STRUCTURE: Providers and commissioners across Cambridgeshire and Peterborough have created a joint board for strategic planning which they hope will ultimately share financial risk across the health economy.

The organisations have formed a “system transformation board” through which they intend to submit an expression of interest to NHS England to develop a new integrated model of care, Andy Vowles, chief strategy officer for Cambridgeshire and Peterborough Clinical Commissioning Group, told HSJ. The board is considering a number of options for how the model could operate.


The patch was identified as one of 11 ‘challenged health economies’

HSJ reported this week that a proposal is expected to be put before the boards of the participating organisations over the coming weeks, but has yet to receive official sign off from any of them.

The board is chaired by CCG chief clinical officer Neil Modha and includes chief executives of provider organisations across the region and the directors of adult social care for Cambridgeshire County Council and Peterborough City Council. Representatives for Healthwatch Cambridgeshire and Healthwatch Peterborough are also involved.

It is working under the principle of “one system, one budget”, Mr Vowles said.

“We need to avoid the situation where one organisation makes a saving and the consequence of that is to shift the cost to somebody else.

“We all recognise there’s one pot of taxpayers’ money to fund the service, and what’s really driving our programme board… is how do we collectively plan how to make best use of that budget?”

A joint board enables different parts of the system to “[think] about the future in a way that… the local economy certainly has not done as effectively as in the past.”

Although the board intends to submit an expression of interest to be one of the “vanguard” sites testing new models of care outlined in the NHS Five Year Forward View by the end of the month, its work predates the document, which was published in October.

Organisations in the region began working more closely together when the patch was identified as one of 11 “challenged health economies” by NHS England, Monitor and the NHS Trust Development Authority early last year.  

“Following the initial stage of work there, we agreed a transformational programme across our system,” Mr Vowles said. The board has been in operation for five months.

He said the forward view was “completely aligned” with what the board was already doing. Becoming a vanguard site would be a “logical next step” to test some of its concepts and “could help with bringing that work forward”.

The board is “exploring what future organisational forms might enable us… to bring into reality ‘one system one budget thinking’”, Mr Vowles said. A “possible end point” could be to have a single budget across all health and care organisations but “we wouldn’t go straight there”.

He also stressed individual organisations would have “sovereignty” on final decisions affecting them and any proposed changes would need to be approved by their respective boards.

A paper discussed at the CCG’s January governing body meeting said that “work on identification and evaluation of new models of care is likely to remain a key element [of the programme] regardless of the national developments arising from the forward view”.

The board has recruited a “cross-system transformation team”, staffed by CCG staff and secondees, and established a £1m “transformation fund”, into which all organisations involved have jointly contributed.