Agenda item

Present for this Item:

Herefordshire and Worcestershire Integrated Care Board

David Mehaffey, Executive Director of Strategy and Integration

Alison Roberts, Associate Director, System Development and Strategy

Worcestershire County Council:

Lisa McNally, Director of Public Health

Mark Fitton, Strategic Director for People

Rebecca Wassell, Assistant Director for Commissioning

Karen May, Cabinet Member with Responsibility for Health and Wellbeing

The Executive Director of Strategy and Integration at Herefordshire and Worcestershire Integrated Care Board (ICB) referred to the Agenda report and reminded the HOSC of the context for the Integrated Care Strategy (the Strategy). Integrated Care Systems had been legally established by the Health and Care Act 2022, although in practice integrated working had been ongoing since 2015.

The Strategy for Herefordshire and Worcestershire had just been published and would be circulated to HOSC members. There was a close relationship between the Strategy and the Health and Wellbeing Strategy, since both were focused on improving health outcomes. The overriding principle was to work as close to the ground as possible and only at system level where necessary.

The ICB Associate Director for System Development and Strategy outlined the engagement approach during development of the Strategy, which had taken six months engagement with partners and involved three phases to gather information, consider how best to work together and to share the draft Strategy for feedback.

The Chairman invited discussion and the following main points were raised:

·         The Cabinet Member with Responsibility (CMR) for Health and Wellbeing pointed out that that factors affecting health were 20% economy and 80% wider determinants such as having a good home.

·         The Council’s Director of Public Health highlighted examples of how the Integrated Care Strategy could impact residents’ health. The number of women smoking during pregnancy had reduced down to the national average through integrated working between Public Health and Worcestershire Acute Hospitals Trust, and integrated working with the District Councils to signpost young people to opportunities for physical activity, had greatly increased those reaching the recommended level of activity. Future plans included a Public Health funded junior parkrun, being worked on with the District Councils and the NHS.

·         It was clarified that the majority of District Councils had provided input to the Strategy.

·         A member queried the absence of podiatry on the list of groups which had provided input to the Strategy, and pointed out its importance in heading off any issues experienced by children, yet GPs may not always refer them on to Podiatry. It was clarified that the group was not exclusive, therefore further appropriate sectors were welcomed, including podiatry. It was also confirmed that optometry was represented on the group.

·         The ICB Directors explained that the Strategy set out the priorities and it was now important to get people out there and working on the priorities. There was a collective desire for implementation and the ICB would make use of existing structures to ask the organisations involved how work would be taken forward.

·         A member sought acknowledgment that providing timely cancer diagnosis and treatment (one of the Strategy’s areas of focus) was more positive for breast than for other cancers such as prostrate, and he and another HOSC member reported having to push for prostrate cancer tests from GPs. The ICB Executive Director undertook to look into this observation, but advised that tackling cancer was a top three priority although NHS partners had to be optimal in how they identified and treated cancer and Urology was a struggling area, although there were strong aims to tackle this.

·         The Director of Public Health sympathised with the comments about screening for prostrate cancer, and suggested that the Public Health team may be able to help by promoting awareness, following success with bowel cancer screening, in liaison with NHS colleagues.

·         HOSC members welcomed the progress set out in the report, and the ICB representatives suggested a further progress report in around 5 months would be helpful.

·         A member commented that social prescribing did not seem to be happening and the Director of Public Health highlighted the importance of providing opportunities, since the ‘wagging finger’ approach did not work. Social prescribing in essence had been used for years although not always health related and needed to be maximised. Healthy life expectancy varied dramatically and working with communities was key and was an area she was resolved to support.

·         A member highlighted the tragedy of suicides as well as expressing concern that increasingly people seemed to have to push to access diagnosis and treatment. The Executive Director acknowledged demand had increased following the Covid pandemic and gave the example of referrals to children’s mental health having increased by 90% from September 2021 to March 2023. School mental health teams had been introduced however could not keep pace with demand, which had increased by 235% over the period.

·         The Executive Director referred to progress reducing elective care waiting lists, with the number waiting 78 weeks down from 3000 in September 2021, to 400; it was a fight to reduce numbers but partners were desperate to do so.

·         The CMR signposted the HOSC to a report being brought to the Health and Wellbeing Board on preventative action on suicide.

·         Responding to an account of a resident experiencing pain in her arm, who subsequently suffered a heart attack after being turned away from the GP telephone receptionist because the practice was only able to respond to emergencies, the Executive Director expressed concern that this was not an experience health commissioners expected. Demand for GP appointments had increased hugely, it was not that capacity had reduced, but no practices in Herefordshire and Worcestershire should only deal with emergencies.

The Chairman thanked the representatives for their update, and hoped that the clear direction of the Strategy, as reported by partnership assembly members was indeed correct, as this would really benefit Worcestershire residents. He requested that the final Strategy be circulated to HOSC members.