Agenda item

for the Coventry and Warwickshire Health and Care Partnershipincluding a report from Sir Chris Ham – Nigel Minns

In February 2019, Warwickshire County Council (WCC) held a public interest debate. It approved a motion that the Council believed that an integrated care system focused on communities was the right way forward for the health and wellbeing of citizens in Warwickshire. This was followed by a governance review, led by a task group including senior representatives of WCC and Coventry City Council alongside NHS organisations. It was chaired by Professor Sir Chris Ham, Independent Chair of the Coventry and Warwickshire Health and Care Partnership. A copy of Professor Ham’s report, including his proposals for future governance, was provided as an Appendix to the report. Alongside a review of the governance of the health and care system, it was logical for the Health and Wellbeing Board (HWBB) to consider whether its own membership remained appropriate or whether it would consider recommending any changes to the Council.

It was proposed that the governance arrangements as set out in the Appendix be endorsed by the HWBB, the key elements being:

• A new Coventry and Warwickshire Health and Care Partnership Board would be established to work alongside the Joint Coventry and Warwickshire HWBB (the Place Forum);

• The two bodies would have many (if not all) members in common and would meet on the same day in the same place, but with different agendas;

• The Partnership Board would meet in public, with published terms of reference, agenda and minutes;

• The current Better Health, Better Care, Better Value board would be replaced by a new Partnership Executive Group (PEG) whose members would be drawn from NHS organisations, Warwickshire County Council and Coventry City Council. PEG would report to the Partnership Board;

• Each of the four ‘places’ (North Warwickshire, South Warwickshire, Rugby and Coventry) would have a Partnership Board for their place; and

• The ‘Place Forum’ would continue to be a developmental workshop led by the two HWBBs. It was important to ensure that new arrangements built on existing local arrangements. The Place Partnership Boards proposed in these arrangements would have a key role in bringing together the HWBB county-wide priorities and the local health and wellbeing priorities, both identified through the JSNA, with the health and care system priorities identified through the NHS long term plan.

There were existing partnership boards in North Warwickshire (covering North Warwickshire and Nuneaton and Bedworth), South Warwickshire (covering Warwick and Stratford Districts) and Rugby. It was proposed that they take on the role of the Place Partnership Board in their areas. As these Place Partnership Boards played a key role in delivering the HWBS in each ‘place’, it was proposed that they provide regular reports on progress to the Warwickshire HWBB.

Nigel Minns, Strategic Director for People Directorate presented the report on behalf of Professor Ham who was unable to attend. Professor Ham’s wish was for the new partnership arrangements to be held much more in public. The HWBB was asked to consider its membership and whether it wished to recommend any changes to Council. One option was for additional representation from primary care as service providers, in addition to the current clinical commissioning group (CCG) attendees. It was questioned whether the health representation from CCGs and trusts should be the chair, as presently, the chief officer or both. There was a balance between representation and the size of the HWBB. Reference was made to the Kings Fund model shown in the previous report. The four quadrants of this model described the wider determinants of health and the role of district and borough councils in delivering many of the relevant service areas was highlighted. The partnership boards would lead on these wider areas and would have a key role in feeding in to the work of the HWBB. In relation to the PEG, some district and borough council representatives considered that they should be involved in this group, as many of the wider determinants of health would have an impact for the integrated health and care system. In relation to housing a councillor noted that the County Council had significant land holdings which should be made available. There was further work to undertake in finalising the arrangements for the PEG and place partnerships.

A key aspect was the involvement of organisations in the four quadrants and linking the various groups to manage business. The Chair quoted from Professor Ham’s report that there was no intention to change the legal powers and duties of partners, but to link effectively. Nigel Minns clarifed that all four quadrants collectively were the ICS and that the body which ‘held the ring’ and brought it together was the HWBB, where all key organisations were represented. The partnership boards would concentrate on the three quadrants of the model which focused on the wider determinants, with key roles for the county, district and borough councils, as well as other organisations. The role described in the fourth quadrant was much narrower and specific than that of the whole system, involving the statutory health and care functions. As a result, the PEG, which would focus on this quadrant, included only those bodies, with statutory responsibility for commissioning and providing health, public health and social care services.

There was no intention to exclude people, just to ensure organisations focussed on the areas where they had most influence. Sarah Raistrick echoed the points made adding that this was one of the more open and inclusive processes to review governance structures. Whilst she attended the HWBB as a CCG representative and was herself a GP, primary care as a provider of care also had a role and should be included in the system. She added that this was a good time for the board to own, feed in to and shape the system.

Resolved

That the Health and Wellbeing Board:

1. Endorses the governance arrangements for the Coventry and Warwickshire Health and Care Partnership (formerly the STP) as proposed by Professor Sir Chris Ham (independent chair).

2. Recognises the key role of the three Place Partnership Boards (North Warwickshire, Rugby and South Warwickshire) in delivering the Warwickshire Health and Wellbeing Strategy and agrees to receive regular reports from these Boards.

3. Considers and recommends to the County Council any changes to representation arrangements for the Health and Wellbeing Board, noting that there will be a development session in October to give further consideration to this aspect.