Agenda item

Members were provided with a report that gave them the opportunity to discuss and comment upon the South Yorkshire and Bassetlaw (SYB) Accountable Care System (ACS) Memorandum of Understanding (MOU).

It was clarified that the MOU was an agreement, not a plan or a legally binding contract.  It did not replace the legal framework or responsibilities of statutory organisations, yet sat alongside to complement and enhance them.  It was explained that 27 partners were supporting the direction of travel, that there were implications around how those partners worked together and the agreement acted as a commitment to resolve some of the issues.  

It was stated that role of the NHS Clinical Commissioning Group’s (NHS CCG) was to commission the right services at a high quality for people, something that they will continue to do.  It was advised that resources would be used collectively for some services across that area, alongside the Place Plan in Doncaster.

It was explained that South Yorkshire and Bassetlaw had agreed to work collectively to do things in a different way.  It was added that with an increase in demand and ageing population there was expected to be a health and social care funding gap of around £140M for Doncaster by 20/21.

It was outlined that the Accountable Care System (ACS) was the NHS England’s current way of delivering improvements in care. Colleagues from the NHS were taking account of this new policy direction and were collectively taking precautionary and sensible steps to develop joint approaches to service delivery.  It was noted that there has been no change in law and statutory responsibilities at an organisational level remain, therefore this is a coalition of the willing.  It was shared that local authorities, without contribution or commitment had been invited to join the NHS as part of the journey, as what happens within the NHS impacts on local people and social care.

Governance – It was explained that there were no governance implications for the Council who were only supporting the agreement.  It was clarified that the MOU does not supersede any statutory or legal responsibility where the Council was commissioning or providing services.  That any changes would need a decision by Cabinet and services changes would be considered by the Council’s Health and Adult Social Care Overview and Scrutiny or by the regional Joint Health Overview and Scrutiny Committee.

An example of recent service changes was a decision around hyper acute stroke services currently being considered by the regional health scrutiny group. The decision included a proposition that Doncaster became a hyper stroke service unit; one Member raised their own concerns about the impact from this on the overall availability of beds at Doncaster Royal Infirmary.  It was explained that this this may mean an up to an additional 400 admissions and that work would be undertaken with the Trust to look at this.

Accountability - It was shared that there was a huge commitment from all those involved, that a governance structure was in place providing the right level of oversight which meets on a regular basis.  It was added that commissioners would seek assurances through NHS England and providers through NHS improvement.  Members were informed that there may be opportunities to have one regulator for both in the future and that this would be positive from a place perspective.

Timeline – Members were informed that new governance arrangements would be in place from April 2018 with a firm change from April 2019 when the South Yorkshire and Bassetlaw Accountable Care System would be formally established. 

Parties and Partners - It was raised that under the list of Parties to this agreement as part of Section 2, there was no reference to any Arm’s Length Bodies or commercial enterprises.  Members were informed that this could be looked into and feedback would be provided.

Minor Injuries – In respect of minor injuries, Members were informed that there would be a review of existing urgent care centres, minor injury and walk in services.  The review would look to establish the baseline position and develop a plan to have a model for urgent treatment centres across the system.   Reference was made to the independent review of hospital services which would look at the model across South Yorkshire and Bassetlaw. 

Urgent And Emergency Care - Members were informed that a programme of work was currently being developed to take account of national requirements.  This involved delivery models developed at place with a joint focus on redesigning the urgent and emergency care system and developing out of hospital services to reduce demand on Accidents and Emergencies (A&E) and acute beds.  It was explained that Accidents and Emergencies (A&E) all operated differently across the system. 

Transformation Priority Workstreams - In respect of Transformation Priority Workstreams listed under Section 8.  It was advised that workstreams were in place, led by clinicians.  It was clarified that the majority should be maintained and that it would just be those services where it made sense to work across regions.

Managing Demand and Optimising Care – This covered the elective and diagnostic care workstream, responsible for the planning, oversight and governance of a regional or sub-regional elective and diagnostic care system.  Concern was raised that that through focusing on the two priorities, by reducing system demand and improving efficiencies in delivering a service might in reality deter people from accessing services they really needed.  It was explained that sometimes people accessed services that weren’t needed at that time or would be better using alternative ones.  Members were informed that it wasn’t about deterring people, but more about ensuring that a consistent approach was being used.

Mental Health - Concern was raised that learning disabilities was not being treated as a priority and a Member questioned whether it could be separated from mental health.  It was explained that the programme sat across South Yorkshire and Bassetlaw and Members were assured that the needs of people with a learning disability were considered to be as prominent as those of people with mental health disabilities.  The Doncaster Clinical Commissioning Group Chief Officer offered to highlight it as a concern raised by the Panel.

Members were reminded that local authorities were not being asked to delegate anything across South Yorkshire and Bassetlaw.  It was explained that there was a joint committee consisting of NHS Clinical Commissioning Groups that worked across that area and had the delegated authority to make decisions on their behalf. 

It was shared that there was a real opportunity for Doncaster to work more in this way.  It was added that with Sheffield and Doncaster were offering the two biggest sites and viewing it from a broader prospective, this could be seen as a potential opportunity for investment into Doncaster which may result in new jobs and better technology.

Members were informed that there was a regular update received on the Accountable Care System that could be forwarded onto Members.

RESOLVED that the Panel note the South Yorkshire and Bassetlaw Accountable Care System Memorandum of Understanding.