Decision Maker: Director of Public Health
Decision status: Recommendations Approved
Is Key decision?: No
Is subject to call in?: No
REASON FOR THE DECISION
Information
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.
Place Plan
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.
Governance
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
REJECTED
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
Accompanying Documents: