Agenda item

Sir Andrew Morris OBE Hon FRCP, Lead for the Frimley ICS to update the Panel on the progress of the Frimley Sustainability Transformation Partnership (STP) move to the Integrated Care System (ICS).

The Chairman welcomed Sir Andrew Morris OBE Hon FRCP, Lead for the Frimley ICS who provided an update to the Panel on the progress of the Frimley Sustainability Transformation Partnership (STP) move to the Integrated Care System (ICS) and the progress over the last couple of months.

The Panel were provided with the Frimley Health and Care System Plan On A Page and an update on the highlights of the transformation initiatives:

It was explained that the ICS isn’t an organisation.  It is a collection of partners who buy into what and how we want health and social care services delivered, glued together by a memorandum of understanding.

Bracknell was within Frimley’s ICS which was one of the most advanced in the country and had leading edge care.

Prevention and Self Care:

·         Bracknell provided residents with a roadmap to help themselves.

·         Work was pushing ahead on the transition from the Sustainability Transformation Partnership (STP) to the Integrated Care System (ICS)

·         Health services only had a 20% to 25% impact on health.  Housing and education have the biggest impact.

·         The Frimley ICS was working with West Berkshire and Heartlands ICS’s to pull together a series of data down to ward level on the health of the population, which could be scaled up and down.  This would help decision making.  Hot spots could be identified in localities to give a granular make-up of the population and how best to meet their needs.  For example: Slough might come out as the worst performer for health outcomes if compared to Surrey Heath, and the challenge would be to identify how to get Slough to meet the Surrey Heath standards of life expectancy.  John Lyle, Joint SRO A&E Delivery Board was leading this work on a 2 day a week basis with help from NHS Digital and NHS England.

·         Thought needed to be given to how we want people in their 80s and 90s to live.

·         Generally men die before women.  Consideration should be given to how we want lone elderly females to live.  

·         Local authorities could play a big part in the provision of lifestyle for older adults.  For example: Windsor wanted to map what sort of capacity would be required if older people wanted to sell their homes and move into accommodation that would be suitable for the elderly.  Currently their options would be limited. Mapping would provide the information necessary for planning for this scenario. 

·         At this stage, options for Local Authorities were often limited but they would need to link health with housing and education to decide and influence investment for the future.

Integrated Care Decision Making

·         Progress was being made on the integrated care team.  It was hoped it would be rolled over to East Berkshire to provide more care in people’s homes.  It would require investment but the principle of keeping people out of hospital was agreed.

GP Transformation

·         The intention to provide an 8 to 8 service was moving on to Saturdays and Sundays as an alternative to using urgent care at hospital.

·         GPs were under great pressure trying to put more resources in to practices such as physios, pharmacy and paramedics. Around 30% of all GP consultations were not necessary and contact with another professional would be appropriate.

·         E-consult pilots were in process.  These gave patients the opportunity to describe what was wrong within a fixed number of characters which was submitted to the GP.  The GP responded within 24 hours and signposted the patient to a GP appointment slot or the most appropriate practitioner.

·         Where E-consult had been rolled out the GPs could use their time better. 

·         E-consult was being trialed in East Berkshire.

·         In East London E-consult had released more time for GPs to focus on those patients who were more in need to support them better.

Supporting the Workforce:

·         Workforce redesign.  Apprenticeships were still not being levered on the scale that they needed to be.  There were not enough doctors, nurses or paramedics coming through.  Discussions with universities had taken place to formalise the Health and Social Care Programmes on a contract where the employer supported their employment to make them a registered practitioner.

·         The ICS was keen on developing the ‘passport’ which allowed workers to move around the system.  If this was not developed there would not be enough people.

Care and Support

·         Lots of progress had been made on social prescribing and this has had a positive impact in Bracknell.

·         The Heathlands project was within the Bracknell Forest ‘patch’ and would make a big difference for people with dementia and provide more capacity.

·         £31m capital was being invested into ICS capital schemes of which Heathlands was one.

Reducing Clinical Variation

·         £7.5m was being invested to connect systems across Oxford, Frimley and Heartlands to share patient records.  This was the third geography to be funded and all health databases would be brought together as one and everyone in health and social care would be able to view interconnected patient records.  This would reduce duplication of effort and generate efficiencies.  It was an ambitious project but the technology existed to make it happen.

In Addition:

·         Decisions needed to be taken on the location of hubs.  There was an engagement exercise with the public on urgent care in order to establish where the capacity should be. 

·         The ICS was going for Self Assurance which is  a ‘badge’ from the NHS and the application for this was being progressed.

·         The summer had generated more demands on health services due to it being unusually hot.  With winter approaching it was implementation that would be important and that was the challenge.

Following questions and discussion by Members of the Panel, it was explained:

·         Silo working, engagement and buy-in to the ICS and resistance to change across all teams was an issue that was constantly being worked on.  The ICS was a coalition of the willing and some resistance to the process was inevitable but was being tackled.  In order to overcome scepticism, evidence of real change was used to demonstrate the effects of the new approach.  Work would continue to ‘get people on side.’

·         In order to have GPs only see those patients who need to see them, the challenge was to change the behaviour of the public.  Generally, the public only know GPs and Accident & Emergency (A&E).  If teams were integrated, public thought needs to be changed with the provision of good, clear information and proof of things working.  Surrey Heath patient feedback had been good with patients being able to stay at home and have visits and avoid having to go to A&E.  Once this type of good news story gets round behaviour would change.

·         Frimley ICS was one of the 10 leading ICSs in the UK.

·         This year, Frimley were working to a financial bottom line.  If Frimley Health Trust overspent, another health organisation had to underspend as they are working to the control total.  Some ICSs have refused to progress because of the control total issue.  All partners in an ICS get money, all have to work to an aggregate position.  Frimley Heath Trust was struggling to make its savings plan and someone else would have to offset this spend of underachievement. No one could be compelled to generate savings to offset an over-spend somewhere else in the footprint though.

·         Last year, Surrey Clinical Commissioning Group (CCG) overcommitted by £2m or £3m which had to be offset by other CCGs.  So far, the situation was OK in the Frimley ICS.

·         Patients were directed to the correct point of care by the GP who made one call to a multidisciplinary team.  These multidisciplinary teams met once a week to talk and take over people’s care. This process made it attractive to GPs who only had to make one call and had been in place for a couple of years now in Bracknell.

·         Long stay patients, (those who are in hospital for 21 days or more) often with mental health and addiction issues were being targeted. It was hoped to reduce them by 50% with all parties working to produce a reduction.  There were genuine issues around the capacity for mental health patients and appropriateness of placements was an issue, but this was unlikely to change in the near future.  Most patients came back out into community, a few moved on to specialist care, but this was only a handful of people every 2 to 3 months.

ACTION: Sir Andrew to raise the issue of patient stays at 120 days in Frimley as reported by one Member with Fiona Slevin-Brown, Chief Executive of Frimley Healthcare Trust and discuss they cycle of mental health and addiction issues and their implications for long tem hospital stays.

·         The £7.5m investment in shared patient records included the Royal Berkshire Hospital.

·         There are 500 GPs across the Frimley ICS footprint.  Shared records would contribute to patients only having to tell their story once.

·         All health and social care in Berkshire bought into the Berkshire interoperability project 2or 3 years ago to share care records.  It now included patients who go outside of the Berkshire borders, spreading outwards so that patient records could be accessed by neighbouring service providers.  The initial project was to localise records and then grow outwards. Information governance was still an issue and needed to be worked through.

·         Patients already thought their records were shared.

·         Technology had moved on in the last 15 years since the last failed attempt at records sharing, and now existed to make it possible.

·         The Health and Wellbeing Board Alliance (HWBA) is made up of the Chairs of the Health and Wellbeing Boards (HWB).  The HWBA met monthly and had good input from local authorities and wanted to do the right thing by the people they serve.   Local authorities brought a healthy perspective, could bring people together and improve the quality of life for all the residents they serve. The HWB chairs held the ICS to account and there was not a problem responding to any issues anyone had.

·         Councillors have reach and access into localities where they could challenge inequality.  Areas of deprivation for example, should be challenged with the ICS.

·         Poor quality housing, quality of the estate, homelessness and socioeconomic factors affected health and wealth and affected people’s quality of life.  Nice environments promoted health and wellbeing.  Local Authorities had it in their gift to facilitate positive living environments such as the new Town Centre in Bracknell.

·         The mapping exercise would help to overlay housing and education data across all of East Berkshire.  The granular population health management programme would contribute to the work being done by John Lyle, Joint SRO A&E Delivery Board.

·         The CQC was looking at inspecting systems.  Integrating care was hugely important and challenging but politicians wouldn’t do anything with health to push something through without a healthy majority in Parliament.  Until then the health service would continue to work on a system basis.  Legislation was possible to overcome some of the integration challenges but not until 2022. It would be down to local ICSs to work together.  This was an opportunity to shape the changes.  Heathlands was a good example of health and social care coming together to solve a problem, and there was lots of potential for further work together.

·         Care in the NHS is free at the point of delivery but is means tested in social care.  It was unlikely the green paper would change this as this issue was difficult to resolve.  This issue would come back to the ICS on how they work together.

·         Bracknell had some unique contextual demographic issues around housing which were hidden.  Affordability causing homelessness was hidden. Child and Adult social care service were joined and aligned. We could be leaders in the system as we look at all residents. Population health management were deeply evolved, but work on the ICS children’s work was not as well developed.

·         The funding arena for local authorities for the next 2 to 3 years looked challenging and there was a question over where the balance in funding would come from.  Local authorities faced a big social challenge, the nation had to face Brexit challenges which may affect the economy and if the economy struggled this would affect the public sector.

The Chairman observed that new legislation is not necessarily required, just the will to accomplish things and honest discussion. 

The Chairman thanked Sir Andrew for attending the meeting and his valuable contribution.