A copy of the presentation is enclosed.

The Board received a presentation from Ian Williamson – Integrating Health and Social Care – the next steps and the progress made. The presentation provided details of:

• Progress made over the last five years
• Rationale for change
• Ongoing work
• NHSE proposals
• Likely changes
• Health and Wellbeing Board – considerations for 2021

The Chair invited the Board to comment and ask questions.

A member of the Board referred to the difference between the provision of health care and social care and asked how will an integrated service combining both work in view of the provision of social care being means tested, unlike health care which is free at the point it is accessed. Reference was also made to the organisational nature of the presentation and how the issues referred to would look from a patient perspective.

It was reported that the impact of the strategic changes had involved closer working, which is already being seen by Neighbourhood Teams between professionals. On the ground, patients and residents are receiving more care and support that enhances the individual’s freedom and is consistent with the ‘Our Manchester Principles’. Work would continue to produce a simplified dashboard for the changes and their implementation. The Board was informed that the was no national view for the provision of social care and the proposals describes were from the NHS which presented an incomplete picture for the services.

The Chair stated that there is a social care and public care absence with indications that proposals will be coming from the Government following the demise of Public Health England and what will follow on from it. Reference was made to the NHS England engagement paper - Integrating care - the next steps to building strong and effective integrated care systems across England. The theme of the paper related to NHS budgets, the paper presented wider context relating to Integrated Care Systems, involving:

• Stronger partnerships in local places between the NHS, local

government and others with a more central role for primary care in

providing joined-up care;

The document also describes four fundamental purposes:

• improving population health and healthcare;

• tackling unequal outcomes and access;

• enhancing productivity and value for money; and

• helping the NHS to support broader social and economic

development.

The Chair informed the Board that from the arrangements and from an NHS perspective there will be single GM budget. Decisions about the budgets will be made at the lowest possible level with an expectation that the budgets could be used at a neighbourhood level. It was noted that the presentation given was organisational, however this was necessary to demonstrate how a population, health and neighbourhood devolved agenda may be delivered. The point was also made that Manchester has been working on arrangements in advance of decisions being made by the NHS and is ahead in those preparations. The Chair referred future organisational change and the ongoing work to strengthen the clinical leadership role in primary care and the recognition this has received across all sectors as a strength and an area to be enhanced and built upon.    

A member of the Board provided a summary response to the presentation the Local Medical Committee and highlighted some concerns, in particular: a lack of reference to the involvement of the LMC over the past five years, the work of primary care, recognisinge the work of GPs in fighting Covid19, representation of the LMC within a future structure and references to PCNs.

The Chair reported that Primary Care representation in a future structure would be for the LMC to determine. The Board was also informed that as part of the work on clinical leadership the Chair and members of the LMC had been invited to be involved in meetings of the PCN Group.

A member of the Board referred to the lack of a community involvement in the structure at a national level and could this be raised and addressed in Manchester’s response to the consultation, in view of the engagement work that has taken place.  

The Executive Member for Adults Health and Wellbeing acknowledged the strong role GPs and Clinicians have at all levels and the importance of showing how decisions are made. In noting the significant change at a national level, it was also important to use the changes positively to continue in Manchester by using the most successful elements of engaging the public to provide a voice on the provision of services. Also, to ensure that a public based voice is at the heart of a response made to a national consultation, including public health and social care.

A member of the Board referred to the commissioning of work carried out on a city-wide basis and questioned how this could happen under the arrangements suggested. Also, it was noted that PCNs were useful but were not a model for all types of engagement. The structure also appeared to include gaps for the involvement of patients.

The Chair stated that the purpose of the NHS engagement paper was the welfare of patients but also working to ensure that the public did not become patients. The point was also made that in a hierarchy of commissioning the starting point would be at a neighbourhood level and then, if necessary, to make a case to widen the provision to a city-wide level and not the other way around.

Ian Williamson thanked the Board for the comments and contributions made to the presentation which would be noted. Acknowledgement was also given to the valuable work of GPs and professionals for their valuable and pivotal work.  

Decision

To note the presentation and the comments received.