Fiona Edwards, Frimley Integrated Care System (ICS) Leader to introduce herself to the Panel and provide a brief overview of the vision for the Frimley ICS and how it integrates with the NHS Long Term Plan.
Minutes:
Fiona Edwards, Leader: Frimley Integrated Care System (ICS) attended to introduce herself to the Panel and provide a brief overview of the vision for the Frimley ICS and how it integrated with the NHS Long Term Plan.
The Chairman welcomed Fiona Edwards, Leader: Frimley (ICS) to the meeting.
Fiona Edwards, Leader: Frimley ICS thanked the Panel for their invitation and confirmed that she had received a number of questions from Members of the Panel in advance of the meeting that she would seek to address.
Fiona Edwards, Leader: Frimley ICS introduced herself to the Panel and outlined how she:
· Was the Chief Executive of the Surrey and Borders Partnership NHS Foundation Trust and had responsibility for the provision of health and social care services for people of all ages with mental health, learning disabilities and drug and alcohol services in Surrey, North East Hampshire and Farnham.
· Had been a member of the Frimley ICS since its inception
· Was a resident within the Frimley ICS patch and had been for over 20 years
· Had been a public servant and Chief Executive for over 20 years.
· Had experienced the ICS first hand last year and attributed her recovery and rehabilitation to a working integrated health and social care model.
· Felt her personal case was a good example of a well functioning emergency system.
· Felt very proud of the successful integrated care system in practice that demonstrated her vision of the ICS, but also acknowledged that this was not everyone’s experience.
She outlined some further details about the Frimley ICS and explained that it:
· Worked on behalf of residents serving about 800,000 people across East Berkshire, Surrey Heath Clinical Commissioning Group (CCG) and North East Hampshire and Farnham CCGs.
· Was formed around the population and catchment area of Frimley hospitals as a health led establishment but had recently begun to shift to a place based approach.
· The financial flow for the population of about 800,000 was £1.3 billion.
· Local Government and the wider determinants of health were now being worked on and Councillor Dale Birch, Executive Member for Adult Service, Health and Housing was closely associated with this in his role as Chairman of the Health and Wellbeing Board.
· Residents expected the integrated care system (ICS) to work in an integrated way.
· Her vision for the Frimley ICS was to help the system work much better for residents when they needed help, supporting the wider determinants of health such as supporting healthy communities and the role the environment, housing and transport played.
· The ICS was in the process of refreshing their strategy to support the NHS Long Term Plan which would take a population based approach looking at health data and residents’ health.
She explained that the issues and challenges of how best to work across the large footprint of the Frimley ICS to support close, joined up working were:
· The definition of place was increasingly the local authority (LA) boundary.
· Primary care networks were now becoming part of the system. This aligned better with LA boundaries.
· The ICS was not a statutory body, rather a coalition of willing partners working to benefit residents working in an interconnected style rather than separate organisations.
· Over the next 3 months the ICS would we working to reduce clinical variation, looking at GP transformation, care and support, wider residential care, workforce deployment and digital to join up systems across the health service.
Arising from questions from Members at the Panel, Fiona Edwards, Leader: Frimley ICS explained that:
· As part of the NHS Long Term Plan, timescales had moved quickly to match funding deployment.
· The ICS was seen as the delivery vehicle under the National Policy Framework.
· Frimley ICS was the only health organisation that served people from Buckinghamshire and co-terminosity was not concrete.
· There were 76 GP practices in 14 primary care networks (PCN) in the Frimley ICS geography.
· All bar one GP practice had aligned to a PCN and that one was not in the Frimley ICS patch and would be supported through the CCG framework.
· The establishment of PCNs in the timescales had been a major achievement.
· GPs had been keen to join PCNs.
· Bracknell had 2 PCNs and their boundaries were co-terminus with the Bracknell Boundary.
· Ascot would be aligned with Windsor and Maidenhead.
· The lead GP, Dr Andy Brooks had done well.
· There was tolerance for GPs not to join a PCN, there was some pressure to join, but support was provided if a GP practice chose not to.
· The Frimley ICS footprint was not small. It was in the bottom half of ICSs size wise, but this meant that they were small enough to have conversations with GPs at this stage and they continued to argue that the Frimley way of working, from the bottom up, was the best way of working.
· Frimley ICS was considered to be one of the two best ICSs in the country next to Surrey Heartlands.
· The Frimley ICS was listened to and had a voice because it was doing well.
· She had herself experienced unconnected healthcare in respect of patient record keeping.
· The ICS had worked around the Connected Care Programme.
· She was working locally within the Frimley footprint to enable the exchange of data to benefit patient care. This was running quite well in some of East Berkshire but needed to extend across the whole area and played into the wider programme of work with the Thames Valley and Surrey local record programme which was a platform to connect across the health system in Bucks, Berks, Oxfordshire and Surrey which could be replicated nationally. This was a good example of how such an approach could be scaled up. There was a key partner on board and headway should be made in the next 12 months with residents noticing a difference in 2 to 3 years.
Councillor Dale Birch, Executive Member for Adult Services, Health and Housing outlined how Bracknell Forest had been key in supporting the development of digital records, were a lead LA and were still engaged from pilot stage to live stage, now.
Arising from further questions from Members at the Panel, Fiona Edwards, Leader: Frimley ICS explained that:
· A key job of the ICS was to oversee the PCNs.
· PCN proposals and development had to be supported by the ICS as a body which was part of the mandate going through the population based refresh and had been a challenge with the swiftness of the timescales.
· The PCNs built on the Federations and Fiona had good relationships with the 5 network leads that sat around on the ICS board with her.
· GP livelihoods were totally wrapped up in the networks and the 8 senior GPs were willing to work for a more accountable and corralled approach, the progress of which she was optimistic about.
· Some GPs had stepped up to be clinical leads to demonstrate the population gain to residents and address the bridging work that needed to be done.
· Population analysis needed to be at the front of their dialogue.
· PCN guidance had workforce investment and expanded roles in it but that had to be done in the context of system priorities over a period of investment of 5 years, so recruitment would take time.
· The first challenge that they were beginning to address was whether or not there was enough GPs which was a national issue. Frimley ICS was beginning to turn this tide with their investment in people development, being innovative, making the ICS an attractive place to work and working differently.
· The first year of integrated care teams had worked well in East Berkshire where primary care, community services and mental health service staff had been collocated and created different ways of working, reducing the need for residents to go into hospital and providing more responsive services locally.
· The re-design of what the ICS already had, and recruitment would take 3 to 5 years.
· The next phase of development would be how the ICS connected and managed in local authority areas. Co-designing health commissioning, to design a response that worked for local residents.
· 80% of residents’ health was not determined by health intervention, rather by the wider determinants of health which required a move towards a prevention model.
· Transport should be integrated into the co-design thinking.
· Now PCNs were defined, they would be looking at the population data to see if they were organised to do the necessary work well.
· The ICS was in the process of reviewing commissioning arrangements and the structure to ensure a better alignment and to ensure local arrangements were clear. There was a discrepancy in approach currently, but it was hoped this would get better.
· Bracknell was a success story and it was clear how health and care were organised. Local arrangements were embedded in the local authority arrangements and residents could see and feel more seamless working.
Councillor Dale Birch, Executive Member for Adult Services, Health and Housing outlined that the Bridgewell Centre and intermediate care was an example where there had been lots of integrated work for about 7 years where Bracknell had been one of the leaders in closer working. Heathlands was the next iteration of this.
He outlined that:
· NHS Digital (NHSD) and local government needed to work out how to commission and contract together where the contracts hold sufficient value for the providers and also sufficient performance management for all partners.
· Data sharing had been an issue.
· Government was aware that delivering the Long Term Plan was going to require legislative change.
· There was a consultation that the Local Government Association under Health and Wellbeing had responded to on 12 April which Members could read.
· Members would be pleased to see the extent that local government and the NHS were coming together.
In response to additional questions from Members, Fiona Edwards, Leader: Frimley ICS advised that:
· Moving to any new legislative frameworks would not be too difficult as they were likely to take 18 months to 2 years to develop.
· Berkshire Health Foundation Trust were a member of the Frimley ICS and work had been ongoing to develop a provider coalition as part of the ICS.
· She met regularly with neighbouring systems and her role was to make sure they kept in step and understood the impact of their decisions on the organisations within the ICS.
· The ICS needed to refresh its understanding of people’s understanding of the changes that were happening.
· There were key anchor institutions that residents connected with at different times in their lives and the ICS must be led by where the residents wanted to go. The challenge was how the ICS resourced and supported that.
· Residents’ experience of the ICS should be clear, simple and responsive and that was the ambition.
· Legislative change would take about 2 years to come into effect and it would take this length of time for residents to feel that things were better joined up.
Councillor Dale Birch, Executive Member for Adult Services, Health and Housing outlined how, in his role as Chairman of the Health and Wellbeing Board, (HWB) he wanted to refashion the HWB to be the stronger conduit to get communications into the language of residents and to completely rethink the way the HWB challenged its partners.
In response to additional questions from Members, Fiona Edwards, Leader: Frimley ICS advised that:
· The plan was to build on existing examples of social prescribing, building and developing them, not redesigning them.
· The refresh of the plan for the ICS needed to focus on children and families.
· The leadership role of the LA on children and families was more connected.
· There were quite small pockets of inequality in services.
· The refresh would play a bigger role in supporting those communities to close the gaps.
· The workstream for Bracknell had to be developed in Bracknell.
· ICS data has process measures rather than outcome measures. They needed to talk more widely about health and wellbeing outcomes. There would be some variations but also common themes.
· The Bracknell community support dog Lexi was a good example of an outcome that was not measurable on a spreadsheet but had immeasurable personal impact.
· Intergenerational contacts for GPs were a good indicator for GPs to undertake prevention work. The GPs that sit on the ICS board are all supporters of GPs maintaining this kind of relationship with their patients.
· 2019 was about design, development and delivery of the PCN setup.
It was agreed that Fiona Edward, Leader Frimley ICS should be invited back to the Panel in April 2020 to update the Panel on the tangible and demonstrable results and effects of the ICS on local residents.
The Chairman gave thanks to Fiona Edwards, Leader Frimley ICS for her attendance at the Panel.