[To receive an update presentation on the STP (Sustainability and Transformation Partnership). Steven Marshall (Director of Strategy and Transformation CCG) will give the initial update and then there will be a wider discussion with Health Partners and the Panel].
The Chair and Vice-Chair of the Health Scrutiny Panel had submitted the following questions in advance to the Deputy Chief Accountable Officer of the STP, Mr Steven Marshall.
1) Who do you see the STP as being accountable to?
2) Where does the Chair and Lead Officer get their support from?
3) How do you see the STP evolving into an ICS (Integrated Care System)?
4) What Governance arrangements do you foresee for the future ICS?
5) What role do you see for Local Government in the ICS?
6) The CCG in Wolverhampton has been rated as outstanding in the last four years. This is partly due to excellent finances. How do we ensure that Wolverhampton does not suffer financially in the future, with money being allocated in other areas at the expense of Wolverhampton?
7) How can we ensure that the future ICS will not make some health services worse in Wolverhampton?
8) Will the meetings of the future ICS Board meet in public?
9) Where do you see the future leaders of the ICS originating from?
10) How far should the ICS take on responsibility for quality and financial performance as opposed to planning and implementing the transformation of care?
11) What are your views on legislating for ICS’s?
In relation to question 1, the Deputy Chief Accountable Officer of the STP responded that the STP was not a statutory body, it was just a mechanism which brought a group of statutory bodies together for a common planning and organisation consideration. The STP did not have any legal authority, each organisation within the STP had their own accountability structures.
The Deputy Chief Accountable Officer, in response to question 2 remarked that the Chair and Lead Officer had a small Project Management Office, housed at the Science Park. There were currently discussions taking place about how it might need to change following the evolution of the STP.
With reference to question 3, the Deputy Chief Accountable Officer responded that fundamentally an integrated care system was about devolving decision making authority, as to where funding should be spent, to a more localised footprint. In order for the STP to evolve into the ICS there were a series of hurdles which needed to be crossed during the financial year 2020-2021, in order to demonstrate to the regulators of the NHS that it had the mechanisms in place to become self-regulating. Once it had achieved this the ICS would then decide how it would run the Black Country ICS. The ICS also had to be made up of Local Authorities and the voluntary sector.
With reference to the Governance arrangements of the ICS (question 4), the Deputy Chief Accountable Officer commented that a paper had been presented to the STP Board in November 2019 which proposed a move to recognise the importance of place. Each place, including Wolverhampton, had been asked to establish an ICP (Integrated Care Partnership) Board. This was a work in progress and discussions were ongoing. The Voluntary Council, the Local Authorities, BCPFT (Black Country Partnership Foundation Trust), RWT (Royal Wolverhampton NHS Trust) and the GPs were all part of the discussions. Each place has been asked to nominate three board members to the STP Board. There would also be a non-executive Member from one of the acute Trusts and a lay member from one of the four CCGs. In total the Board for the STP would have 31 Members. The proposal also included a recommendation to broaden the involvement to a partnership forum involving wider representation that would meet 3 or 4 times a year.
In response to question 5, the Deputy Chief Accountable Officer responded that Local Authorities were partners in the ICS and the ICP. He saw Local Authorities as being very important in the partnership.
The Deputy Chief Accountable Officer, in response to question 6, remarked that Wolverhampton would be part of the ICS system. The demand from regulators would be that the system worked well. It was important to note that there would be sovereignty of place as part of the ICP, before it moved to an ICS. He saw it as part of his role and others working in Wolverhampton to ensure there was sufficient funding in Wolverhampton for the needs of the residents. What was key was the active involvement of Wolverhampton partners to ensure adequate funding. There would be opportunities for capital funding as part of the ICS.
In response to question 7, the Deputy Chief Accountable Officer stated that no one wanted to see any health services becoming worse in Wolverhampton and he didn’t think anyone would accept this state of affairs. They had a duty under the 2012 NHS Act to continue to improve health services and any place structure would continue to fulfil this aim.
The Deputy Chief Accountable Officer, in response to question 8, remarked that a decision had been made that the ICS Board would meet in public.
In reply to question 9, the Deputy Chief Accountable Officer commented that the future leaders of the ICS would be determined by the Partnership. It was clear that changes to the CCG landscape were ongoing and these needed to be resolved before decisions were taken about the leadership of the ICS.
The Deputy Chief Accountable Officer, in response to question 10, remarked that the aspiration was for the majority of the ICS capacity to centre around transformation, which needed effective planning. What would continue to happen would be the holding to account of quality and financial performance at a local system level.
In response to question 11, the Deputy Chief Accountable Officer commented that he thought the Government’s agenda would be focused on legislation not relating to the NHS. He didn’t see an agenda for legislation at the present time. He thought the Government were trying to convey that the way the NHS was constructed currently with a supplier and provider relationship had run its course. He thought they saw the future as one of a more clarity of working, with organisations working together in collaboration to deliver health services. He thought the Government wanted clinicians and managers to have more of a say in how funding was distributed.
A Panel Member commented that she had recently read the publicly available King’s Fund document entitled, “Leading for Integration – If you think competition is hard, you should try collaboration.” She commented that integrated collaborative working had to be the best wherever or whoever you were, as that was how you made services most effective. The third sector, she felt were often unequal partners in partnership working. It was her view that organisations integral to the delivery of health services could not deliver them without the contribution of the third sector, who provided excellent value for money. She therefore felt it was important that the voluntary sector was sufficiently involved in partnership working.
The Deputy Chief Accountable Officer responded that the Member had made a valid point. He added that it was important that some of the smaller community organisations should also have a sufficient voice as well as some of the better known national charitable organisations. The question was therefore how they created a shadow ICP Governance Board that was ready to mature in April 2021, whose Membership could resolve how to work effectively together. An important element of focus would be to ensure how the third sector was fairly represented.
The Director for Public Health commented that there was a positive opportunity ahead. Partners had been working together over the past year quasi informally to improve health outcomes. As an example, he cited the Healthy Child Programme, where the five indicators were better than ever before within Wolverhampton. He also made reference to the significant performance improvement in health checks that had been brought about by working in partnership.
The Director of Adult Services stated that he agreed about the importance of the voluntary sector. He also thought there was a risk in Local Authorities involvement in future integrated care systems. With Boards of over 30 people, the reality was there would only be 4 or 5 representatives from Local Authorities, with the rest taken up by health bodies. The role of Health and Well-Being Board’s and Health Scrutiny would be equally important in challenging, scrutinising and holding to account the whole integrated care system. In relation to the question on legislation and the ICS, he saw it as a real opportunity to be at the forefront to shape policy. He could see Wolverhampton as leading the Black Country in this area.
A Member of the Panel asked about the mechanism for PPG (Patient Participation Groups) to scrutinise the STP. The Deputy Chief Accountable Officer responded that the PPG’s could feed back into the Communication Lead at the CCG.
A Panel Member asked for an update on the vascular services that had moved to Dudley. He wondered if they would ever be returned to Wolverhampton. The Chief Executive of the Royal Wolverhampton NHS Trust responded that it was not currently one of his priorities. However, it could change in the future should capacity allow.