Meeting documents

Purpose:

For the Committee to hear from representatives across the health and social care system about the progress being made on its journey to being an integrated care system by 2020.

Attendees:

Lin Hazell, Cabinet Member for Health & Wellbeing

Gill Quinton, Executive Director, Communities, Health & Adult Social Care

Neil Macdonald, Chief Executive, Bucks Healthcare Trust

Lou Patten, Chief Officer, Clinical Commissioning Group

Papers:

Briefing paper attached

Intended outcome:

For Members to understand the progress being made on the integration of the health and social care system and what more needs to happen before 2020.

The Chairman welcomed Ms G Quinton, Executive Director, Communities, Health & Adult Social Care, Ms L Patten, Chief Executive, Clinical Commissioning Group and Mr N Macdonald, Chief Executive, Bucks Healthcare NHS Trust.

During discussion, the following key points were made and questions asked.

·         Ms Patten provided details around Population Health Management and explained that there was growing evidence to support the need to look at the projected needs of the population now and in the future when planning health service.  It could not be based on assumptions of where patients had received their care in the past but a wider review of the type of people living within the county and establishing their level of need was important.

·         This approach also required taking a wider look at planning and involved closer working with the County and District Councils. A framework would be developed by the Integrated Care System and owned by the Health & Wellbeing Board.

·         Ms Patten stressed that this approach was about services not buildings and provides opportunities for groups of clinicians to come together to provide services at scale.  This summed up the hub concept.

·         A new on-line community asset mapping tool was due to be launched soon which would allow people to search for activities by location and type. 

·         GPs were embracing and endorsing prevention methods and the importance of GPs, as part of the Integrated Care System, was acknowledged.

·         Health data was used to target communications to specific groups with key relevant messages based on their needs.

·         Making every contact count was still important and it was acknowledged that more could be done.

·         In the last 10 years, the number of people with diabetes had doubled.  There were good clinical measures around diabetes which link to the effectiveness and the support patients were getting, for example, blood sugar levels.  GP practices in Buckinghamshire were the best in the country for diabetes outcomes and 7^th in the world for care and support planning for patients with diabetes.

·         Nationally, 30% of children would be leaving primary school obese of which 70% would go on to develop health issues related to obesity, including diabetes.

·         In response to a question about prevention and providing health checks, Ms Patten explained that there was an annual health check programme but this was aimed at those identified at potential risk and limited funding meant that it could not be available to everyone.  There was a need to provide opportunities for wider conversations across the system.

·         The funding for next year had yet to be announced but the health budget for Buckinghamshire remained under-funded as the Government top-sliced some of the budget based on the assumption that Buckinghamshire was a healthy county, even though there were significant inequalities across the county.

·         Social care funding affects health funding, particularly around community services and length of stay in Hospital - the two were interchangeable.

·         In response to a question about governance of the ICS, Mr Macdonald explained that the ICS was not a statutory body and therefore decisions were taken by each organisation under their own statutory duties.  Transparency and challenge around decision-making was primarily through the ICS Executive Board which consisted of the Chief Executives from across the system and the Health & Wellbeing Board. A number of joint boards had been set-up to aid integration. 

·         A Member briefing would be taking place shortly to bring all Councillors up to date with the ICS.

·         In response to a question about how the public could engage with the work of the ICS, Ms Quinton mentioned that a number of stakeholder events and roadshows had taken place.

·         All ICS work streams were monitored on a monthly basis.

·         One in 9 posts were vacant across the system so recruitment remained a major challenge.

·         A new piece of work around social isolation was being led by Public Health which would bring all the voluntary sector organisations together.

·         A Member expressed concern about the confusing terminology being used across the system, particularly in relation to hubs. 

·         Ms Patten explained that there were three levels of service delivery:

o   locality level (population size around 100k where decisions were taken locally);

o   county level (decisions taken by the CCG, BHT and the County Council); and

o   STP level (decisions taken at scale across the footprint), for example, joint commissioning of the 111 and 999 services and workforce challenges.

·         Sharing best practice and learning amongst localities and GP surgeries was important.

·         A recent national strategy around an improvement plan for carers had been published.  It was hoped that the forthcoming Green Paper on adult social care would include proposals for improving support for carers.

·         The shared patient records and care plans project was due to be launched in January/February 2019.

·         In response to a question about the Red Cross pilot, Ms Quinton explained that it was a service commissioned by Adult Social Care to support people, who were medically fit for discharge but need support at home to reduce readmission.  The Red Cross provided practical support, such as turning the heating on at the patient’s home if they lived alone.

·         A Member asked about the service patients receive who attend Hospitals outside Buckinghamshire.  Ms Quinton explained that from an adult social care perspective, the team had regular dialogue with colleagues in Wexham Park and were constantly looking at how to integrate services.  Wexham Park had been involved in the Discharge to Assess project.  Discharges from Hospital were measured and any delays attributable to social care were reviewed.  Mr Macdonald added that some of the community team were based in Wexham Park.  GP services had been strengthened in the south of the county.

The Chairman thanked the presenters for attending.