Meeting documents

To be presented by MsJ Hoare , Managing Director, Buckinghamshire Integrated Care System, Mr N MacDonald, Chief Executive, Buckinghamshire Healthcare NHS Trust, Ms L Patten Accountable Office Buckinghamshire and Oxfordshire CCG and Ms G Quinton, Executive Director, Communities, Health and Adult Social Care.

Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare Trust, welcomed Ms J Hoare, Managing Director, Integrated Care System (ICS).  Mr Macdonald provided the following update on the history of the Sustainable Transformation Partnerships (STPs) and the ICS:

• The 44 STPs were created approximately three years ago.  The STP for this area covered Buckinghamshire, Oxfordshire and Berkshire and was known as ‘BOB’. 
• Buckinghamshire was designated as an ICS approximately two years ago.  Buckinghamshire was one of the only ICS’ which was not co-terminus with the boundary of the STP; there were two ICSs in the BOB. 
• There was a national policy to move all the STPs into the ICS by April 2020 or 2021.
• There was an application process and the BOB STP had been successful in becoming a Wave Three Integrated Care System.

Mr Macdonald provided the presentation which was included in the agenda pack and highlighted the following:

• The system priorities for 2019/20.
• BOB had refreshed its Strategy and the work plan showed a desire to be working at a regional level. 

The following points were noted in discussion and in answer to member’s questions:

• A member of the board commented that, at present, the ICS/STP did not have statutory status but this could change.
• Mr Macdonald stated an Independent Chair of the ICS had been appointed and would commence in October 2019.
• In response to a member of the board asking how communications would be managed; Mr Macdonald stated that a monthly briefing was issued which could be circulated to the Health and Wellbeing Board members for cascade.  NHS England had provided presentation slides on the recent changes which would be circulated.

ACTION:  Ms McDonald

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

• The local Buckinghamshire ICS would become the ICP; many things would remain the same as it would build on the existing work programme and provision in the local area would continue to work at place level and adopt a population health approach.
• The ICP would be a partnership with the providers and commissioners working together to utilise the skills and abilities across the system.

• The ICP would continue its relationship with the Health and Wellbeing Board and the Health and Adult Social Care Select Committee.
• The realignment of Clinical Commissioning Group functions.
• The development of the Primary Care Networks (PCN); there would be 12 PCNs each covering a population of approximately 30,000-50,000 – the details would be confirmed by the end of June 2019. 
• The system was working together to understand population health needs and making intelligent decisions to deliver the services.
• Going forward, the aim was for people to avoid hospital admissions.
• Professionals were working together to co-ordinate the needs of the public and discharge people from hospital more quickly.  
• It would be important to develop care plans which worked across all services and optimised the use of digital capability which could be shared.
• A clear, single point of access and direct booking services were being developed.
• An improvement in the children’s triage service in primary care settings was being implemented following higher than expected admissions.
• There was a range of methods available for engagement with the public, staff and stakeholders.
• The digital strategy set out direction of travel and deliverables to integrate technology/data to improve services and comprised of three pillars; technology, digital and information.
• The development of the workforce which would optimise resources and make Buckinghamshire an attractive place to work.

The following points were noted in discussion and in answer to member’s questions:

·         In response to a query on how the 1500 people on the residents’ panel were represented; Ms Hoare explained that the Communications Team used a company who identified the residents to ensure it was a representative panel.

·         Mr Whyte, Cabinet Member for Children’s Services, referred to the last bullet point on page 28 of the agenda pack which stated that the 111 Direct booking pilot at the Swan practice was live.  Mr Whyte commented that he had heard it was almost impossible to book an appointment and that there was no improvement for residents.  Ms Hoare advised that the pilot was at an early stage and that she would obtain feedback. 

ACTION:  Ms Hoare

·         Mr Whyte reported that he had not been involved in the discussion and decision on the improvement in the children’s triage service in primary care settings.  Mr Macdonald acknowledged the need to ensure elected representatives were made aware of the changes and improvements.

·         Ms J Baker stated that the residents’ panel appeared to be a duplication of the role of Healthwatch and advised it could be an opportunity to work together.   Ms Baker explained that Healthwatch gets out and about in the community, whereas the residents’ panel appeared to be more static and would not pick up the views of the public at large.  Ms Hoare confirmed that Ms Jervis from Healthwatch had been involved in the wider partnership work and agreed it was important to avoid duplication.  Engagement was an important component and they would be building on what had been carried out before rather than losing anything that had already been gained.

·         A member of the board requested increased liaison between the ICP and the district councils.  Ms Hoare agreed this would strengthen the opportunities and optimise resources across the system. 

Ms J Bowie, Service Director, Integrated Commissioning, continued with the presentation and highlighted the following points relating to the Better Care Fund (BCF):

• 2018-19 was the second year of the two year BCF. 
• 2019-20 would be the transition year; the policy framework had been received and the service was awaiting planning requirements and allocations.
• An evaluation had been undertaken on the schemes carried out during 2018-19; an audit had been commissioned for 2018-19. 
• There was an indicative plan for 2019/20. 
• There was no expectation for a Q1 return. 

• The plan was to continue the focus on delayed transfers of care (DToCs).
• The Buckinghamshire system was performing better than average to its comparators.
• The trend was showing a reduction in the number of days of DToC but had not met the national target.
• The DToC data was broken down by Trust. 
• The implementation of the choice policy would ensure the correct level of capacity during discharge.

The following points were noted in discussion and in answer to member’s questions:

·         In response to a question from a member of the board on whether the BCF targets would be met, Ms Bowie explained it would partly depend on where the targets were set for 2019/20.  Ms Bowie stated she was confident the correct analysis was being carried out on the areas where further work was required and was cautiously optimistic regarding future progress.

RESOLVED:  The Health and Wellbeing Board NOTED the presentation and NOTED the progress made by the Buckinghamshire partnership in the first quarter of 2019, COMMENTED on the transitional plans to align as an Integrated Care System and CONSIDERED the points for the BCF 2019/20 and evaluation of 2018/19 in Buckinghamshire.