Integrated Care Systems (ICS) update (10.00am)

Report attached.

Contact: Nicky O’Connor, Shropshire, Telford & Wrekin CCG

Joint Commissioning Board (10.10am)

Report attached.

Contact: Laura Tyler, Assistant Director, Joint Commissioning

Integrated Care System (ICS) update

The Programme Director for Shropshire, Telford & Wrekin Integrated Care System introduced and amplified the ICS update and presentation (copy of slides attached to the signed Minutes) which covered the following areas:

·         The Integrated Care System Development

·         Urgent Care and Ambulance Pressures

·         Covid-19 Vaccination Programme

·         Hospital Transformation Programme

·         Community Diagnostic Hubs

·         Elective Waiting Times

·         SaTH CQC Inspection

The Programme Director updated the Board, she recapped the reasons for ICS’s being set up and explained that the Bill was still going through Parliament.  She explained what the new structure would look like from April next year with a view that the structure would be much more fit for purpose. From 1 April 2022 there would be an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP) and that those two bodies together would make up the Integrated Care System (ICS).  The ICB would probably look different to the current ICS Board, in that it would be smaller but would have the same chair, there would be non-executive Directors on that Board who would be new to the system so could not currently be in a non-executive role on any of the current organisations.  There would also be some new Executive Directors,  indeed there were four mandated executive roles in the legislation, and they were the Chief Executive, a Director of Nursing, a Medical Director and a Chief Finance Officer.  In addition to this, there would also be partner members who would be the two Local Authorities, a representative section of provider organisations and GP members.  Decisions would be made across those three sections.  In order to retain the history and knowledge within the organisations they were asking the chairs of the current provider organisations to chair some of the subcommittees of the ICB so that they also became involved in the workings of the Board.

The ICP was a much less mandated grouping of people and would be chaired by the two Local Authority Leaders and would probably meet two to three times a year and it would have representatives from the ICB, representatives from the Local Authorities, representatives from Healthwatch and whoever else it was wished to have on that Board, for example, Police, Fire Service etc.  The primary function of the ICP was to set the Integrated Care Strategy for the system.  Sitting elsewhere in the system would be the two place-based arrangements which would link closely to the Health and Wellbeing Board and were largely focussed on the population of those particular places on and around arranging provision of health care and care for the people in those populations.  There would also be a provider collaborative which was where the providers could get together and decide what might be the best way of providing care beyond the boundaries of organisations themselves and linking up care, so it was more streamlined for patients.  Still in development within the system was the neighbourhood arrangements which were centred around the 8 Primary Care Networks and that was about focussing multi-disciplinary arrangements around individuals, families and making sure that care could be concentrated in the right places, for the right people.

More detail was requested with regard to neighbourhood arrangements and what was meant by neighbourhood.  In response, the Programme Director explained that there was flexibility to design what they wanted it to be but were centred around populations of around 30-50,000 people and around the Primary Care Networks which were already in place across the system.  She confirmed that their purpose was to ensure good primary care provision, bringing multi-disciplinary teams together e.g., social workers, GPs, other providers of community services to particularly focus on individuals and families who have particularly complex needs.

As Shropshire was a very large county with a very large rural population, especially in Shropshire, concerns were raised over difficulties accessing care in some of the rural areas due to having to travel a long way, if they were elderly, they may not have transport, public transport wasn’t always available and have to rely on other people to drive them.  It was requested that some form of outreach be built in to deliver services more effectively to the rural areas instead of rural areas always having to go to a central point.  The Programme Director explained that they were currently trying to set the infrastructure in a way that could respond to those needs and that both place-based Boards as they evolved would need to take that on board as a particular issue for this area and work with the neighbourhoods to ensure they could provide better solutions for people.  She confirmed that the ethos was to provide care in people’s own homes as much as possible.

The Director of Adult Services wished to highlight that the covid services for Shropshire, Telford and Wrekin were among the top performing regions in delivering the covid vaccination to children aged 12-15 and she wished to congratulate the team.  She requested the Director of Public Health to update the Board in terms of the booster programme.  The Director of Public Health commented on the importance of the flu and covid vaccination programmes this winter and would refer later in the meeting to the winter wellness campaign that was being launched to encourage people to ways of keeping well over winter.  The vaccination programme across the county had been phenomenal but people still needed to come forward for their booster vaccinations.  She then drew attention to the mobile covid bus particularly in the South of the County.

RESOLVED:

That the contents of the update be noted.

Joint Commissioning Board

The report of the Assistant Director of Joint Commissioning was received (copy attached to the signed Minutes) which provided an update from the Joint Commissioning Board and sought approval for the Better Care Fund (BCF) submission for 2021/22 which was due to be submitted on the 16 November 2021.

The Head of Joint Partnerships gave a presentation (copy of slides attached to signed Minutes) which covered the following areas:

·         BCF Introduction

·         Key changes within policy guidance

·         BCF national conditions 2021/22

·         Updated Shropshire H&WB Governance

·         Approaches to Integration

·         BCF Key Themes

·         Discharge Alliance

·         Disabled Facilities Grant

·         Metrics

The Assistant Director went into more detail about the additional metrics being measured this year which included a focus on length of stay 14 days and length of stay 21 days. She explained that the data packs had been set nationally based on a local authority area and which was based on an average 18-months data pack.  However, the concern with doing that is that the 18 months also included the covid period where it had skewed the data somewhat across the system.  Hence they looked at the average data set over the 18 months, but also then looked what that average was, as well against Quarters 3 and 4.  They knew as a system that Quarters 3 and 4 were always quite a difficult time of year, so targets had been set based upon those Quarters 3 and 4, so it looked like they were not putting any stretched targets in.  However, as a system they felt they would be very much stretched targets due to the pressures on the acute services and the issues across workforce and recruitment.  These targets had been very much set against a background of increasing pressure and it was felt that they were going to be quite stretched.

The Assistant Director reported that the discharge alliance group would monitor these targets.  She explained that when they went to some of the regional meetings the feeling was that as long as we had a real understanding and justification as a system about: why we were setting those targets, were really clear about how those challenges were trying to be met and what would be done in the future, they were happy with what was being proposed so far.

The Assistant Director informed the Board that a new target of percentage of patients discharged back to their normal place of residence, which again, was an average annual target.  This target had been kept the same as there were real pressures in getting people home particularly with recruitment in the domiciliary market in particular, so there had been an increase of people going into care homes.  This would also be a stretched target along with unplanned hospitalisation for chronic care sensitive conditions where the target was based on what the trajectory would be for the annual target.

The Assistant Director reported that the submission had been sent through to the regions to sense check and get some initial feedback prior to the submission date of 16 November 2021.  She confirmed that all of the BCF strands and plans would be reviewed going forward to make sure they were fit for purpose.  The Head of Joint Partnerships summed up where they were in terms of response from the region.  They had had some comments back and some suggested amendments around further linking the narrative document with the expenditure tab, particularly around enablers e.g., domiciliary care and how people were going to be moved through the system more quickly.  That was one area that need to be bolstered within the narrative document matching back to the financial template.  The other area around the metrics, although it explained why they were setting the metrics where they are, was a request to have additional ideas about where we are at now, what the challenges were, and how those improvements were going to be made.  This was why within the recommendations, the HWBB were being asked to delegate sign off by the Director of Adult Services outside of the meeting so those adjustments could be made.  No adjustments to the finances had been suggested by the regions so overall the feedback was positive.

In terms of hospital discharge, the Director of Adult Services explained that this system performed really well in terms of discharging patients in a timely manner, and she requested that the Assistant Director gave a run-down of the additional capacity and investment that the Shropshire system had put in place to support the system as it went into winter.  She confirmed that the HWBB would receive a report on the Shropshire Winter Plan at its January meeting.

In response, the Assistant Director explained that as a system, they had been looking at where additional capacity was needed and where the biggest impact would be.  She reported that they had successfully managed to get some additional funding to really bolster first, the Reablement Team to ensure people could be discharged from hospital quickly, and also an element of support for domiciliary care, as there had been a few issues with the throughput which thankfully, was starting to improve. The Assistant Director then went on to explain some of the other work being undertaken to try and support the system, including a recruitment and retention campaign.  There was a huge amount of work behind the scenes to support the system.

RESOLVED:

1. To note the contents of the report;

2. To note and approve Shropshire’s BCF planning template submission
    set out in appendices A and B; and

3. To approve delegated authority for final sign off of plan, if regional
    feedback suggests amendments.