Section 75 Agreement between London Borough of Bexley and NHS South East London Clinical Commissioning Group

What is a Section 75 Partnership Agreement?

Section 75 of the National Health Service Act 2006 and the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000 provide that Local Authorities and NHS bodies, including Clinical Commissioning Groups, can enter into a partnership agreement to establish and maintain pooled funds. The powers under the Act and Regulations permit:

• The formation of a pooled budget made up of contributions from both parties out of which payments may be made towards prescribed functions of the Clinical Commissioning Group and prescribed health related functions of the Council
• The exercise by the Clinical Commissioning Group of the Council’s prescribed health related functions
• The exercise by the Council of the Clinical Commissioning Group’s prescribed functions
• The provision of staff, goods or services or the making of payments between the Council and the Clinical Commissioning Group.

These powers support the three “flexibilities” namely pooled budgets, lead commissioning and integrated provision.

Why do we need to put a formal Section 75 agreement in place?

The Section 75 agreement provides the legal basis and flexibility for the pooling of resources in support of our overall integration plans. This will enable the strategic and more efficient commissioning of locally-tailored health and social care services, leading to improvements in the way care and support is provided, as well as delivering better outcomes for residents and patients.

The Section 75 agreement between the Council and NHS South East London Clinical Commissioning Group provides clarity about the responsibilities of both parties, prevents ambiguity and provides a reference point for problem-solving in the event of potential disputes arising.

What difference will the Section 75 agreement make to people who use services?

There will be no change in services provided specifically as a result of the proposed Section 75 agreement. The agreement will better enable both partners to continue to work together to improve the commissioning and delivery of services.

How will you consult with stakeholders and when?

The consultation will start on 10 December 2020 and end on 4 March 2021. The Council and CCG are inviting people in Bexley, including those who use health and social care services, carers, our partners, providers and other interested stakeholders to take part in an online survey. To have your say, please complete the Consultation Survey on the London Borough of Bexley website by 4 March 2021.

A link to the consultation will also be included on NHS South East London Clinical Commissioning Group’s website.

We would welcome a wide range of views. We propose to promote the consultation to stakeholders, including Partnership Boards, the CCG Patient Council, Patient Participation Groups in GP practices, Healthwatch Bexley, and Bexley Voluntary Service Council.

We can arrange for an Officer of the London Borough of Bexley or NHS South East London Clinical Commissioning Group (Bexley) to discuss the proposal with your stakeholder group by invitation.

Alternative formats of the survey will be made available upon request. To request an alternative format, please contact Steven Burgess, Policy and Strategy Officer, London Borough of Bexley, Email steven.burgess@bexley.gov.uk,Telephone 020 3045 3550.

What are the main proposals for the Section 75 Agreement?

The proposals have been outlined in a report to the Bexley Health and Wellbeing Board on 10 December 2020. The report includes an Appendix that describes the key provisions of the draft Section 75 Agreement.

How will the Section 75 agreement improve services?

By working closer together and ensuring that all relevant expenditure is considered in a strategic and meaningful way, the Section 75 arrangements are likely to lead to an improvement in the way functions are exercised and will in turn support delivery of better outcomes for Bexley residents.

What services do you propose to cover in the Section 75 Agreement?

Subject to sign-off by the London Borough of Bexley and NHS South East London Clinical Commissioning Group, the total value of services to be covered by the new Section 75 agreement is estimated to be up to approximately £80m. It is recommended that this comprises:

• Prevention and early intervention services, including social prescribing
• Learning disability services
• Integrated physical disability and sensory support services, including community equipment and wheelchair services
• Integrated older people services
• Discharge to Assess home care
• Enhanced health in care homes
• Continuing Health Care
• Bexley Community Contract
• Winter pressures funding
• Better Care Fund, including improved BCF and the Disabled Facilities Grant.

What is the Better Care Fund?

The Better Care Fund (BCF) is a partnership between NHS England, the Ministry of Housing, Communities and Local Government, the Department of Health and Social Care, and local government. The BCF provides a mechanism for joint health, housing and social care planning and commissioning through a single pooled budget. It aims to support the delivery of person-centred integrated care, with health, social care, housing and other services working seamlessly together to provide better care.

NHS South East London Clinical Commissioning Group and the London Borough of Bexley are required to agree an integrated spending plan for how we will use our BCF allocation. Further information about the Better Care Fund is available on the NHS England website.

The Care Act 2014 amended the NHS Act 2006 to provide the legislative basis for the BCF.  All funding jointly agreed as part of our local BCF plan must be transferred into one or more pooled funds established under Section 75 of the NHS Act 2006.

What are the proposed governance arrangements?

The Council and NHS South East London Clinical Commissioning Group will jointly agree how the pooled funding is governed and used to deliver shared outcomes. We propose that the governance arrangements will be reflective of our Integrated Care System and the borough-based arrangements. This includes a role for the Bexley Health and Wellbeing Board and the Bexley Borough-Based Board.

What is the role of the Bexley Health and Wellbeing Board?

The Bexley Health and Wellbeing Board has a statutory duty with the NHS South East London Clinical Commissioning Group to produce the Joint Strategic Needs Assessment and a Joint Health and Wellbeing Strategy.

Through the Joint Health and Wellbeing Strategy and the Joint Strategic Needs Assessment, the Bexley Health and Wellbeing Board sets out the key priorities for improving health and wellbeing for Bexley residents and exerts strategic influence over commissioning decisions and planning.

Bexley Health and Wellbeing Board is the accountable body for the Better Care Fund and integration work being undertaken under the Section 75 agreement between the Council and NHS South East London Clinical Commissioning Group, which includes responsibility for signing off local Better Care Fund plans.

What is the role of the Bexley Borough Based Board?

The Governing Body of NHS South East London Clinical Commissioning Group has established the Bexley Borough-Based Board as a prime committee of the Governing Body with delegated executive powers. The Borough Based Board is a commissioner only committee and has been established to ensure that decisions are taken at the right scale for delegated services, with local government involvement wherever possible. It can operate collaboratively with the Council either with local authority non-voting attendance or as a ‘committee in common’ with representatives from the Council.

Members of the committee are held to account by the Governing Body for undertaking duties for agreed areas of delegated responsibility. One such duty is to establish partnership arrangements with the Council to ensure appropriate integrated working, including the use, monitoring and management of agreed pooled funds.

How will any formal agreement be monitored?

It is proposed that the Bexley Borough Based Board will be responsible for implementing and monitoring delivery in support of the overall vision for integrated care agreed by the Bexley Health and Wellbeing Board.

Under section 199 of the Health & Social Care Act 2012, the Bexley Health and Wellbeing Board requires the Clinical Commissioning Group and the Council to provide it with relevant information, for example, quarterly and annual reports, in order to be able to review performance and consider future work.

It is proposed that the Bexley Borough-Based Board, supported by the Integrated Directors and Integrated Commissioning Team, will oversee the preparation of relevant information, for example Better Care Fund submissions and associated commissioning plans for consideration at the Bexley Health and Wellbeing Board. This will facilitate key discussions at a strategic level between members of the Board.

Who will be accountable or responsible for the services delivered through the Section 75 agreement?

An Integrated Commissioning Team for Bexley supports the development and delivery of commissioning plans across health and social care and will report back on progress to the Bexley Borough-Based Board and partners.

Performance and contract management arrangements are used to monitor the impact of interventions in line with requirements. This includes regular meetings between commissioners and providers, reports to the Borough-Based Board and submission of monitoring returns to NHS England and Improvement, the Department of Health and Social Care and/or the Ministry of Housing, Communities and Local Government.

How will staff be affected by the Section 75 Agreement?

The Section 75 Agreement specifies the roles and responsibilities of post-holders within the Integrated Commissioning Team and the procedures for the team.

The Agreement covers the exercise of functions of both the Council and the Clinical Commissioning Group by the post-holders and the role of the Integrated Directors. It includes clauses that deal with the HR policies applicable to the staff, the employer rights and the appointment of new employees.

The Agreement includes clauses that deal with the accountability of post-holders in the Integrated Commissioning Team to NHS South East London Clinical Commissioning Group and the Council. The Agreement also includes clauses that deal with the accountability of persons who report to post-holders in the Integrated Commissioning Team.

What are the next steps?

Consultation responses and feedback will be reviewed by the Council and NHS South East London CCG. At the end of the consultation period, we will produce a short report showing the themes and issues raised. A summary of the consultation responses and next steps will be available to view online at www.bexley.gov.uk. Please get in touch using our contact details to request feedback in an alternative format.

What are your contact details?

Alison Rogers, Acting Director for Integrated Commissioning,
London Borough of Bexley and NHS South East London Clinical Commissioning Group (Bexley).
Email Alison.Rogers@selondonccg.nhs.uk

Steven Burgess, Policy and Strategy Officer, London Borough of Bexley.
Email steven.burgess@bexley.gov.uk
Telephone 020 3045 3550