In September 2014, Salford City Council, Salford CCG, Salford Royal NHS Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust established an alliance to work in partnership to deliver health and social care for older people. This included establishing an alliance board of commissioners and providers to oversee a pooled budget of £112 million and oversee changes in how care was delivered.
Over the past two years, commissioners and providers have expanded on these arrangements to bring together the funding and service delivery for all health and care for adults within an integrated care organisation. The aim is to develop a focus on population health and to extend integrated services from older people to wider sections of the population. Since March 2015, the Salford alliance has been pursuing these plans as one of the NHS primary and acute care system (PACS) vanguards.
In July 2016, local leaders disbanded the alliance board and established a new joint commissioning board, comprising city councillors and GPs from the CCG’s governing body, to oversee a larger pooled budget of £236 million for all adult health and care services (excluding specialised services). While this group oversees the budget and services, the CCG administers the pooled budget, with a joint commissioning team comprising CCG and council staff. Commissioners and providers sit on an advisory board to discuss use of resources and changes to services.
Under the new arrangements, the city council and CCG contract direct with Salford Royal to deliver a range of adult health and care services. In mid-2016, the council transferred its 450 social care staff to Salford Royal to undertake assessments and contract for the provision of adult social care support. This means that Salford Royal will deliver a large proportion of the services, including acute care, community health care and some social care services in-house.
Salford Royal is the accountable body for all the services in the integrated care organisation, whether delivering services itself or sub-contracting them. It holds the contract with Greater Manchester West to deliver mental health services. It will carry out the adult social care assessment function and deliver a large proportion of intermediate care services, while sub-contracting with independent providers for most domiciliary and residential care services.
Salford Royal has created a new division, Salford Division of Health and Social Care, to oversee the services provided by the integrated care organisation. It is also continuing to oversee changes to integrate services, such as establishing new neighbourhood-based health and social care teams.
The funding for the Salford integrated care organisation is held in a pooled budget jointly administered by the CCG and council. Overspends and underspends will be managed within the pool and efficiencies realised will be used to offset the expected provider growth and demand pressures. Any net underspend will be re-invested in services. Governance meetings are in place and attended by CCG, council and provider management, ensuring performance and financial risks are promptly identified, with action plans developed collaboratively, as required.
Eighteen legal documents underpin the new arrangements, including a Section 75 agreement delegating functions from the city council to Salford Royal; a new service contract with Salford Royal; sub-contracts; agreements on pensions; commissioning and operational principles; a scheme of delegation for decision-making; and a risk-share agreement.
An immediate priority for the integrated care organisation is to engage primary care more fully in its work. GPs are already part of new multidisciplinary community groups and are engaged in the leadership of the new system, although not part of the integrated care organisation itself. In October, GPs brought Salford’s 46 separate practices into a new grouping, Salford Primary Care Together. This should provide a basis for GPs to engage with the integrated care organisation and to jointly integrate care and services. It is likely that commissioners and providers will want to revisit the governance arrangements for integrated care in time, so that the new primary care organisation can play an active leadership role.