1. Closer working between the CCG & Council

2. Why come closer together?
People need health, social care, housing and other public services to work seamlessly together to deliver better quality care. More joined up services help improve the health and care of local populations and may make more efficient use of available resources.
Opening statement of recently published NHS England Integration and Better Care Fund

3. Drivers for Change
Keeping a strong ‘NEL’ focus – ensuring we get the best we can for NEL
Maximising the value and impact of the ‘NEL pound’
Delivery of services to local populations is increasingly complex, & financial pressures mean new models and ways of working are needed
To ensure we have the right strategy and interventions for economic, community and well-being benefit for the local population
Having a single and shared ‘outcomes model’ for commissioning across the Council and CCG responsibilities, will enable the joint resources of the 2 organisations to have greater influence across the cradle to grave experiences of our community
Integrating public services provides the best opportunity to move closer to a long term sustainable financial position, & to improve the outcomes
Making best use of the staff resources and therefore improving NELs resilience (leadership and broader staffing)
National direction is for integration across Health & Care/Councils

4. What would be different/better?
We would have a joint strategic plan outlining the ambition for NEL in terms of health, care and wellbeing in its broadest sense, including education, housing, jobs etc
We would be better able to shape & secure cradle to grave services for NEL population with the “NEL£” which would be more joined up and deliver improved outcomes:
transitions between stages of life and services would be improved
Supporting people to regain independence either following a period of ill health or living with a long term condition – mental & or physical
Streamlined commissioning and contractual arrangements for providers (e.g. Health Checks), simplification of processes (e.g. invoicing/payment etc)
We would have a greater ability to withstand pressures & provide strong voice/have greater influence on ‘big issues’ – fight ‘NEL corner’
Reduction in duplication, better use of resource to service priorities, greater opportunity to realise efficiencies
It would build skills/resilience across organisations

6. Important to note that:
Both organisations will continue to exist and will retain ultimate accountability
What will be delegated to the ‘union’ will be determined/approved by CCG Gov.Body/CoM & NELC Cabinet – working principle will be that it should be included unless there is legal/statutory limitation or a good reason for it not to be
CCG & Council overarching governance will not change (CoM, Gov. Body, Community Forum, Cabinet & Full Council etc) – need to ensure the ‘union’ element does not add another ‘layer’ of governance
Some amendments to CCG/Council constitutions would be required as the proposal would change high level scheme of delegation to reflect items that both organisations have agreed to delegate to the ‘union’ element
Each organisation will retain the ability to move areas back to their own direct control should circumstances occur where this was felt necessary.
The arrangement will be governed by an extended/enhanced legally binding section 75 agreement

7. Next steps
Strategic Case for Change presented to CoM, Governing Body and Cabinet for approval
Appointment of a Joint Chief Executive – provisional timeline
Complete phase 2 of the Programme Plan (May to 31st August) including agreement on which items should be included & excluded from the enhanced partnership and addressing critical governance issues
Proposed go live – 1st September
Complete phases 3 and 4 of the programme plan – active implementation and OD.

8. Recommendations The Governing Body is asked to:
Approve the Strategic Case for Enhanced Partnership
Approve the suggested timelines and the target date for change to new arrangements (1st September 2017)
Approve the draft model and the suggested approach to retained & union functions and decision making ; with appropriate decision makers of both organisations making final determinations on the detail in advance of ‘go-live’ date.
Approve the early appointment of a Joint Chief Executive and that this be discharged via a specially convened Joint Appointment Committee