SalfordCity Council - Record of Decision

I, Ian Stewart, City Mayor in exercise of the powers contained within the City Council constitution do hereby approve:

  • Approve the enclosed Memorandum of Understanding to support the

development of the Alliance Agreement;

  • Delegate authority to the Assistant Mayor for Adults and Older People to

sign the final MOU; and

  • Provide delegated authority to the Councils nominated representatives of

the Integrated Care Board (and its Subgroups) to develop the new legally-

binding agreement

In February this year, as part of Salford’s Integrated Care Programme, it was agreed to develop proposals for new contractual and payment arrangements to support the planned development of integrated care in Salford. The Integrated Care Board subsequently recommended that an Alliance Agreement would be the most appropriate vehicle for bringing together commissioners and providers; enabling the provision of more integrated care and services and supporting risk sharing[1]

Each organisation has therefore been asked to support the principle of an Alliance Partnership encompassing Health and Social Care Services for older people, supported by a Memorandum of Understanding (MOU). The MOU within the report sets out the proposed population focus, service content, aims and improvement measures to be adopted by the Alliance in total across the 4 partner organisations.

In parallel to the development of the Alliance Agreement, work is continuing to refine Salford’s integrated care model and to develop plans for rolling it out on a city-wide basis. A Cost Benefit Analysis (CBA) is also being undertaken, using a Greater Manchester template as part of the Public Service Reform proposals. The Alliance Agreement and the associated CBA will also be critical in developing Salford’s response to the Government’s recently announced £3.8 billion ‘Integration Transformation Fund’, as the indicative timetable requires pooled budget proposals to be developed during December 2013 – January 2014.[2]

Assessment of Risk:Medium

The Alliance Agreement has potential to help transform the way partners deliver care to older people, aligning services and financial resources within a single contractual framework, with shared standards and performance indicators agreed for all parties. It also provides a vehicle to implement different payment regimes, thereby facilitating financial risk and benefit sharing. It can also provide a model for developing wider integration in the future.

Whilst the limitations of existing contractual arrangements and associated payment mechanisms have been recognised, it should be emphasised that there are risks associated with moving towards different contracting and payment models. The materiality of these should not be underestimated nor should the difficulty of resolving them.

  • The level of trust and commitment to joint working between partner organisations will be key to the success of the proposed changes.
  • General Practice is a strong partner in a commissioning role but there is not presently a vehicle to engage them, collectively, as a provider group. Primary care is commissioned at a Greater Manchester level using nationally determined contract mechanisms.
  • The potential partners within the Alliance have different organisational size, levels of resilience and roles within the system. They will have different externally determined funding sources based upon either place of registration or place of residence. They have different forms of regulation e.g. Monitor, Care Quality Commission etc.
  • Organisations within the Alliance have different business models and organisational objectives. There will inevitably, at times, be a tension between the Alliance’s aims and those of the parties within it. Hence the importance of having effective collective leadership, principles to work to and development of mechanisms to manage risk where these tensions emerge.
  • Issues related to choice, competition and procurement.

The source of funding is:Salford City Council, Community Health & Social Care and NHS Salford CCG. In respect of financial implications, initial baseline estimates have calculated that the level of financial resources within scope and for the City Council is approximately £37m. The financial arrangements from April 2015 will need to be considered alongside the development of a new care model. In line with public sector reform principles a cost benefit analysis is in progress and should be completed by January 2014. This should identify financial benefits, risks and implications for the Council.

Legal Advice obtained Yes/No (Nicky Smith). – set out in the report

Financial Advice obtained Yes/No (Dianne Blamire),

The following documents have been used to assist the decision process.

Health & Social Care Integration Transformation Fund (ITF) report

Salford Integrated care Programme for Older People – previous reports establishing the programme and progress reports to Assistant Mayor and Health and Wellbeing Board

Contact Officer:Jennifer McGovernTel No 0161 793 2202

*This matter is also subject to consideration by the Assistant Mayor for ______and, accordingly, has been referred to that Assistant Mayor for a decision.
*This decision is not subject to consideration by another Assistant Mayor. / X
*This document records a key decision, but the matter was not included in the Council's Forward Plan and it has been dealt with under the emergency procedure.
*This decision is urgent and is not subject to call-in, in accordance with paragraph 5 of the Decision Making Procedure Rules
*The appropriate Scrutiny Committee to call-in the decision is the Adult Services Scrutiny Select Committee.

Signed: Ian Stewart Date: 24 September 2013.

City Mayor

FOR COMMITTEE SERVICES USE ONLY

*This decision was published on 24 September 2013.

*This decision will come in force on #2 October 2013 unless it is called-in in accordance with the Decision Making Process Rules.

[1]The Alliance Agreement is a mechanism that enables partners to align services and financial resources within a single contractual framework, with joint standards and performance indicators agreed for all parties. It also provides a vehicle to implement different payment regimes and facilitate financial risk and benefit sharing.

[2] See