Issue - meetings

The report informs the Cabinet of the work carried out with NHS Richmond on arrangements to strengthen borough based commissioning of community services.

It also requests agreement in principle to the proposals set out in Appendix A in order that further exploration and the detailed co-design of services with staff and implementation planning may begin.

Report of the Cabinet Member for Adult Services Health and Housing and the Cabinet Member for Children’s Services and Education attached.

This is a key decision.

The Chair and Vice-Chair of the Health, Housing and Social Care Overview & Scrutiny Committee, Councillor Percival and Councillor Stratton respectively, informed the Cabinet of the views expressed by their Committee on 13 January 2010, as summarised below:

·              The Health, Housing & Social Care Overview and Scrutiny Committee welcomed the opportunity to consider the important issue of Borough Based Commissioning on 13 January.

·              The Committee appreciated that this was a complex issue and that NHS Richmond and the Council had done a lot of work to get the proposals to this stage.

·              In general terms, the Committee was supportive of the development of robust, democratic and transparent arrangements to strengthen the Borough Based Commissioning of Community services. The Committee considered that these fitted in with the national trend and a growing expectation by our residents that seamless and effective Health and Well Being services would be delivered on the ground.

·              Concerns were raised regarding the specific proposals.

Ø                  In particular, the Committee felt that the proposals for new governance and management structures appeared to be over bureaucratic and hierarchical.  There was a danger that the opportunity to introduce a more streamlined, efficient and less expensive system that would speed up the real integration of services for the benefit of all our residents could be missed. The Committee requested that the current proposals were reconsidered in the light of these concerns.

Ø     The Committee also felt that it was important to stress the importance of transparency, democratic legitimacy, and a proper system for conflict resolution as part of the development of the proposals as well as performance measures and detailed financial information.

In addition to the above comments, the Chair and Vice-Chair raised the following concerns:

·              In referring the Cabinet to the delegated funding arrangements for children in Appendix 2, concern was raised that the Children’s Trust Board should be on the same level as the PCT Board and the Cabinet as it is the commissioning authority for Children’s Services. 

·              At the Kings Fund Conference, delegates had been advised that the NHS would need to achieve 6% productivity gains nationally.

·              Quoting from the Council's Health Update of December 2009: "The government has identified the need to generate up to £20 billion of savings and productivity gains."

·              The Cabinet was also referred to an extract from a consultant’s report on borough based commissioning, and to the notes of a meeting held between the Chief Executives of London PCTs and Councils, both referring to the potential benefits of a single organisation arrangement, as stated below:

Ø     Quoting from a briefing paper by Finnamore Management Consultants (commissioned by the Council and the PCT) - page 10, second paragraph, under 4.1: ‘”One organisation or Two? A single organisation may be more difficult to implement, as it represents the biggest change’. However it would be very effective in ensuring that a single, clear leadership could address and overcome structural, cultural and performance management challenges."

Ø     Quoting from the notes of the ‘Working together to strengthen borough-level  ...  view the full minutes text for item 148