles and work as a lead for a wider system which ensure those individual statutory roles are able to deliver their duties regarding market shaping, sustainability and provider failure In the event of any dispute resolution pertaining to service, commission or finance issues will be sought via accountability arrangements or locally the Shadow Partnership Board. 5. Summary of benefits Bolton has a strong history of partnership working between the Local Authority and the NHS. The intention is to bring two leadership teams together and use their skills with matrix style working, rather than focusing on structural change. By bringing together the accountability for health and care budgets in Bolton, the aim is to support the move away from hospital and residential care services to investment in prevention and early intervention and wider outcomes. Decisions will be made by a balanced formal commissioning committee, with the support of an accountable officer to involve health considerations into day to day Council planning as well as bringing an understanding of social care and public health responsibilities into NHS discussions. This approach will: Sustain capability and capacity Focus on outcomes Deliver at appropriate pace a sustainable solution Recognise the skills and capability in Bolton Accommodate flexibility and change for the future Create a more integrated system and service designed around the needs of citizens and in line with the wider GMCA approach 7