Meeting: Joint Commissioning Management Board and JCOG Joint meetingDate: 14th February 2019 Time: 9am – 12 noonLocation: Boardroom at Sovereign House

AttendeesJackie Pederson - Chief Officer Doncaster CCG

Damian Allen - Director of People – Doncaster Council

Cath Doman - Director of Health & Social Care TransformationDoncaster Integrated Care Partnership

Anthony Fitzgerald - Director of Strategy & Delivery Doncaster CCG

Steve Mawson – Assistant Director of Finance and Chief Financial Officer Doncaster Council

Hayley Tingle - Chief Financial Officer Doncaster CCG

Rupert Suckling – Director of Public Health

Dr David Crichton – Clinical Chair Doncaster CCG

Andrew Russell – Chief Nurse Doncaster CCG

Lee Golze – Head of Business Transformation & Strategic Commissioning DMBC

Chris Marsh – Project Lead, Complex Lives, Doncaster Council

Dr Nick Tupper – Strategic Clinical lead Doncaster CCG

Linda Tully – Lay Person, Doncaster CCG

Faye Tyas – Head of Financial Management Doncaster Council

Paul Hemmingway – Communications Lead Doncaster CCG

Patrick Birch – Strategic Lead for Adults Transformation Doncaster Council

Denise Bann – Strategic lead Commissioning Doncaster Council

Victor Joseph – Consultant in Public Health

Dr David Crichton – Clinical Chair Doncaster CCG

Andrew Russell – Chief Nurse Doncaster CCG

Lisa Devanney – Associate Director of HR & Corporate. Services Doncaster CCG

Jo Forrestall – Head of Strategy and Delivery Community Services – Doncaster CCG

Amy Coggan – Head of Performance and Intelligence – Acute Care – Doncaster CCG

Stephen Emmerson – Head of Strategy and Delivery Mental Health – Doncaster CCG

Carolyn Ogle –Associate Director of Primary Care & Commissioning Doncaster CCGIn attendance:Gill Parker – note takerOlwen Wilson – Better Care Fund Project Manager Doncaster CouncilJon Gleek – Head of Service Strategy and PerformanceApologiesJo Miller – Chief Exec DMBC (alternate Chair)

Cllr Rachael Blake – Portfolio Holder Doncaster Council

Jill Parker – Assistant Director HR, Communications and Exec Office Doncaster Council

Tracy Wyatt – Deputy Chief finance Officer Doncaster CCG

Ian Boldy - Designated Nurse for Safeguarding Vulnerable Adults and Head of Individual Placements – Doncaster CCG

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Item Discussion/Comments Action

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Welcome, introductions and apologies

Jackie welcomed everyone and introductions were made around the room.

Apologies received as above.

This is a very important and timely meeting, with the following aims:

To understand where we are at with the work done so far To deliver the joint strategy To demonstrate the work done so far To check where we are on the system What the next steps are What are our ambitions for the joint strategy and how we are going to do joint delivery Check what’s missing Joint communications for staff – what are the messages? Talk through the governance processes

We must not lose sight of our ambitions.

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Context – Alignment of Strategies

There are three key documents:

1. The Place Plan, currently being refreshed, setting out the ambitions for the health and care system that providers and commissioners want to achieve for the people of Doncaster by working together.

2. The Commissioning Strategy, setting out joint commissioning intentions for each of the three life stages including what commissioning needs to be done separately and what jointly

3. The Joint Commissioning Agreement, between Commissioners which sets out the partnership arrangements between the Council and CCG. This needs to follow the joint commissioning strategy and is therefore being extended by 6 months to do this.

If we can crack the joint plan and joint strategy, it will help us reduce duplication in the future.

Our job is to update, question, shape discuss how, so we understand how to plan for the next six weeks. Overall we need to be ambitious.

Damian commented today is the first opportunity we’ve all come together. He questioned when we say something – do we all mean the same by it? We need to try and put our differences aside and walk in each other’s shoes. Our aim is to have a shared culture and understanding, and although we each have different governance mechanisms, we must not lose sight of our ambitions.

3 Joint Health and Social Care Commissioning Strategy 2019 – 2021

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Anthony introduced the strategy we are working towards and advised where we’re at with it.

Our aim is to capture and align policies from a Health and Social Care perspective – we are taking the Life Stages approach.

There is still much work to do on the strategy – we need to be able to sell it to ourselves, the public and the providers. It has been a difficult journey ensuring all commissioners are happy. We will only commission together where it makes sense to do so.

The presentation below was discussed in detail:

Key points arising from the presentation and discussion

We are shifting from commissioning pathways to integrated commissioning for outcomes and populations. Focusing on neighbourhoods and localities and looking at whole system cost reductions. This requires a whole system approach for health and social care. We still have some way to go with regard to the seven areas of opportunity.

The Commissioning Agreement has been extended to October 2019. Commissioning is to bring about the right conditions to achieve the desired outcomes. The

challenge is to understand our patient base and have a more person-centred approach. Joining up our data and intelligence will help us better understand and manage population health.

The risk to us is not being able to manage demand within resources available, so prevention is a major consideration. We need to think broader than traditional NHS and social care services and support behaviour change in our neighbourhoods. This spans the whole of Doncaster Growing Together (DGT), and not just with Health and Social Care. This will enable the partnership to use resources better.

People need to feel supported in their community, duplication to be reduced or eliminated, services easier to navigate and delivered in a timely way. We need to develop new models of care to improve people’s experience, and have extensive plans on how to do this.

Many more opportunities to be had through a neighbourhood focus and with primary care. We need to focus on prevention in all our delivery plans. Commissioning team form will emerge as the strategy matures and partners gain clarity on

where joint working will bring benefit. Work to be done on how people ‘flow’ through the health and care system and the impact of

our interventions – this is still not well understood. We need to focus on our commissioning for outcomes – we haven’t done an impact analysis

yet. We need to do some work to check if we are missing any part of the population. A two-yearly refresh of the commissioning strategy is about right.

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JCOG and JCMB to come together every quarter to share our ideas and thoughts.

Action: GP to convene quarterly joint JCMB/JCOG sessions

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Implementation of the Strategy

Paul updated on the joint work taking place between the CCG and Council Comms teams, and what engagement has been done so far and what is still to come. See presentation below:

This is only the beginning of the engagement process, so the public are aware of what is happening. There have been 230 face to face interventions, but over 350 thousand through social media. We are still awaiting feedback from the Gypsy Traveller Community.

Outcomes of the engagement with young people due to be shared soon.

Jackie commented as health and social care commissioners, we have a group of public we can engage with and run ideas by, as 65% of responses received said they wanted to be involved in shaping and contributing.

Anthony commented that the work plan will continue to evolve – both organisations have been brought together and viewed as to how things can be done jointly. At the CCG, delivery plans have been in place for the last two years – they are now looking at extending and building on these with the Council.

The joint plans contain a section on outcomes/metrics to ensure we are delivering what we set out to. Dashboards will be built for each delivery plan however accountability for delivery needs to be clarified across the CCG and Council. There will be challenges faced by both organisations meeting each other’s governance arrangements that need to be worked through. It would be beneficial for the Cabinet and Governing Body to meet. Jackie to pick this up.

Jon commented that in the Council we have a growing performance environment – Pentana – live performance data. Alongside performance data is operational data so we can see where our skills may be better used.

Jackie agreed to bring these ideas to the next JCMB meeting.

Anthony presented the Form of commissioning Team power point – please see below:

The form is getting in the way of the functions – we need to look at the successes of and barriers to working together. JP

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Designated leads are required for each life stage, with authority to drive forward the work of both organisations. An agile approach will be required.

JCOG and JCMB needs to have a more clearly defined relationship.

Jackie clarified we want to work together, but need to be clearer on individual and joint work, with the joint work being prioritised. We will take steps together, challenge ourselves, review and learn by our mistakes. We are creating our own evidence and we need to be bold.

Rupert commented each organisation has different financial challenges to consider.

Jackie asked for the joint finance paper to be carried forward to the next JCMB meeting, as we are running out of time today.

Actions:

Jackie to pick up with regard to sessions with both CCG and Council governance to ensure understanding re joint commissioning.

Ideas on joint delivery plans to come to next JCMB meeting. joint finance paper to be carried forward to the next JCMB meeting

JP

JP/GP

GP

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Next Steps and Timeframes

Joint commissioning strategy to be presented to CCG governing body in April and Council Cabinet on 9th April.

A drafting group will ensure that proposals are ready to go through governance arrangements and to consider the concept of a joint commissioning lead role.

Damian commented with regard to the Provider Group – the session was very powerful and we don’t want to lose the momentum of what’s been started. We need to be clear on what is out and what is in – tranche two had mental health, which needs to be in. Jackie feels we need to continue with what we are doing, but add more. Damian commented we need to keep quality of implementation – any new business cases need to go through the quality assurance system.

Actions:

Drafting Group consisting of Anthony, Cath, Lee and Denise to look at a joint report for Cabinet and CCG governance ready for March JCMB meeting.

AF, CD, DB,LG

6 Business Cases

All three business cases have been recommended by JCOG.

i. Intermediate Care – Jackie feels that serious conversations are required within the next six months. Most of Intermediate Care is bits identified as what we need to deliver – this needs moving on.

Key decision:

Approval of continuation of the BCF non recurrent funding for the Rapid Response

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element of the Intermediate Care Programme - £362,123 – for six months.

ii. Complex Lives Phase two

Jackie feels this is now a service and should therefore be embedded. Chris commented there is a lot more strategic work still to be done. Anthony agreed, commenting it is not yet ready for main-streaming and needs to stay on as transition work for now. Damian feels this should be mainstream by now. If a service is showing value for money, it should be core funded. Jackie feels two years is too long – it’s a risk management issue. Damian agreed – Complex Lives to be mainstreamed by 2020. Clarity to be sought regarding 12/24 months. The Directors of Finance have been discussing this.

Key decision:

Approval of continuation of the BCF non recurrent funding for Complex Lives Phase two - £281,000 for 2019/20.

Action:

Risk issues to be written in with regard to second year of funding

iii. Project Lead for Urgent and Emergency Care for six months – this was approved.

Key decision:

Approval of continuation of the BCF non recurrent funding for the Project Lead for Urgent and Emergency Care for six months - £20,893.

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Date and time of next meeting:

Thursday 28th March 2019 from 9 – 10.30am

Civic Office meeting room 313

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