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The London Health and Care Collaboration agreement was signed in December 2015. London Councils’ Teresa O’Neill discusses the most important points of the agreement and what this could mean for health and care in London.
Reform of health and care services has never been more important. A daunting financial outlook faces the NHS and local government and England’s growing and ageing population is placing huge pressure on social workers, carers, doctors and nurses.
In a city as vast and diverse as London, local leaders felt that having more powers and flexibilities which enhance working more closely together across different organisations would help London to make swifter progress on a range of health and well-being issues, such as improving the quality and sustainability of services and increasing investment in prevention and early intervention.
Following the successful devolution of public health responsibilities to local government in 2013, there was an appetite for more.
London’s aspirations align with the NHS Five Year Forward View, which identifies three key areas that need to be addressed: reducing health inequalities by investing in prevention; reshaping care delivery to ensure people’s care needs continue to be met; and ensuring that health and care services are efficiently run and receive appropriate levels of funding.
A capital challenge
The scale of the challenge in London cannot be underestimated. The NHS posted a £2.3 billion deficit in the first nine months of the 2015/16 financial year and London boroughs must cope with a projected £700 million funding shortfall by 2020. In the next two decades London will be home to 10 million people and the number of residents aged 65 and over living in the capital will grow by over 44 per cent.
These realities galvanised London’s health leaders to take the reins and secure a devolution deal from government. London Councils joined forces with NHS England, Public Health England, the Mayor of London and CCGs to make a comprehensive case to government for devolving power and flexibility over local spending on health in the capital.
In December 2015, London reached a milestone in its journey towards health devolution when an agreement was signed committing local government and the NHS to collaborate in order to increase prevention and integration, shape new sustainable models of care and make better use of assets. Another agreement was signed by government and national bodies committing to work with London – primarily through five pilots – to unlock devolution to support and accelerate reform.
The devolution agreements operate on three levels. Locally, boroughs will work on joint multi-year plans for integrating health and care to deliver Health and Wellbeing Board strategies, with alignment of provider plans, underpinned by pooling of budgets, joint commissioning and local asset planning.
At a sub-regional level, strategic partnerships will be forged through joint arrangements to develop and secure delivery of clinically and financially sustainable new models of care across acute, primary and social care, with sub-regional estate plans and scheme development to support transformation.
Political leadership for the devolved health and care system will come from the London Health Board. As well as working with the devolution pilots, London’s health and care leadership is committed to developing the workforce and skills, strategic estate planning and collaboration at city level to address wider determinants of health, and London-wide frameworks, such as new payment models for use at sub-regional and local levels.
Exploring how health devolution works in practice through five pioneering pilot projects will give London’s health leaders a way of testing their proposals in the context of a complex, diverse and dynamic city. Lessons learned and progress made by the pilots will inform future decisions about how to devolve power and responsibility across London.
Haringey is seeking a whole system approach to prevention, focusing on using planning and licensing powers to create healthy environments and piloting new ways of helping people into employment.
Barking and Dagenham, Havering and Redbridge: Accountable Care Organisation
Integration of health and care services to focus on early intervention and managing the chronically ill is the aim of Barking and Dagenham, Havering and Redbridge’s pilot project. By developing an accountable care organisation (ACO), they hope to integrate care services to better serve the needs of the local community.
This would also involve integrating commissioning and sharing financial risks and benefits of joint ventures.
North Central London: estates
A partnership between five boroughs – Barnet, Camden, Enfield, Haringey and Islington – is working to ensure the best possible use is made of the current NHS estate, by incentivising the release of unused assets and securing the space needed for integrated services.
Lewisham: integrating social care with physical and mental health services
Expanding joint commissioning will help health and care leaders in Lewisham integrate services around their Neighbourhood Care Network, which, in the next two years, will focus on adults over 60, severe mental health, children with complex needs and early intervention with children.
Hackney: full integration of health and social care
In order to make better use of funding and improve results, Hackney will integrate its health and care services. This will include exploring different integrated delivery mechanisms and incentivising prevention.
The pilots will test health devolution in London, exploring how greater collaboration, integration and devolution work in practice, including impacts within and beyond the London system.
These will eventually help us to work towards a clinically and financially sustainable landscape of commissioning and provision, living within annual budgets and delivering fiscal balance.
This will benefit patients and care users as it will reform the way services are provided to emphasise maintaining their independence and well-being.