Agenda item

To consider a report which provides an introduction to the current approach to commissioning and de-commissioning in Leeds, highlighting progress towards a shared approach and key challenges. It provides an opportunity to shape future developments to ensure that the city is well placed to deal with current and future financial challenges.

Chris Dickinson, Head of Commissioning & Market Management, LCC Children’s Services and Rob Goodyear, Director of Commissioning (Partnerships & Performance), NHS Leeds North CCG, presented a report on the approach to commissioning and de-commissioning in Leeds.

The report identified the need to work towards a shared and integrated approach to commissioning in Leeds. This required the support of both the HWB Board and the Leeds Integrated Commissioning Executive (ICE). An overview of those areas where integration and/or similar approaches already existed and those areas where there are differences was provided along with future ambitions or work already in motion to achieve integration.

Rob Goodyear described the approach adopted by the Leeds CCGs, noting that until very recently, CCGs had undertaken annual commissioning and de-commissioning (C/DC) but that the latest NHS Guidance has moved this to two years. This is new guidance, which is not reflected in the paper. The 3 CCGs have developed a shared toolkit for ‘commissioning for value’ which  took consideration of the LCC approach as an example of best practice. The Board received assurance that the Leeds CCG approach to C/DC would continue to learn from other parts of the system more experienced in de-commissioning and re-commissioning, was fit for purpose, and with engagement and consultation built in.

Chris Dickinson outlined the approach adopted by LCC, with differing commissioning cycles often set to budget setting cycles and some contracts set for 3 to 5 years with annual review discussions. LCC had an established approach to governance but sought to align with the Leeds CCGs.

A correction to page 11 was reported to properly reflect that the LCC budget was set by full Council, not Executive Board as stated.

The challenges were highlighted as being the budget reductions and the different commissioning cycles operated. In response to this, a new cross-services post of Deputy Director of Integrated Commissioning had been created to facilitate closer working across the CCGs and LCC Adult Social Services. Recruitment is underway to this post. Additionally, the CCGs had undertaken recent work looking at how they could operate as “one voice”.

The Board broadly welcomed the approach outlined and the following key issues were discussed:

·  Engagement with LCC community committees and the suggestion that General Practitioners could discuss local health issues with local ward Councillors in the first instance.

·  Consideration of how commissioning could challenge and improve the Leeds health targets.

·  Commissioning for outcomes is best practice - such as the commissioning of the drug and alcohol treatment service. Need to move to this being the default

·  The focus on the Leeds £ whilst acknowledging procurement rules

·  Recognition of the role of the Third Sector as both service provider and commissioner

·  The balance of tensions between city-wide high-level decisions and local provider led consultation on C/DC

·  A cost benefit analysis was required to ensure all partners share the same approach to C/DC

·  The need for meaningful consultation with appropriate timeframes, noting a comment on the approach taken to the West Yorkshire STP

·  The expectation that commissioners should have a common understanding of what engagement and consultation is and develop a shared engagement framework. The Chair suggested that this should be considered by PEG.

RESOLVED -

a)  The Board agreed that the current approach and future steps adequately supported the vision and role of the Board

b)  The Board identified two matters to refer to PEG to develop:

(i)  the development of a shared consultation and engagement framework as an opportunity to progress towards a shared approach to commissioning and decommissioning.

(ii) opportunities for; and development of; joint procurement.

With a report back to HWB on the outcome of those discussions in due   course.

c)  The Board agreed to provide strategic direction for future progress towards a shared approach to commissioning and decommissioning.

d)  To take learning from best practice within the system and apply to future decision making.

e)  To support the Integrated Commissioning Executive to set system priorities for shared challenges and testing further integrated commissioning models.