Decision details

To approve the business case and plans to implement a test-bed year of Accountable Care in shadow form in 2017/18

40.1     The Cabinet considered a report by the Director of Adult Social Care and Health

40.2     It was RESOLVED to:

1)            agree to continue to progress work to develop a local fully integrated Accountable Care Model across the East Sussex Better Together footprint, as set out in the report, involving a transitional year in 2017/18;

2)            agree to receive a further report to Cabinet in July 2017 setting out a business case for the future organisational arrangements to implement a full Accountable Care Model in 2018/19;

3)            agree to a transition year of Accountable Care through forming a commissioner provider alliance to manage collectively, with East Sussex Better Together Commissioning Partners, the health and social care system in 2017/18; and

4)            to delegate authority to the Chief Executive, in consultation with the Leader of the Council, to take any action considered appropriate to give effect to, or in consequence of the above resolutions, including (but not limited to) determining the services included, agreeing and entering into an agreement which will govern the alliance and pooled budget arrangements with the East Sussex Better Together partners

Reason

40.3     As outlined through the Council’s Reconciling Policy, Performance and Resources process it is predicted if nothing changes between current and projected demand and available health and social care budgets the anticipated funding gap will be over £200million by 2020/21.  We have made strong progress already through our East Sussex Better Together (ESBT) programme to integrate services and redesign care pathways in line with best practice, however, we also need to transform the way services are organised and provided to bridge the financial gap, which requires full integration to achieve a health and social care economy that is sustainable in the long-term.

40.3     Taking account of learning from elsewhere, and after local deliberation, moving to a fully integrated model of Accountable Care offers the best opportunity to achieve the full benefits of an integrated system.  It is equally the case that formal integration on this scale would represent significant risks to all the organisations involved in our health and care system.  A transitional year of Accountable Care, under an alliance arrangement, would allow for the collaborative learning and evaluation to take place between the ESBT programme partners and other stakeholders, to further develop the evidence base locally for increased levels of formal integration and designing the appropriate contractual and funding arrangements to suit local preferences. Over the medium term there will also be a need to have dialogue with national Government in order to achieve our aims and objectives.

40.5     Accountable Care models based on a whole population capitated budget and longer outcomes based contracts are an opportunity to transform commissioning and service provision.  Significant amounts of engagement have taken place with local decision-makers and stakeholders to both share the rationale for moving to an Accountable Care Model and the potential options.  Consensus has been reached that a transitional year is the most effective way to further develop the evidence base, allowing collaborative learning to take place across the constituent parts of the local health and care system in keeping with the local circumstances of strong partnership working.

40.6     The Cabinet has agreed that authority is delegated to the Chief Executive, in consultation with the Leader of the Council, to take the necessary actions to continue work towards developing a local Accountable Care Model and to implement a commissioner provider alliance for 2017/18.  This will include agreeing the services included, and entering into the necessary contractual arrangements, such as those related to pooled and aligned budgets, and an agreement which will govern the alliance.