Meeting documents

Presenters:  Ms L Watson, Managing Director, Buckinghamshire Integrated Care System; Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare Trust and Ms G Quinton, Executive Director, Communities, Health and Adult Social Care.

The Chairman welcomed Ms L Patten, Accountable Officer, Clinical Commissioning Groups; Ms L Watson, Managing Director, Buckinghamshire Integrated Care System; Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare Trust (BHT) and Ms G Quinton, Executive Director, Communities, Health and Adult Social Care (CHASC).

Ms Patten highlighted the following points from the presentation included in the agenda pack:

• Commissioning would be done at scale where it was possible to save money and share learning.
• The Accountable Care System had become the Integrated Care System and was working together to integrate services.

• Ms F Wise had started on 5 March 2018 as Executive Lead for the STP locally and would be in charge of the work streams to be done at scale.
• Ms Patten had joined Oxfordshire CCG as well as continuing her role with Buckinghamshire CCGs.
• The key programme areas were cancer alliance, prevention and population health management, capacity planning, digital and estates.
• Ms Patten suggested a more in depth look at the work of the cancer alliance at a later date.
• The areas where the STP shared best practice and provided assurance included urgent and emergency care, mental health, primary care and maternity.

In response to questions from Members the following key points were made:

• Ms Wise would be making links beyond the STP boundaries in order to maximise the benefit of shared national best practice.
• Ms Wise was aware that previously there had been work on patient engagement by Healthwatch Bucks and she would be looking into it.
• Ms Quinton commented that that she agreed with the concept of commissioning at scale and integrated health care.  However, the funding regime and work force issues could cause problems and she felt there needed to be more equity across the whole system.
• The Chairman said Buckinghamshire was seeking to engage with MPs on the development of the Green Paper on Health and Social Care which was due out in the summer of 2018.

Ms Watson continued with the presentation and made the following key points:

• Ms Watson had been in post for three months as the Managing Director of the ICS.

• There were seven organisations that had made a commitment to work together through a formal memorandum of understanding for the delivery and planning of the strategy for health and care within Buckinghamshire.  There was a collective vision:  Everyone working together so that the people of Buckinghamshire have happy and healthy lives.
• The Objectives.
• The transformation so far.
• The need for engagement with communities which had been carried out by "Your Community, Your Care" roadshows; supplemented by comprehensive engagement with public and stakeholders; listening to professionals and ongoing participation in NHS/National Council for Voluntary Organisations development programme.
• The emerging care model consisted of four tiers; for those with minimal risk to those with extreme risk.
• The ICS Care Concept – to articulate to residents what it meant to them and what was available.
• Next steps – building on what already existed; a draft programme was still in discussion. 
• Professional support services – investment in estates across Buckinghamshire, enhancement in A&E and patient experience at Stoke Mandeville hospital. 
• Technology – improvement in the systems to support integrated team working and improve the efficiency and safety of booking appointments online.

In response to questions from members the following key points were made:

• The detail in the presentation highlighted the complexity of the system and that working together should make it easier for patients to move through the system more effectively due to shared records and shared working.
• The information on the CCG and BHT websites would be amalgamated in conjunction with public and stakeholder engagement and revisited at a later meeting.

Ms Quinton continued with the presentation and highlighted the following points:

• BCC had recently launched a new strategy called "Better Lives" which focussed on three key tiers; more people living independently ideally in their own homes; helping people in a crisis situation regain control of their lives; helping those who needed support on a long term basis.
• The strategy was underpinned by the "strengths approach" i.e. what people could do rather than what they could not do.
• Currently the Adult Social Care budget was £161m.
• There were 8,500 services users supported by 266 providers.
• 10,000 clients contacted BCC per annum; of which 7,500 lead to an assessment; with 2,200 resulting in the provision of a care package – a ratio of 5:1.  The best practice ratio was 22:1; and indicated over-provision of services in Buckinghamshire which lead to dependency and worse outcomes for individuals.
• The average length of stay in residential care was 2.6 years; nationally the average was 1.8 years.
• There was a need to work closely with colleagues in health, reduced duplication in services, simpler pathways through the services and to provide a focus on prevention and reablement.
• Tier 1 - Living Independently - would be focussed on the provision of information and advice, building of strong local networks by working with communities to improve the health and wellbeing.
• Tier 2 – Regaining Independence – would look at reablement teams, discharge to assess pathways, rapid response and therapeutic teams in order to reduce duplication, provide earlier intervention and support to people to return home.
• Tier 3 – Living with Support - working with the care market e.g. housing with extra care for support.  There would need to be changes to community support services rather than day care centres.

In response to questions from members the following key points were made:

• The quality metrics would need to be studied in order to move the appropriate provision and ensure funding was spent appropriately.
• There were improvements which could be made which would result in better outcomes for people.
• There was an opportunity through the integrated system to link the clinical cases with the provision and prevent people becoming dependent too early.
• The system needed to appear as one system.

RESOLVED:  The Board RECEIVED the presentation and CONSIDERED its role in supporting the identified areas.