Meeting documents

To include:   1.    NHS Long Term Plan Update – to be presented by Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust and Mr R Majilton, Deputy Chief Officer, Buckinghamshire CCG. 2.    Summary of Multi-Morbidity Analysis - to be presented by Mr R Majilton, Deputy Chief Officer, Buckinghamshire CCG. 3.    Primary Care Network - to be presented by Mr R Majilton, Deputy Chief Officer, Buckinghamshire CCG. 4.    Preparations for Winter Planning - to be presented by Ms F Woodroffe, Bucks System Winter Director. 5.    Better Care Fund– update at the meeting by Ms J Bowie, Service Director, Integrated Commissioning, Health and Adult Social Care.

NHS Long Term Plan Update

 

Mr R Majilton, Deputy Chief Officer, Buckinghamshire Clinical Commissioning Group, provided a presentation on the NHS Long Term Plan Update and highlighted the following points:  

 

• The slides replicated what was in the long term plan produced by NHS England during the planning process at the beginning of the year. 
• There were a number of work streams across the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS) e.g. maternity, prevention. 
• The BOB Strategy summary was now due on 9 September 2019, not 2 September 2019 as stated in the pack.
• The acronym ‘DOG’ stood for ‘Delivery Oversight Group’.
• The final draft would be circulated to the Health and Wellbeing Board for comment before submission to NHSE/I on 1 November 2019.
• A Briefing session would be set up for HWB members before submission

ACTION: Ms McDonald

 

RESOLVED:  The Health and Wellbeing Board NOTED the ICS Long Term Plan Timeline.

 

Summary of Multi-Morbidity Analyses

 

Dr J O’Grady, Director of Public Health, provided a presentation on the Summary of Multi-Morbidity Analyses for Buckinghamshire and highlighted the following:

 

• Work had been undertaken between Public Health and the NHS to help identify the most important areas to focus on to improve people's health and wellbeing.  The aim was to produce bespoke profiles for the primary care networks to inform them about the needs of their population; the levels of deprivation and where emergency admissions were happening.
• The meaning of multi-morbidity was that a person had more than one long term condition (LTC). 
• Half of patients in Buckinghamshire had a LTC, and 30% had two or more LTCs.
• 62.6% of non-GP costs were for multi-morbid patients but they only made up 29.2% of all patients.
• Many LTCs were caused by lifestyle factors and were preventable. 
• An ageing population increased the chance of developing a LTC; a healthy lifestyle helped delay LTCs. 
• Multi-morbidity was very common and occurred in predictable patterns in the population i.e. in more deprived areas.
• A significant proportion of the patients also had a mental health diagnosis.
• Prevention and holistic support was needed to support these patients to manage their varying conditions as GPs had identified that if LTCs were seen as a whole, care and wellbeing improved along with a reduction in GP time.

 

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

 

• Dr O’Grady confirmed that the statistics for Buckinghamshire were consistent with the national picture. 
• The Chairman commented that it would mean a major change in the way patients were treated and asked how it would work in practice and how the outcomes would be followed up.  Dr O’Grady explained that Public Health had diagnosed the problem and work would be carried out with the primary care networks and clinical leads as well as the hospitals, Adult Social Care and the voluntary sector.  No specific model would be proposed; it would be co-designed with the Integrated Care Partnership. 
• A member of the board added that the vast majority of LTCs were treated in primary care; some practices were using the multi-morbidity model but there were challenges in skills and capability and the training of the workforce in multiple areas.
• Some GPs were in touch with ‘Talking Heads’ in Buckinghamshire to discuss what could be put in place by talking therapies to address concerns; good multi-agency plans were being drawn up. 
• Ms T Jervis, Chief Executive, Healthwatch Bucks requested that the patient voice be fed into the new approaches.

 

RESOLVED:  The Health and Wellbeing Board AGREED to support the following recommendations:

1. To improve and scale up prevention initiatives across the ICP to support people to improve their health and wellbeing.
2. Initiatives that aim to reduce costs should be focused on multi-morbidity and not be restricted by age. Holistic support was needed to support these patients to manage their varying conditions.

 

Primary Care Network (PCN) Development Update

 

Mr Majilton provided a presentation and highlighted the following points:

 

• All GP practices had formally joined together as PCNs as part of the plan for integrated working; each PCN covered a population of around 30,000-50,000.
• The early priorities were social prescribing and the recruiting of additional pharmacists. 
• The principle of the vision of primary care networks was to provide a community of professionals for physical and mental health and the voluntary sector.

 

RESOLVED:  The Health and Wellbeing Board NOTED the Primary Care Network update.

 

Winter Plan

 

Ms F Woodroffe, Director of Urgent and Emergency Care/ Winter Director and Dr D Sahota, Clinical Director of Emergency Care provided a presentation on the Winter Plan which would be going to the A & E Delivery Board for sign off.  The following points were highlighted:

 

·       Over 50 members of the Bucks ICP attended a winter wash up event in April 2019; feedback had produced a number of key messages.

·       The priorities for winter 2019/20 were listed.

·       The clinical areas of focus were paediatrics, frailty and mental health.

·       Only those requiring acute medical attention should be in an emergency department; everyone should have access to same day emergency care in line with the national direction i.e. a planned care pathway where a patient would get their investigation diagnosis and treatment in one day and then go home to continue that pathway as an outpatient.

·       An integrated approach to discharge was required.

·       There would be a transparent approach to sharing winter monies. 

·       Work was being undertaken to increase the uptake of flu vaccination for staff. 

·       The falls and frailty vehicle would be available five days a week.

 

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

 

• In response to a query on the level of flu vaccine available at the moment; Dr Sahota advised that the vaccine arrived in batches and that the over 65 year olds should be targeted first.  Dr Bajwa agreed that the situation was slightly worse this year and emphasised that it was also important for staff and carers to be vaccinated early.
• Dr Sahota agreed to feedback Ms Jervis’ comment from Healthwatch Bucks that letters provided to parents should be easily understandable and readable and that there should be an alternative method of communication for those who were unable to access information via the internet.

ACTION:  Dr Sahota

• Mr N Macdonald, Chief Executive, Bucks Healthcare Trust, reminded the board that performance had improved last winter.  However, the hospitals were busy and some people had already been admitted with flu. 
• Ms Woodroffe confirmed there was an agreed communications plan with a nominated lead for Buckinghamshire County Council and the ICP to disseminate the same message to all the areas.
• Ms D Richards, Managing Director, Oxford Health NHS Foundation Trust, highlighted that mental health had been part of the partnership approach to winter and a safe haven was opened last winter in Aylesbury in partnership with Mind; the patient satisfaction levels were very high and prevented some people attending A&E.  A second safe haven would be opening in High Wycombe this winter.

 

RESOLVED:  The Health and Wellbeing Board SUPPORTED the commitment to:

 

·       Ensure the safety of our patients

·       Support our staff

·       Work together across Health, Social care and the third sector to provide the best care in the right setting

·       Engage our population

 

The Better Care Fund (BCF)

 

Ms J Bowie, Service Director, Integrated Commissioning, provided a presentation and highlighted the following points:

 

• The BCF allocation for 2019/20 was almost £40m.
• The allocation was split into four elements. 
• 2019-20 was a transition year and the BCF in 2020-21 would be subject to the outcome of 2019-20.
• Various schemes were funded through the BCF.
• The Improved Better Care Fund (iBCF) was split over two elements; maintaining a stable care market and protecting preventative services.
• The winter pressures grant had been incorporated into the BCF for 2019-20.
• The High Impact Change Model had been developed; local systems were challenged to see how they performed against national key areas to ensure the best use of funding. 

 

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

 

·      A member of the board queried why only Wexham Park Hospital had the Discharge to Access model embedded and asked what was happening in the rest of Buckinghamshire.  Ms Bowie reassured the Board that the Discharge to Assess model would be carried out all year, across the whole system and that it would not be a case of ‘one size fits all’ as Buckinghamshire was a large county. 

·      Mr Majilton stated that the BCF was a good example of integrated working and was supportive of the recommendations. 

·      L Hazell expressed concern over what would happen if the BCF was discontinued in the future and proposed that the Health and Wellbeing Board write to the Prime Minister and Secretary of State to ask for the BCF on a sustainable basis. The Board agreed that the Chairman should write and ask for clarity of funding over a longer period. 

ACTION:  Mr Williams

·      In response to being asked if the reablement metrics and delayed transfer of care (DTOC) statistics would improve next year; Ms Bowie stated it was difficult to provide assurance but they were looking to learn lessons nationally and locally regarding the best targeted interventions and they were sighted on where more work needed to be carried out. 

 

RESOLVED:  The Health and Wellbeing Board DELEGATED AUTHORITY for final approval of the 2019-20 plan including locally set metrics to lead officers for BCC Integrated Commissioning and Buckinghamshire CCG.

 

RESOLVED:  The Health and Wellbeing Board NOTED the Better Care Fund budget and spend for 2019-20.

RESOLVED: The Health and Wellbeing Board APPROVED that the Integrated Commissioning Team would continue to service the requirements of the BCF nationally and locally including regular reporting via the Integrated Commissioning Executive Team on performance and quarterly updates to the Health and Wellbeing Board.

The Health and Wellbeing Board NOTED the performance of the Better Care Fund Performance April – June 2019.