Agenda item

This item provides an update on local developments regarding the Southwark and Lambeth Integrated Care Programme.

Sarah McClinton, Director of Adult Social Care, introduced the report, which set out progress developing Southwark and Lambeth Integrated Care (SLIC).  She reported that this multi-partner programme’s overarching aim was to reduce reliance on hospital admissions and length of stay, as well as to reduce admissions to care homes. The holistic, person-centred model, which covers mental and physical health was based on identifying risk early in the community and developing preventative and proactive interventions in response, with two key workstreams covering older people, and residents with long term conditions. Together, the director noted, these account for approximately £575m spend across Lambeth and Southwark, compared to approximately £36m spent on older people social services.

The director outlined progress to date, and emerging lessons, as well as noting partners’ intention to submit an application for Lamb Pioneer status. This application had given the local system some impetus to testing the feasibility of an integrated care organisation and tackling emerging barriers, including workforce development, information systems and capitated budgets.

In noting the integration item also on the agenda, at item 11, the board welcomed the opportunity to consider the programme in this context, and its implications and governance arrangements. Members recognised the challenges, particularly in current financially strapped times, of maintaining a focus on what is important, while ensuring best value and the development of a financially sustainable system for which at its centre must be the patient.

Andrew Bland stated that it was crucial that these providers come together into a governance framework that provides services in a sustainable way, with this marking the difference between now and previous modernisation initiatives which relied on good faith.

The board members endorsed the Cabinet Member for Health, Equality and Adult Social Care’s request that the board notes the positive opportunities integration brings, and agrees to their exploration and realisation of the benefits for residents. The board recognised, however, the complex governance arrangements, which were highlighted by the Lamb Pioneer application as lacking clarity. Romi Bowen highlighted that this experience had shown there was a need for a stronger ongoing relationship between SLIC and the health and wellbeing board so that the board can better monitor, steer and empower individual agency’s representatives on the sponsor board or operations board.

Members concurred with Professor John Moxham’s observations that the system will only improve health and premature death rates if there was a programme that picks up people at risk and addresses their co-morbidities.  Partners’ focus must continue to be on shifting resources from general hospital functions to primary, community and social care. Andrew Bland reiterated the CCG’s long-standing preference to approach the integration of services around the local population and all their needs. He also noted that this agenda occurs in the context of increasing financial constraint, with the board requiring a very tight grip on the issues in order to ensure the very best decisions are made for Southwark.

In concluding this discussion and in anticipation of the next agenda items, Romi Bowen suggested the establishment of a small group to refine and clarify governance arrangements.