Agenda item

Jane Hogg, Integration and Transformation Director: Frimley Health Foundation NHS Trust, to present the Panel with an introduction to The Sustainability Transformation Partnership move to the Integrated Care System and the governance arrangements.

Please note:  There is a hyperlink to a video on slide 3 of the presentation which is not available by clicking on it when viewing the agenda in Mod.gov.  The video will be available to view at the meeting. 

To view the video in advance of the meeting, copy and paste the web address below into your browser.

https://www.youtube.com/watch?v=UcM92BHs9yA

Jane Hogg, Integration and Transformation Director: Frimley Health Foundation NHS Trust introduced a video clip to Members illustrating the issues facing services to be reconfigured to ensure people receive the best outcomes with the envelope of funding available.

It was explained the Integrated Care System (ICS) was a national initiative and at a local level covered 800,000 people across five local authorities and three Clinical Commissioning Groups. It was noted the slow pace of change integrating departments at a national level was adversely affecting the pace of change at a local level but colleagues locally were keen to explore how to join up services as much as possible within the current legislation.

There was a discussion about how to regulate the system locally. A Health and Wellbeing Board Alliance had been set up which was comprised the five Health and Wellbeing Board Chairs across the five local authorities involved and Health and Wellbeing Board Vice Chairs or Co-Chairs; Non Executive members of provider Boards and Lay members of CCG Governing Bodies were also providing independent challenge but it was thought Scrutiny Panels could also provide a useful challenge to commissioners and providers of health and social care services.

A key challenge for those involved in ICS currently was how to work with care service providers as is it a vast sector and it was agreed with the Care Provider Forum that they identify representatives who could participate in the ICS transformation programmes. 

Members were informed there were seven work streams which had been identified, some of which were more advanced than others.

An example of progress was that Bracknell Forest was one of the first to have a Care Quality Commission system review of how to transfer patients from urgent care.

Areas which had begun but required further work included the development of a crisis café for patients with a mental health problem as feedback from clients was they would prefer an informal setting and not to be sent out of the system if they required a residential placement.

Whilst benefits were already being realised, the Integrated Care System had a five year plan aimed at ensuring the system enabled people to work differently together and be more person centred. The Health and Wellbeing Alliance Board has developed key messages and identified benefits for their local residents.

Members queried how commissioners were tackling joining up health and social care finances and it was acknowledged this had been a challenge. A Finance Reference Group had been set up which included Finance Directors or Chief Finance Officers from health providers and commissioners, including local authorities and their focus was twofold. Firstly, transparency around budgets had led to the identification of a financial envelope of approximately £1.6 billion. The second was to do the right thing with the money and sort out any issues this created in organisations afterwards.

Members alluded to a theoretical system NHS England had produced which suggested at least one million people needed to be in the local area for ICS to work but Jane Hogg, Integration and Transformation Director: Frimley Health Foundation NHS Trust, said they had already explored a number of for working across bigger boundaries already where it made sense, such as on workforce issues and maternity capacity, and the system hoped to remain at its current size and configuration.

Members challenged how they intended to prevent silo working within and between organisations and were informed there was good joined up working at the top of the system and on the front-line, but more work needed to be done to ensure middle layers of organisations were on board. A leadership programme for middle leaders was already being explored.

Members asked if it was the intention to set up one organisation eventually and were informed judicial challenge around privatisation of the health system had already moved the debate away from the ‘one organisation’ approach and there were good examples of collaboration and alliances internationally. For example:  Canterbury in New Zealand estimated they were 2,000 residential and care home places short in 2007 and were now oversubscribed by 1,000 as more people were cared for at home and the financial burden in the system had eased. The intention for ICS was to create one assessment of eligibility and for professional trust between organisations to ensure the client/patient received the right service, at the right time, regardless of where the funding came from.

Actions:

·         Members to feedback to Jane Hogg, Integration and Transformation Director: Frimley Health Foundation NHS Trust, how they could provide challenge to the Health and Wellbeing Board Alliance.

·         Members to consider how they may help engage the public in this agenda.

·         Members to consider how this fits into the identified priorities for the Panel Work Programme.