Agenda item

The presentation annexed to this paper provides the Board with an update on the opportunities and ambition, the devolution ‘asks’ and next steps.

Declarations of interest:

None

Witnesses:

David McNulty, Chief Executive, Surrey County Council and Chair, Surrey Heartlands Transformation Board

Matthew Parris, Evidence and Insight Manager, Healthwatch Surrey.

Key points raised during the discussion:

1.    The Chair of the Surrey Heartlands Transformation Board explained that the primary thinking about the devolution opportunity had emerged from conversations regarding the Sustainability and Transformation Plans (STPs) and how health and social care systems can be improved by working together.

2.    Members were informed that the Surrey Heartlands STP had been developing devolution plans since last spring, and that key partners had visited Manchester to hear about how health devolution had assisted their work.

3.    Members acknowledged that devolution was a vehicle which would enable change to be delivered at speed and scale.  The ambition of the STP was to reduce variation of care, quality and outcomes whilst delivering sustainable services within an ageing population with complex health needs.  Members were informed that care would still vary based on individual medical needs, but that variation of care due to process would be reduced. 

4.    The Chair explained that given the complexities of the STP footprint, covering 11 organisations, effective partnership working with stakeholder groups, workforce and advocacy groups was key.  He stated that public engagement was also important throughout the devolution process.  

5.    Members recognised that there were two approaches to devolution; namely the Cities and Local Government (CLG) Devolution Act and the NHS England (NHSE) Devolution Framework.  It was explained that the STP were not going to follow either of these routes, instead agreeing upon a more pragmatic way forward that would achieve the devolution required.

6.    Members acknowledged that bringing decision making closer to operational levels would allow for local accountability and control, whilst collaboration would enable a variety of expertise.  The Chair explained that as part of the wider economic system, the devolution opportunity would allow for a closer fit between prosperity and health and wellbeing through the reduction of variations. 

7.    The Chair explained that a list of initial devolution asks had been discussed with but not yet agreed by central Government, and that the next steps would be dependent upon the drafted Memorandum of Understanding being signed off centrally, with a view to going live in April 2019.

8.    Members were informed that whilst STPs were not considered to be the solution to social care funding shortfalls, health devolution would ensure funding and resource was used as effectively as possible rather than shifting pressures.  It was explained that funding would be more accessible without the need to enter the bidding process, which would also have a positive impact on staff time. 

9.    Members acknowledged that health devolution would provide a big opportunity for Surrey County Council (SCC)  with regard to improving services and sharing best practices.  The Chair expressed the view that the success of the Orbis partnership provided complementary skills, and informed the Board that two key SCC officers were leading the work-streams for shared services and asset strategy for the devolution proposal. 

10.  Members questioned how the finances would be controlled across 11 organisations if devolution was achieved.  The Chair explained that all partners faced pressures financially, and that there was always a danger of duplication when working collaboratively.  He expressed the view that coming together would allow for better use of resources, reducing duplication and create solutions to reduce pressures system-wide. 

11.  Members noted that the STP would be dealing with over £1billion of commissioning activity and therefore they would need to ensure that the capacity was available.  It was explained that Adult Social Care would still be required to fulfil Care Quality Commission (CQC) standards.  

12.  Members were informed that a number of housing and workforce opportunities were linked to the Three Southern Counties (3SC) devolution proposal, particularly in relation to affordable key worker housing, and that it was expected that the health devolution opportunity would adopt some of the thinking of the 3SC proposal. 

13.  Members raised concern regarding “the ability to set the adult social care precept at a rate that fully meets demand pressures” as one of the initial devolution asks, given Surrey’s lack of funding within social care.  The Chair explained that this had not yet been agreed.  He explained that any precept money would be ring-fenced for adult social care and it was necessary to plan ahead to ensure services were sustainable in the future.

14.  Members questioned whether delegations of primary care would include taking control of GP practices.  The Chair explained that devolved commissioning would not take over control of GP practices.  Members were informed that the North West Surrey CCG already operated with this delegation of primary care, and that it would be useful if it was used across the entirety of the Surrey Heartlands footprint to allow better planning and to achieve balanced delivery of care needs.

15.  Members were informed that the devolution proposals would provide many benefits to residents.  The Chair explained that a lot of work had already been done to improve a number of care pathways including cardio-vascular and musculo-skeletal.  The STP had also been working to embed mental healthcare provision within the plans.  He went on to state that the proposals would provide partners with local control.  This was exemplified with procurement, where proposals would allow partners to make local decisions, source equipment locally, enabling the decision-making process to be less constrained and more effective.

16.  The Chair assured Members that whilst Surrey Heartlands STP only covered 85% of the county, there were meetings in place to discuss how benefits derived from health devolution could be accessed by 100% of Surrey’s residents.

Recommendations

The Board recognises the opportunities presented in Surrey Heartlands’ devolution proposals, and is supportive of the principles, and improvements it intends to unlock for Surrey residents, partnership agencies and the council.

It recommends:

·         That a further update is brought regarding the governance of the STP as plans progress

In order to support the public in understanding Surrey Heartlands’ vision, the Board recommends:

·         That the STP seeks to clarify through case studies the benefits of devolution for the resident, and presents these to the Board at a future meeting.