Report of the Portfoilio Holder for Adult Social Care and Health
The Board considered the report of the Portfolio Holder for Adult Social Care and Health reviewing the suspension from within the Nottingham and Nottinghamshire Integrated Care System (ICS) and the proposed changes resolving the primary issues raised by Nottingham City Council that resulted in the decision to suspend its role within the ICS in November 2018.
(1) Note the strong desire shown from local NHS partners to find solutions locally that will result in the lifting of the suspension of Nottingham City Council’s membership, in the interests of the population health and care for City residents;
(2) Agree that the changes to the ICS locally are of significant benefit to City Residents and to lift the suspension from the ICS and re-join as a full member with immediate effect, subject to an agreement for unanimous voting on proposals which could lead to outsourcing or privatisation of NHS services at ICS and ICP level; and
(3) Confirm agreement to the ICS decision to have three ICP’s for Nottingham and Nottinghamshire, which includes the specific creation of an ICP for the City of Nottingham.
Reason for Decision
The local NHS partners have been highly committed to work with us to resolve these issues and we are grateful for their demonstrable commitment to the importance of having the City Council within the ICS.
The ICS Board has addressed each of the issues raised by Nottingham City Council, making substantive changes as a result. The City Council is therefore now in a position to consider actively re-engaging with the ICS and lift the suspension.
One condition of the suspension being lifted is that the ICS agrees to move to a position where unanimous agreement is required around decisions that could result in privatisation or outsourcing of NHS services. The reason for adding this, is because the ICS and ICP’s are not fully developed and will continue to evolve the way in which decision are made. In particular as the ICP in the City is not yet established, such a decision making process is not yet in place.
The major change agreed is the move to having a dedicated City ICP that matches the geography of the City Council. The re-engagement with the ICS will ensure that the focus on the City population is taken forwards through the new City ICP and that the City Council can be integral to the City Partnership and the way it makes decisions going forwards.
The other major changes agreed are the inclusion of democratic representation at the ICS Board going forwards, a significantly higher commitment to engagement of local plans with citizens, councillors and stakeholders, and the inclusion of significantly enhanced social value elements to commissioning and procurement and adoption of wider best value decision making approaches in procurement.
Other Options Considered
The first other option considered was to remain suspended from the ICS. This option was rejected as the Council is reassured by the significant changes made and the commitment of the local NHS leaders to developing the local partnership. At the meeting of this Board in November 2018 (minute 45) it was made clear that the integration between health and social care is in the interests of citizens of Nottingham City.
Another option considered was to formally notify the NHS partners that the City Council does not wish to have any part in the development of the ICS in its current form and to remove the Council from the partnership. This option was also rejected for a number of reasons. The partnership will continue without the Council as a member and a preference to being able to influence decision and change from within was shown. Another reason to reject this option was to ensure that where it is beneficial to citizens a closer integration of health and social care can occur.