Agenda item

(Indicative timing 10:05 – 10:45am)

A summary of the Agenda report was provided by the Associate Director for System Development and Strategy for Herefordshire and Worcestershire Integrated Care System (ICS) and the Executive Director of Strategy and Integration.

It was emphasised that the ICS was not one organisation, and included all of the representatives present, as well as the voluntary and community sector. The Agenda report focused predominantly on the ICS, the Integrated Care Partnership (ICP) and more specifically, the Integrated Care Strategy.

Since the last report to the HOSC in January, some significant legislative changes had taken place, including implementation of the Health and Care Act 2022, which put ICSs on a statutory footing. Essentially, the Act meant that all providers and partners involved in the ICP had responsibility to improve the health of the local population, including the wider determinants of health and wellbeing.

Other important factors were:

·       the ICP would be co-chaired by the two Health and Wellbeing Chairs, reflecting the joint working approach

·       the important role of public health

·       the timeline for production of the Strategy which included three phases of engagement including ICP representatives and wider engagement with people who lived and worked in the ICS area

·       the Strategy would be published in April 2023.

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

·       In terms of the membership of the ICB and how it would work in practice, it was explained that the aim had been to create an equal partnership between the three statutory organisations, which would encompass public health and the Health and Wellbeing Board (HWBB), and organisations had been asked to nominate representatives – however ICP meetings took place within a much wider forum.

·       No cap had been given for membership of the ICP which had more than 50 partners, as it was a platform for development and it was pointed out that Bristol and Somerset ICP had 200.

·       Regarding appointments to the ICB, Board members were all highly experienced, and recruitment had involved advertising in medical journals and the wider press, use of an agency to search nationally, and appointments panels involving Council Cabinet Members.

·       Regarding the key requirements to include in the IC Strategy, a HOSC member suggested that ‘population health and prevention’ should top the list and stressed that interventions such as NHS health checks were far too late to influence and promote the importance of healthy lifestyles, which should start at school age. The Director of Public Health completely agreed with the importance of this message, which would be included in plans for a whole prevention agenda and wider public health work set out in the Health and Wellbeing Strategy – she clarified that the health check programme for those aged 40-70 was to screen for specific markers.

·       The Cabinet Member with Responsibility (CMR) for Health and Wellbeing agreed that prevention was key.

·       In terms of monitoring expenditure of the considerable budgets involved, it was explained that this would be largely the responsibility of the relevant organisation’s Board and auditing mechanisms, whereas the ICB oversaw the strategic allocation and requirements.

·       A major change from the ICB would be the ability to move finance around the system, whilst also shifting away from the current very monetary based system to one which focused on outcomes and flexibility - and this would have a positive impact on communities.

·       It was clarified that the three phases of development concerned the development of the ICB and its Strategy, and not the development of services.

·       A recent example of a positive difference was the ability of Herefordshire and Worcestershire Health and Care Trust (HWHCT) to respond more quickly and directly to challenges in areas of mental health services by making use of the voluntary sector – this type of response had been used during the Covid pandemic and was now being really strengthened.

·       The CMR highlighted the challenge of integrating services across Herefordshire and Worcestershire which were very rural.

·       In terms of whether responsibility for outcomes sat with the ICB or the individual organisation (contracted for the service), the relationship was described as being one family but with very clear accountabilities. The individual organisation would likely look at any specific issues for example relating to a specific staff member, whereas the ICB would consider wider issues.

·       Collective decisions would be easier since the ICB included Chief Executives from organisations responsible for health and social care.

·       The Committee was assured that the collaborative (rather than competitive) approach to allocating resources would still be subject to all the necessary checks.

·       The Executive Director of Strategy and Integration believed the major benefits of the integrated system would be collaboration, less restriction, focus on outcomes, removal of competition when procuring services, and information sharing about patients to health and social care professionals.

·       Some selective outsourcing may be used to improve specific outcomes.

·       The IC Strategy would plug any gaps required by national guidance that were not already covered in the HWBB strategies.

·       Regarding wider engagement, the Director of Communications and Engagement for the ICB explained that the current desktop exercise involved working through the huge input received during the pandemic so that it was not lost. Thought was being given to the subsequent phases of engagement around the Strategy, which would include harder to reach communities – a focus on outcomes rather than the processes of the ICS would likely be of more interest to the public.

·       The CMR highlighted the benefit of incorporating wider determinants of health, for example active travel which had such a significant impact on health and wellbeing

·       The Director of Public Health agreed the ICS was an exciting development as the public health budget and staff team were small and public health would now be the responsibility of the whole system.

·       A Committee member agreed the potential of the new system was fantastic, but asked about the risks and challenges, and the representatives highlighted workforce shortages as by far the biggest concern, plus vacancy numbers putting a strain on existing staff.

·       When asked about capacity for example for GP appointments to meet the needs of more people coming forwards following the pandemic, the representatives pointed out that capacity in Worcestershire was one of the best in the country, however demand was 18% higher than before the pandemic and in September, GPs had seen 420,000 people. Nonetheless, problems in getting GP appointments were recognised and being acted on. Demand from the level of people coming forwards with complex health needs was also concerning.

·       Despite the challenges from workforce pressures and increased demand, the representatives all felt the integrated care system was the best way to meet demand collectively and move forwards.

·       Regarding differences in appointment systems across GP practices, the ICS Executive Director explained that this was because they were individual businesses. The ICS was working to support practices and share learning through primary care networks and members wishing to see practice terms of reference were encouraged to contact the individual practice to discuss.

·       When asked whether a resident should direct concerns from their community about services to the ICB or to the organisation concerned, the representatives advised they would be happy to be contacted.

·       The CMR stressed the importance of everyone supporting the ICS, which as a system was safe, aimed for the best outcomes and focused on wider health; it had to succeed.

·       A member queried how and where any particular district area concerns should be raised under the ICS, and the CMR referred to the place-based approach which she believed was effective, and urged members to contact their district council representative, who would then feed into the HWBB and the overall Worcestershire system.

·       A member referred to the ambitions of the plan and asked whether there was sufficient budget available, how it would be prioritised, and how expectations would be managed, and the CMR responded that the key components were very much evolving, however funds would be aligned to outcomes, and the Strategy would be aspirational for every resident.  The representatives also pointed out that irrespective of funding, workforce was the significant risk.

·       A member asked whether the ICB would have a role in looking at patient flow, which was being monitored by the HOSC as an ongoing concern and was reassured that this was absolutely the case; the Strategy would focus on a longer-term view and sustainability of services, whilst also tackling current issues such as patient flow.

·       The CMR highlighted that the County Council was very much involved with the ICS, and encouraged a solutions-focused approach to scrutiny about areas such as patient flow, being mindful of the importance of promoting the benefits of Worcestershire as a place to come and work.

It was agreed that a further update would be scheduled before the Integrated Care Strategy was finalised.