Agenda item

(indicative timing: 10:05am – 11am)

In attendance for this item were:

Herefordshire and Worcestershire Clinical Commissioning Group

David Mehaffey, Director of Integrated Care System Development

Alison Roberts, Associate Director for Integrated Care System Development

Worcestershire County Council

Cllr Karen May, Cabinet Member with Responsibility for Health and Well-being

Cllr Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

The Associate Director for Integrated Care System (ICS) Development provided a summary of the agenda report on the development of the ICS for Herefordshire and Worcestershire (H&W), which was one of 42 across England.

Integrated Care Systems were about health and social care working more closely together by removing traditional boundaries between organisations thereby giving people the joined-up support they needed. With a population of around 800,000, the ICS for H&W was one of the smallest in the country.

The Health and Care Bill 2021 was currently going through Parliament, and at this point in time, the legislation was due to be in place for July 2022.

To support the cultural change, structural changes were being made and the report provided further detail on the four main structural changes; the Integrated Care Board (ICB), Integrated Care Partnership (ICP), provider collaboratives and Place-Based Partnerships.

The next steps were to work on the governance structure and recruiting to the ICB, which would be set up initially as a shadow organisation.

During the discussion which took place, the following main points were made:

·         A HOSC member asked about the rationale of the Place Based Partnership, how it would work for residents, bearing in mind the diverse nature of the county and whether this would be reviewed? The Director of ICS Development (the Director) explained that partnerships would link with primary care networks (of which there were 10 in Worcestershire and 5 in Herefordshire) and would align with neighbourhoods and districts, therefore he believed there was provision to work at local level – he took on board a request for this to be mapped out.

·         The Cabinet Member with Responsibility (CMR) for Health and Well-being pointed out that the Health and Well-being Board was considering the membership of Place board since the role of district councils was crucial for the collaborative approach.

·         In response to concerns that the smaller size of the H&W ICS would mean less funding, it was explained that the population and rural nature of the area was factored into its funding. The introduction of ICSs meant NHS funding was being reset and the representatives present looked forward to receiving H&W’s allocation.

·         The funding allocations for 202/23 and 2023/34 were known and the representatives were pleased with the funding formula.

·         In terms of buy-in from staff for the removal of organisational barriers and contracting regimes as part of the integrated approach, HOSC members were advised that the Covid pandemic had meant staff had already needed to collaborate to a greater extent. Nonetheless a change of hearts and minds would be required to move from a culture where money had followed activity levels.

·         The fact that both counties had good relationships between health and social care meant that everything was geared up to work as collaboratively as possible, which was not the same in other areas.

·         In terms of finances, there would be a period of transition from the CCG to the ICS. Funding received for Herefordshire and Worcestershire would be allocated to the Place Based Partnerships. However, it was acknowledged that evidence of substantial change was not envisaged until 2024/25.

·         Funding for social care was not yet unified, although the Better Care Fund was an integrated fund.

·         It was confirmed that the ICB would still be responsible for conducting needs assessments (which were previously carried out by the CCG) and setting strategic plans.

·         It was envisaged that the new legislation would remove the barriers that prevent local NHS, Public Health and Social Care from being truly integrated and provide the opportunity to plan and deliver services wrapped around the needs of individuals.  This was in contrast to the current situation where organisational boundaries and contracting could result in competition rather than collaboration.

·         There were no particular plans for public communications on development of the ICS itself, which was unlikely to be of great interest to the public.  There would however be a focus on what would improve through removal of organisational barriers and better service planning.

·         A HOSC member suggested that some members of the public may need reassurances that the ICS was not a route to privatisation of health services, however the representatives stressed that it was in fact the opposite, since competition was being removed between NHS organisations.

·         A HOSC member asked about one of the new ICS duties set out in the report to arrange for provision of services and let contracts to entities to deliver services – what was the definition of ‘entities’? It was explained that while currently, the CCG commissioned services to individual organisations, the ICS would allocate to a collaboration.

·         Clarity was sought on what would actually change under the new outcome based, collaborative approach? The example given was Orthopedics, where the CCG currently commissioned a number of services for example physiotherapy- by allocating collaboratively, decisions about how much to dedicate to separate parts of the service would be much closer to the service itself.

·         The HOSC was advised that there would be a performance framework which would be based on how better collaboration improved outcomes. There would also be practical measures to verify that outcomes were improved.

·         The shift to an outcomes focus would mean that commissioning would also be based around this, when historically it had been based around activity.

·         Performance of services within the H&W ICS compared to elsewhere varied depending on the service – the Director undertook to provide further information, however examples included high performance on vaccinations and primary care, with very low performance for ambulance handover delays.

·         In spite of the delayed national legislation, the H&W ICS was pressing ahead and appointments were being made with lots of applications being received. The Board would first operate in shadow form and staff would be in designate roles. Some areas needed to await the legislative change, for example the mental health collaborative.

·         In terms of the leadership structure of the ICS, there would be a similar number of lay members; the main difference would be that NHS Trust and the Local Authority would have a voting role on the ICB therefore governance was broader.

·         The ICS Development Director confirmed that the HOSC would continue to have the same role in scrutinising services.

·         When asked whether Worcestershire would retain resilience as part of the approach to sub-divide the ICS into two ‘Places’ – Herefordshire and Worcestershire, the ICS Development Director explained that H&W was the sixth smallest ICS and that the two Hospital Trusts would work together to provide resilience. There was a benefit to working at scale but the two areas may need to organise themselves slightly differently.

·         The CMR for Adult Social Care did not feel there would be a great change in view of existing close working with health but believed the shift in the commissioner/provider approach would be helpful. Evolvement of the ICS would be interesting as there were differences between the two counties and he viewed the ICS as a considerable step forward.

·         Development of the ICS should have a positive impact on equality and diversity and the representatives advised that much learning had taken place during Covid, which would be embedded; a non-executive Director would also be recruited with this specific aim.

·         Comment was invited from the Healthwatch Worcestershire representative present, (Simon Adams, Managing Director) who asked whether the ICS would mean less funds being available to Worcestershire because of different costs in Herefordshire, and reminded the Committee that when the CCG’s had merged, assurances had been given that budgets would be kept separate. The Director acknowledged that equitable finances would always be a challenge however he cautioned against too much focus on funding because the ICS would be a financial reset with historical debt removed. The Healthwatch Worcestershire representative suggested that finances and any dips in performance were areas for the HOSC to keep an eye on.

The Chairman thanked everyone for their attendance and requested a further update for the HOSC be scheduled.