Version 2.5 (Final) Alliance Agreement for Berkshire West Integrated Care System. Alliance Agreement for Berkshire West Integrated Care System

Transcription

1 Alliance Agreement for Berkshire West Integrated Care System Version 2.5 (Final) Dated : 05/09/2018 Berkshire West CCG Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust 1

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3 Index 1. The Agreement 1.1. Background 1.2. Purpose 1.3. Commencement and Term 2. The Alliance 2.1. Objectives 2.2. Principles and benefits 2.3. Governance Governance Overview Programme Leadership Clinical Leadership Other Collaborative Working Groups 2.4. New Participants 2.5. Transparency and Information Sharing 3. Costs, Liability and Indemnity 3.1. Alliance costs 3.2. Shared Control Totals 3.3. Liability 4. Agreement Variation 5. Dispute Resolution Process 6. Agreement Termination 7. Entire Agreement 8. Warranties 9. Schedules 9.1. Member details 9.2. Service Contracts 9.3. Shared Control Total 9.4. Risk and Reward Sharing Agreement 9.5. Assurance Framework and KPIs 9.6. Scope of the ICS Programme 3

4 1. The Agreement 1.1. Background The Berkshire West Integrated Care System (ICS) is an initiative to create a new environment of collaboration between Our health and social care organisations to improve services for Our local population. An Integrated Care System is defined as one where health and care organisations voluntarily come together to provide integrated services for a defined population. The decision making processes of those organisations are voluntarily aligned, while the functions, delegations and governance of the Participants, and their roles pertaining to procurement law, remain as set out in existing legislation. There is a long history of collaboration within the local system, shown by the formation of the Berkshire West 10 Integration Board in September 2015 which provides a forum for the progression of any integration initiatives between NHS and Social Care organisations in order to improve service delivery and reduce duplication Our ICS was established in late 2015 following the recognition from local NHS and Social Care leaders that a new way of working was required in order to maintain a longstanding level of high performance within a constrained financial allocation. At that point three members of the ICS saw benefit in moving further and faster in voluntarily integrating services and aligning processes. A key outcome of that decision is this Alliance Agreement. The Participants for 2018/19 are: Berkshire West Clinical Commissioning Groups (CCG), Royal Berkshire Hospital FT (RBFT) - An acute Foundation Trust hospital, Berkshire Healthcare FT (BHFT) - A community / mental health Foundation Trust There is a clear vision for other organisations within the wider ICS to join this Alliance Agreement when the time is right. These are primarily Providers of GP services in Berkshire West which are configured into four locality / neighbourhood aligned primary care alliances, with an overarching Berkshire West GP Alliance which is set to be established in 2018/19. Local Government, whose current representation is through a formal link with the Berkshire West 10 Integration Programme. In the Spring of 2017, NHS England announced its support to the establishment of Accountable Care Systems (now known as Integrated Care Systems) and published a section on its vision for the approach within the Five Year Forward View Delivery Plan document. Following this, eight systems were selected for Exemplar status, of which Berkshire West was one. 4

5 1.2. Purpose of this Agreement Within the ICS, standard NHS service contracts are in place between the CCG and both RBFT and BHFT. The purpose of this Alliance Agreement is to create an over-arching agreement which sets out how the participating organisations will work together in a collaborative and integrated way, while the services contracts set out how We will provide the services. This Agreement is not an NHS contract as outlined in Section 9 of the National Health Service Act 2006, but supplements and operates in conjunction with the existing Services Contracts, which are set out in Schedule 9.2. All members remain separate sovereign organisations, and will work together over the period of this agreement positively and in good faith, in accordance with the ICS Principles, to achieve the ICS Objectives Commencement and Term This Agreement will commence from the date of signature, following the signing of the Service Contracts described in Schedule 9.2 and will be co-terminus with those contracts. Participants may agree to extend this agreement to run in conjunction with future Service Contracts. 2. The Alliance 2.1. Objectives The main objectives of the ICS, as defined by a Local Memorandum of Understanding (MOU) dated January 2016 and signed between the Participants, is to ensure that: Our population s experience of healthcare services will continue to improve; Our population continues to benefit from improved health and wellbeing outcomes; and the local NHS is financially sustainable for the future. Following the signing of the NHS England National Memorandum of Understanding 2018/19 which was issued to all Exemplar Integrated Care Systems, the Participants have defined four main domains of delivery: To make tangible progress on delivering the four priority areas of the Five Year Forward View To manage the finances within a system control total Develop integrated pathways and build population health capability Provide leadership at both a local and national level 2.2. Principles and Benefits To achieve the ICS Objectives, the Participants of the ICS will operate from the principle of clinically led, collaborative working between the organisations, in order to ensure Our services meet the health and care needs of the local population. We will use the opportunity afforded by new, nationally developed business models (e.g. new contractual 5

6 forms and payment mechanisms) which enable locally developed new care models (i.e. new ways of delivering services) to be implemented. The ICS Principles are designed to optimise the benefits We expect to be realised from new care models, in Our hospitals and in Our community settings of care, which includes primary care services. The main areas of benefits which are expected to arise are: To enable people to take more responsibility for their own health and well-being To move care closer to home, wherever appropriate To evolve clinical pathways to be better integrated across providers to improve patient experience. To increase the capability and capacity of high quality, fit for purpose primary, community and social care to provide multidisciplinary wrap around co-ordinated care that provides a good patient experience, and efficiently meets the patient s needs. To better understand the clinical needs of Our population through the use of a population health management approach and thereby to maximise the opportunity to prevent, and to intervene early to reduce the need for more intensive ongoing care. To ensure a high quality, fit for purpose mental health, acute and specialist hospital service. To develop a shared Quality Strategy and systems and take a single, system wide approach to the delivery and monitoring of quality. To operate on a single budget for the whole health care system, making the most effective use of the Berkshire West pound and delivering financial sustainability. Improve staff and workplace wellbeing, and build a sustainable and highly skilled health and care workforce in Berkshire West 2.3. Governance Governance Overview Governance has been established to enable the work of the ICS, which acts in parallel as the governance for this Agreement. It is based on a key principle of reaching joint consensus prior to any further decisions which may be required at an organisation level. We have established a programme governance structure, accountable to the boards and governing bodies of participants, to enable recommendations to be made between Us. This approach does not require formal decision making delegations from statutory boards and is founded on a number of Governance Principles, namely that we will, Strive to reach joint consensus prior to any further decisions which may be required at an organisation level; Maintain strong clinical leadership through a clinically led process to ensure that decision makers can be confident that changes are being made in the best interests of patients; 6

7 Have clear points of accountability for projects and deliverables; Provide oversight to the operation of this alliance agreement; Use business as usual / standard governance procedures as widely as possible to take decisions; Commit to wider integration with Local Government and other strategic partnerships which add value for the taxpayer; Remain transparent and open to scrutiny from patients and the public; and Provide assurance in a coherent manners to Our regulators Programme Leadership The leadership of the ICS is not formally linked to any pre-existing statutory roles and is nominated by The Leadership Team, from among its Chief Executive members. Day to day responsibility for the running of the programme resides with the ICS Programme Director, who is responsible to the Unified Executive Team, while more broadly, leadership of the programme s objectives and goals are distributed amongst the senior management of the local NHS organisations. Individual projects which reside within the ICS programme, which is made up of a number of specific projects as described in Schedule 9.6, have their own management structures with a nominated Senior Responsible Officer for delivery. 7

8 The ICS Leadership Team meets bi-monthly and will: Be responsible for leading the development and of the Integrated Care System s strategy and oversee delivery of the ICS programme Ensure delivery of the requirements set out in the National MoU for Integrated Care Systems agreed between the Berkshire West system leaders and NHS England and NHS Improvement Create a shared understanding of the end point for the implementation of the ICS and ensure this is aligned with the ICS Principles and Objectives Provide a final point of escalation for those issues or areas where system or programme performance requires the highest level of discussion, including providing the final point of escalation for matters concerning this Agreement as laid out in sections 5 and 6 below. The ICS Unified Executive meets monthly and will: Be responsible for the oversight, management and support of the activities of the ICS in order to meet the Objectives of the ICS Monitor the achievement of the Objectives and receive reports from the Programme Director on progress in the development of the delivery of the priorities as described in 5YFV and locally identified programme workstreams (see below) Review the financial performance of the ICS and its constituent organisations; providing oversight of the use of the nationally allocated transformation fund and any resources committed to the operation of the ICS programme of projects. Provide the first point of escalation for this Alliance Agreement in the event of dispute as set out in section 5 below Clinical Leadership Collaborative Clinical Leadership is a key Principle of the ICS. Strategic clinical direction and delivery is provided by the Clinical Delivery Team which meets monthly and is represented by senior clinicians from all parts of the wider delivery system. The Clinical Delivery Team will: Strengthen the clinical element of pathway redesign learning from international best practise, ensuring that the correct level of support is provided to clinically led improvement projects Be responsible for the clinical support and guidance required to ensure the implementation of shared priority projects and the tactical delivery of the 5YFV Hold each other to account for the overall delivery status of each project within the programme portfolio 8

9 Create a clinical link between the ICS Unified Executive and the individual organisations which comprise the ICS Provide clinical direction and support to a virtual shared transformation team operating across all three statutory organisations, delivering Our shared transformation priorities Other Collaborative Working Groups CFO Group The Chief Finance Officers Group brings together Participant finance leads for specific work packages, e.g. to develop an underlying shared view of the ICS as a whole, providing a forum for information sharing and joint problem solving during the development of business cases. This Group will also hold delivery responsibility for some New Business Models work packages, which currently includes: ICS Contract & Payment Mechanisms Shared Back Office / Support Services Shared Estates Strategy Programme Boards The structure and membership of delivery/programme boards for the ICS will be determined by delivery priorities, not necessarily aligned to the current thematic structure. A programme review was undertaken during Winter The ICS Leaders Team will rapidly review and implement the recommendations. Berkshire West 10 Integration Programme Although not a formal part of the Integrated Care System programme, both NHS and Local Government organisations are committed to the principles of greater integration to improve service delivery and reduce duplication. The Berkshire West 10 Delivery Group, overseen by the Berkshire West 10 Integration Board, provides a forum for the progression of any integration initiatives between the organisations. The Chair of the Berkshire West 10 Integration Board has a standing invite to attend the ICS Leadership Team meeting in order to provide a link between the two initiatives New Members There is a clear vision for other leading organisations within the Berkshire West Health and Care system to join this Alliance when the time is right. Any Participant can propose the admission of a new Participant by submitting a proposal to the ICS Leadership Team outlining the rationale for admittance and the likely impact on the Services Contracts and the Risk and Reward Sharing Agreement as described in Schedule

10 While new Participants will be admitted on a fair and non-discriminatory basis, the details of membership and the participation in risk and reward arrangements may be varied as appropriate to the constitution of that organisation and ability of new Participants to bear risk. This includes the possibility of developing a two tier approach to participation at a future date, to potentially include a Full and Associate type of participation Transparency and Information Sharing As an ICS We will produce a single strategy and operating plan, which aligns key assumptions on income, expenditure, activity and workforce. This requires an open book approach to planning and monitoring and We commit to sharing the information this entails, including that required to populate the locally developed group management accounts and assurance framework. From time to time Participants may be involved in a competitive process which will require Us to comply with the laws of competition. We will therefore make sure that we share information, and in particular Competition Sensitive Information, in such a way that is compliant with competition law and the ICS Leadership Team will ensure that the policies and processes of each Participant are promptly reviewed, amended, and kept up to date setting out clearly how information and Competition Sensitive Information is to be shared, who will have access to it, how it will be used and that all relevant staff will be properly trained to ensure proper competition law compliance. 3. Costs, Liability and Indemnity 3.1. Alliance costs Each financial year the ICS will agree a budget, including relative contributions of Participants, to cover agreed joint costs of delivering the programme. The application of this budget will be agreed by the ICS Leadership Team and progress reported monthly to the ICS Unified Executive Team. The ICS will be required to provide reports to NHSE/I regarding the use of any funding earmarked for ICS development Shared Control Totals As an ICS We agree to operate within a system control total, as described in Schedule 9.3, being the aggregate required income and expenditure position for the provider trusts and CCG within the system, as communicated by NHS England and NHS Improvement. This gives us the flexibility, on a net neutral basis, and in agreement with NHS England and NHS Improvement, to vary individual control totals during the planning process and agree inyear offsets of financial over-performance in one Participant against financial underperformance in another. 10

11 3.3. Liability Except as described in 3.1 and 3.2 above, or as affected by the Risk and Reward Sharing Agreement described in Schedule 9.4, Participants are required to meet all of their own costs and liabilities. 4. Agreement Variation This Agreement can be varied at any time by the submission of a written notice of variation by any Participant to the Leadership Team. The notice must set out the variation proposed and details of any amendments to be made as a consequence to the provisions of this agreement the date on which the variation is proposed to take effect the impact of the variation on the achievement of the ICS Objectives and Key Performance Indicators (as set out in Schedule 9.4) and any impact on any Services Contracts The ICS Leadership Team must consider the notice of variation and can accept, modify or reject the notice. If accepted it must be signed by all parties and will form part of this agreement. If rejected the ICS Leadership Team must set out the reasons for rejection. 5. Dispute Resolution Procedure We commit to working cooperatively to identify and resolve issues so as to avoid dispute or conflict in performing Our obligations under this Agreement. If a dispute does arise We agree to notify each other promptly and to follow the procedure below. In the first instance the ICS Unified Executive Team will seek to resolve any dispute to mutual satisfaction of the Participants. If the dispute cannot be resolved by the ICS Unified Executive Team within 10 business days of referral, the dispute shall be referred to the ICS Leadership Team for resolution within 25 business days. If the ICS Leadership Team reaches a decision that resolves or concludes a dispute this decision will be final and binding. If the ICS Leadership Team cannot resolve a dispute, it may select an independent facilitator to assist in working towards a consensus decision. The costs of facilitation will be met from the Alliance budget. If the dispute remains unresolved the ICS Leadership Team can agree to either terminate the Alliance Agreement, or agree that the dispute need not be resolved. 6. Agreement Termination The ICS Leadership Team may resolve to terminate this Agreement if under Service Contracts an Event of Force Majeure renders the continuation of the agreement impossible. The ICS Leadership Team may resolve to terminate this Agreement if a dispute cannot be resolved as outlined in section 5. 11

12 This agreement can be terminated at any time by the consent of all parties. 7. Entire Agreement This Agreement and the Service Contracts constitute Our entire agreement and, subject to the terms of the Service Contracts, supersedes any previous agreement between Us relating to the ICS. 8. Warranties Each Participant warrants that it has full power and authority to enter in to this Agreement and to the best of its knowledge nothing will have or is likely to have a material adverse effect on its ability to meet the obligations set out in the Agreement. 12

13 9. Schedules 9.1. Participants details Participant Address Signed on behalf of the Participant Organisation Print Name: Signature: Print Name: Signature: Print Name: Signature: Print Name: Signature: The Participants are together referred to as We, Us or Our as required by context. Participant means any of Us. 13

14 9.2. Service Contracts Contract Title Contract period Commissioner(s) Provider NHS Standard Contract 2017/18 and 2018/19 NHS Standard Contract 2017/18 and 2018/19 01/04/17-31/03/19 East Berkshire CCG Berkshire West CCG Chiltern CCG 01/04/17-31/03/19 Berkshire West CCG East Berkshire CCG Oxfordshire CCG Chiltern CCG North West Surrey CCG North East Hampshire & Farnham CCG North Hampshire CCG Berkshire Healthcare Foundation Trust Royal Berkshire NHS Foundation Trust The terms of the Alliance Agreement only impacts on contracts between Berkshire West CCG and BHFT and RBFT. All other Commissioners listed above are not affected by this agreement and the agreed terms within the NHS Standard Contract apply. 14

15 9.3. Shared Control Total In May 2018, NHSI published a 2018/19 financial framework paper Integrated Care Systems (Appendix 1) which set out the options for the Provider Sustainability Fund (PSF) and the Commissioner Sustainability Fund (CSF). The CCG is not eligible for the Commissioner Sector Fund. The options for PSF were: 1. Full PSF - 70 % of PSF monies shared dependent upon whole system financial performance (losing 1.50 for every 1 that the System Control Total is missed). The A&E element of PSF is excluded from this. 2. Partial PSF 70% of 2018/19 additional PSF monies (over and above the 2017/18 PSF monies) Shared dependent upon whole system financial performance (losing 1.50 for every 1 that the System Control Total is missed). The A&E element of PSF is excluded from this. The remaining RBFT PSF monies would be dependent upon RBFT financial performance (70%) and A&E performance against agreed trajectory (30%) 3. 50% Partial PSF Half of 70% of 2018/19 additional PSF monies (over and above the 2017/18 PSF monies) Shared dependent upon whole system financial performance (losing 1.50 for every 1 that the System Control Total is missed). The A&E element of PSF is excluded from this. The remaining RBFT PSF monies would be dependent upon RBFT Financial Performance (70%) and A&E Performance against agreed trajectory (30%) In May 2018, the respective Boards of Berkshire West CCG, Royal Berkshire NHS FT and Berkshire Healthcare Foundation Trust approved Option 2 for the Berkshire West ICS. We will undertake a quarterly financial performance review at the CFO Group Meeting at which the financial performance of each Participant will be shared and the resultant impact upon the ICS financial position will be reviewed. This review and the actions resulting from it will be included in a report which can be used at the Unified Executive meetings and attached to individual Participant finance board reports and for presentation at quarterly assurance meetings with NHSI/E. 15

16 9.4. Risk and Reward Sharing Agreement The agreement between the Participants for 2018/19 is set out below and will apply to each of the Service Contracts listed in Schedule 9.2. Overarching financial principles The following five overarching financial principles are supported by the Participants: Controlling the cost of system delivery; Transparency of costs, risks, reserves and mitigations between Participants; Working towards an appropriate system risk sharing and opportunities across the ICS; Joint investment decisions; and Developing and monitoring a revised regulatory approach Financial Payment Mechanism 2018/19 BHFT has held a block contract with the CCG for a number of years and this will continue for 2018/19. In line with the financial principals set out above, RBFT and the CCG wish to move to a cost based contract with 50:50 risk and gain share on cost variances versus indicative contract value. This will require an increased understanding of cost behaviour in relation to provision of healthcare services and particularly when levels of activity demand fluctuate. This agreement overrides all other financial mechanisms within the standard contract (such as MRET, CQUIN, performance penalties). Both RBFT and BHFT have agreed that the 2018/19 financial payment mechanism will be based upon a block contract form of payment with risk and reward sharing as outlined below. This will require greater understanding of the cost of activity variance from plan and this will be reviewed through the regular ICS CFO Meetings. Where required, a contract variation will be made to the relevant Service. The Participants who are parties to the Service Contract which is being varied will ensure that all necessary governance and regulatory approvals are complied with. Risk and Reward Sharing It is agreed that the financial reserves of the CCG and RBFT will be shared within the Berkshire West ICS. The contract payment will be varied according to the 50:50 agreed split on cost variances within the RBFT and 60:40 split of the system gap which may crystallise at the Berkshire West CCG level. This was been approved by Boards of those organisations in June BHFT risks and mitigations continue to be held by the FT reflecting the payment mechanism option selected. This approach is being discussed at Finance and Investment Committee and Board. 16

17 The system wide risk includes the Berkshire West System Financial Gap for 2018/19, estimates of the financial impact of activity demand pressures upon each organisation and estimates of risk in respect of financial savings targets, together with offsetting mitigations and reserves (as shown in the illustrative example in Appendix 2). The percentage shares of CCG risks and mitigations have been calculated based on the share of the commissioning budget that is invested with each provider. The provider risks and mitigations are shared on a 50/50 basis. 17

18 9.5. Assurance Framework and KPIs The Assurance Framework and KPIs will be developed during 2018/19 for inclusion in 2019/20. 18

19 9.6. Scope of the Integrated Care System Programme The overall timeline for the Berkshire West ICS programme can be defined by a number of distinct phases shown as follows: 2015 / 16 Spring 2016 Summer 2016 Summer /19 20/21 Agreed case for change & vision High level options appraisal Established ACS and signed local MOU National MOU signed with NHS England Deliver 5YFV and Financial Balance Identifying the need for change & vision for the future Identifying the options for the future state and selecting the preferred Defining the future and what it means for all parties Formalising the status of the ACS as a national exemplar Delivering the objectives of the programme and the national MOU The first four phases of the programme have now been completed with the National MOU being signed by all statutory bodies in September The programme must now take a renewed focus on the implementation of new care and business models in order to ensure forecast benefits are realised for the local population. The delivery phase will include: Driving the implementation of those workstreams already identified within 2018/19 plans for both New Care Models and New Business Models Identifying further areas of clinical change which will help realise the programme objectives Taking a system wide approach to financial control Working collectively with regulators to ensure a coherent approach to service planning and delivery Jointly developing investment proposals, including those requiring capital, to take shared decisions on how best to spend our collective resource The delivery phase of the programme may be considered complete when all of the programme objectives have been delivered, with realised benefits, and a steady state has been maintained. 19