• Luton CCG agrees to merge commissioning budgets with its local authority in 2018-19
  • Merging their budgets in their entirety “not ruled out”
  • CCG and council are “encouraging” providers to form alliances in preparation for regional ACS

A clinical commissioning group and local council have agreed to merge health commissioning budgets so the cash strapped organisations can spend their funds “most effectively”.

Luton CCG has signed a concordat with Luton Borough Council to begin “integrated commissioning” between the pair in 2018-19. The size of the budget is yet to be decided.

The council and CCGs will remain statutorily independent and an integrated commissioning committee will be accountable to both the CCG governing body and council executive, with the local health and wellbeing board providing “strategic overview”.

While the agreement is “not legally binding”, CCG clinical chair Nina Pearson said “there is a genuine intent to pool as much as we can. [The agreement] is deep and broad; it is not taken light heartedly.”

She said the intention was “wider” than just merging the two health budgets and the pair are considering whether parts of the school, social care and housing budgets can also be pooled and cocommissioned. She said, for example, there was potential to develop a new housing complex for older people with a health facility built onsite.

Dr Pearson added: “I wouldn’t rule out pooling the whole [of the two budgets].” But the process would be one of “gradual confidence building… we are not going for a big bang”.

The organisations will shortly start to review their commissioning functions to agree budget mergers. She said the “emphasis” of the concordat would be on “prevention and early intervention… it is about getting the basics right”.

The CCG and local authority have issued a joint health and wellbeing procurement bid that is currently out to tender. The contract is to provide services such as health checks and improving access to psychological therapies services, both of which were previously commissioned separately by the council or CCG.

Dr Pearson said: “It is unlikely one provider can do the whole breadth [of that contract] so it would mean providers working in partnership or alliances or a lead provider subcontracting”.

An alliance approach is one both organisations are “fostering and encouraging” among providers “in preparation for the accountable care system”. The Milton Keynes, Luton and Bedfordshire STP was one of eight regions announced by Simon Stevens as the first cohorts of ACSs.

Dr Pearson admitted the transitional ACS financial arrangements were “proving really difficult” as the CCG needs to shift money from acute to invest in prevention.

Ensuring the sustainability of acute trust finances was the “big headache we are all wrestling with”, she said. The CCG is looking at “creative options on how everyone is sustainable”.

The council and CCG are also in advanced preparations for co-locating their teams in one building and will also consider pooling the budgets used to support or provide urgent and emergency care in the current financial year.

The agreement in Luton follows similar arrangements in Manchester and Hull.