Decision Maker: Director of Public Health
Decision status: Recommendations Approved
Is Key decision?: No
Is subject to call in?: No
REASON FOR THE DECISION
Social and economic challenges such as rising demand for services, fewer resources, an ageing population and more people aged under 18 over the next ten years, has led to statutory health and care partners working more collaboratively to improve and modernise services and the way services are delivered.
Doncaster Council and Doncaster NHS CCG (CCG) has a long history of working together to achieve positive change for Doncaster residents.
In 2017, the Council entered a Memorandum of Understanding (MOU) with the CCG to establish shadow joint commissioning arrangements to take forward seven areas of opportunity, (originally described in the Doncaster Place Plan) where joint commissioning and delivery could be tested.
The seven areas of opportunity were across all life-stages from birth to old age where joined up care and support is required to have a stronger impact on outcomes for individuals. The seven areas of opportunity are Urgent and Emergency Care, Intermediate Care, Complex Lives, Learning Disability, Starting Well first 1001 days, Vulnerable Adolescents and Dermatology. All the areas of opportunity have been progressed to varying degrees of success with the exception of dermatology where plans are being developed to deliver services closer to home within general practice rather than in hospital.
A formal Joint Commissioning Agreement was put in place in April 2018 to enable the Council and the CCG to jointly commission services. This Agreement expired at the end of March 2021.
A refreshed Joint Commissioning Agreement has been developed between the Council and the CCG. This ODR is seeking approval to enter into the new Joint Commissioning Agreement from 1st April 2021.
The JCA underpins the level of integration needed to ensure services are joined up at key points in the lives of Doncaster residents when they need that most.
Joint Commissioning Strategy and Deliver Plans
To support the Place Plan, in April 2019, the Council and the CCG implemented a Joint Commissioning Strategy (JCS) and detailed delivery plans, aligned with the NHS Long term Plan. The JCS sets out the direction of travel and priorities for the Council and the CCG to 2022, it seeks to reduce duplication and make the best use of local resources.
The JCS is underpinned by guiding principles to shape the way partners work together. The Joint Commissioning Strategy is part of the JCA and is the vehicle by which the requirements of the JCA will be delivered.
The Doncaster Place Plan originally published in December 2016, described a 5 year ambition to achieve integrated health and social care, underpinned by the following key strands of work:-
- Identifying areas where residents could benefit most from integration (Areas of Opportunity)
- Developing formal Agreements to create commissioner and provider collaboration
- Revising governance arrangements and developing delivery arrangements to support integration
The Place Plan was refreshed in 2019, with an increasing focus on people as opposed to services. This means that instead of looking at where care is delivered, we are now thinking about local communities and their needs.
The refreshed Place Plan has the same vision and partnership working commitments at its core. It highlights how services will continue to work together to ensure seamless, coordinated services for the people of Doncaster.
The Place Plan refresh is based on a four layered model, focusing on:
- Supporting communities to thrive, working much more closely with the voluntary, community and faith sector, investing in social prescribing to improve health and emotional wellbeing
- Developing a ‘front door system’, where there is no wrong door to access health and care services. This will help get people to the right place, first time
- Joining up care and support at home.
- Help ensure our specialist services can be used more appropriately, across all three life stages thus reducing the demand and need for hospital and emergency care.
The Joint Commissioning Agreement
The Agreement is between the Council and CCG setting out our joint commissioning arrangements across three life stages of Starting, Living and Ageing Well. The Agreement enables the Council and CCG to prepare for formal joint commissioning of services under a Section 75 (S75) agreement. A S75 Agreement is an Agreement made under section 75 of National Health Services Act 2006, which allows the pooling of resources, the delegation of certain NHS and Council health related functions to the other partner, joint and/or lead commissioning of services and the pooling of budgets. In essence the JCA:-
a. Is a legally binding commitment to develop integrated commissioning and builds on the previously agreed JCA between the Council and CCG.
b. Sets out the work required to support the parties to deliver effective joint commissioning whilst providing the necessary legal assurances for both the Council and CCG. This provides the strategic commitment to bring commissioning together for the benefit of Doncaster residents, and to jointly address the financial challenges in the system.
c. Commits both parties to work together during 2021/22 to support joint working arrangements including integrated working and joint contracting of services where sensible to do so
d. Sets out the areas of joint development, the aims, integration goals and commissioning actions.
The governance framework is contained in the JCA. The governance processes include regular reports to the Health and Well Being Board and to the Joint Commissioning Management Board.
The current Joint Commissioning Agreement
expired at the end of March 2021.
This ODR renews the Joint Commissioning Agreement from 1st April 2021 for up to 12 months to 31st March 2022. The Agreement will underpin current joint commissioning arrangements and enable Doncaster residents to increasingly experience seamless, joined up care and support.
ALTERNATIVE OPTIONS CONSIDERED AND
a. Do nothing: this option would mean that there is no legally binding Agreement in place between the Council and CCG. This could create a risk as the South Yorkshire Integrated Care System is established in 2021/22 and takes over the functions of the CCG. This would not secure the efficiency and impact gains of joint working and service delivery. This option is not recommended.
b. Joint commissioning Agreement: this option would strengthen the capacity for joint strategic planning and investment between the Council, the CCG and the developing Integrated Care Systems, enabling a shared approach to developing provision to meet the needs of Doncaster residents. It would rely on a ‘market development and response’ approach to provision itself, with no specific expectation or assurances about the integration of front line services. This is the preferred option.
Publication date: 21/04/2021
Date of decision: 21/04/2021