March 2019 Realising the potential of a single Commissioning Group: Working together: NHS Eastern Cheshire Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group NHS West Cheshire Clinical Commissioning Group Realising the potential of a single Commissioning Group: How can the voluntary sector make an impact? March 2019

Agenda for today Our Working Together across Cheshire (WTaC) programme Update on transformation of Cheshire CCGs Cheshire West Integrated Care Partnership How the Voluntary Sector can help us deliver our plans – what are the opportunities? Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Working Together Across Cheshire Is a programme of work to: Develop a (potentially) merged Cheshire CCG Support the development of 2 Place based Integrated Care Partnerships (ICPs) Bring about greater integration and collaboration resulting in maximum efficiency in commissioning and service delivery Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Cheshire Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

‘Place’ in Cheshire 1) Cheshire West Place 2) Cheshire East Place NHS West Cheshire CCG NHS South Cheshire CCG NHS Vale Royal CCG NHS Eastern Cheshire CCG Cheshire West and Chester Council Cheshire East Council 1) Cheshire West Place 2) Cheshire East Place Proposed Cheshire CCG Cheshire West and Chester Council Cheshire East Council Cheshire West Integrated Care Partnership Cheshire East Integrated Care Partnership

Why are we coming together? We want to work together to improve outcomes for the population and reduce the risk of a ‘postcode lottery’ across Cheshire We want to improve the quality of care that the people of Cheshire have every right to experience – currently we’re not meeting all of the NHS Constitutional standards We are continuing to see growing levels of demand for services as the population ages and complexity increases People tell us that they continue to experience care that is fragmented and disjointed Available funding does not meet the growing demand for health and care services We are working closely with our Local Authority commissioning partners and providers to develop two ‘Integrated Care Partnerships’ (West and East) to improve the integration of health and social care Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Benefits of a single Cheshire CCG - More powerful national and regional voice - Commissioning at scale - Efficiencies so that staff can align with ICP - Standardise and improve care offer Vale Royal 102,500 population 12 practices East Cheshire 201,000 population 23 practices South Cheshire 173,000 population 18 practices West Cheshire 257,408 population 36 practices Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Benefits of doing this A more powerful voice for Cheshire in championing the needs of local people at regional and national level – advocate for the 750,000 residents Ability to plan in a more “joined up” manner especially in relation to Cheshire as a whole and with respect to the flows of patients Standardise, as far as possible, pathways and approaches to care to improve outcomes for everybody Release clinical and managerial capacity to support the development of Integrated Care Partnerships Better use of CCG workforce - improving efficiency and sharing of best practice, reducing duplication Maximise opportunities for commissioning at scale across Cheshire, with the 2 local authorities and across Cheshire & Merseyside Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

The Route to Potential CCG Merger Oct 2016 Initial Discussions 2017 Cheshire Joint Commissioning Committee Formed 2018 Agreement to consider merger of CCG teams/formal merger Appointment of Single Accountable Officer for 4 x Cheshire CCGs 2019 Appointment of Single Executive Team for 4 x Cheshire CCGs CCG Functions to align with ICPs so that resources, decision making ability and responsibility for delivery transfers Memberships to be assured on: - Clinical representation - Financial aspects - Existing services July – Sept 2019 CCG Memberships to agree / not to CCG merger application April 2020 Single Cheshire CCG could be formed All has / will only take place with CCG membership and Governing Body approval Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Strategic Clinical Commissioning Group Develops in parallel to two ICPs: Cheshire East & Cheshire West Development of two integrated health and social care commissioning boards on local authority footprints Supports place-based approach to integrated care in Cheshire Maximises opportunities to commission at scale Common outcomes framework for integrated care Optimises resources & reduces variation Improved outcomes for population and provides opportunity for greater involvement Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Integrated Care Partnerships Shared cross-system ambition to join up health and social care Place-based approach i.e. two Integrated Care Partnerships co-terminous with the Local Authority footprints Partnership of health and care organisations to improve the outcomes for the population Collective accountability for improving outcomes within available funding over a longer term Focus on integration; single assessment process, single personalised care record, multidisciplinary teams wrapped around the person at the centre Development of 17 ‘care communities’ providing primary and community care Able to co-ordinate care for individuals along whole pathway of care Proactive case management focused on using data to target effective care earlier Integrated IT solutions that are accessible to patients Increased involvement of patients and users in service design and delivery Aim to join up hospital and primary care, health and social care, voluntary sector, mental and physical health and the NHS and local communities. Working together will create the best environment to achieve this Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

The Journey Timeline to April 2020 – ambition agreed by all 4 Cheshire CCGs Appointment to a single Executive Team by April 2019 Stakeholder engagement commencing May 19th 2019 Strengthening collective and collaborative commissioning arrangements ICP’s development & governance - overseen by Cheshire West (ICP) Partnership Board & Executive Map CCG functions and services – some likely to form part of a strategic commissioner, others ICPs Phased transfer of some CCG functions & associated resources to ICPs – starting March 2019 Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Voluntary Sector Context No longer possible to view the public sector simply as a ‘provider’ of public services Needs of the population in the 21st century, along with the most challenging of economic circumstances mean that we need to fundamentally reshape this paradigm Move towards a position of shared power, collaborative leadership, robust engagement and co-production Recognises the significance of the VCFSE as central to this shift, and as an equal partner in meeting the challenges our populations face Proposal to develop a ‘Compact’ to underpin a new and progressive relationship with the VCSFE Use the term ‘Compact’ illustratively - historically ‘Compacts’ have often been viewed as passive agreements between the commissioner and the VCFSE Going forward we develop new language which is reflective of the fact that we have ambitions that extend beyond the traditional Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Voluntary Sector Opportunities Work with us to utilise your vast expertise in effective involvement of service users to improve service delivery Key delivery partner Provide feed back from service users on what is/isn’t working well Consultation (with Healthwatch) on development of Place based 5 year plan Robust and consistent approach to public engagement Use your ability to be flexible and adapt to changing need quickly Share best practice and innovation Potential role in personal health budgets; tailoring offer to individual Active partner in the care communities – what is your relationship with the Integrated Care Partnership? Joint commissioning between CCGs and Local Authority – single approach budget 19/21 commissioning and contracting via Cheshire West ICP? Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Voluntary Sector Challenges How are you working across Cheshire and across Cheshire & Mersey? Review number of separate organisations – align more closely? Reduce competition amongst yourselves? Key strategic partner - Do you have the right relationships? Right offer? Fit for purpose? Fit for business? Are you getting the best from Chester Voluntary Action? What is your partnership agreement? Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG

Summary Are you up for it? Update on proposed CCG changes Update on Cheshire West ICP Opportunities for the Voluntary Sector Challenges for the Voluntary Sector Are you up for it? Working together across Cheshire: NHS Eastern Cheshire Clinical Commissioning Group (CCG), NHS South Cheshire CCG, NHS Vale Royal CCG and NHS West Cheshire CCG