Agenda item

Elective Surgery Backlogs and Recovery–  a verbal update to be presented by Isobel Day from Buckinghamshire Healthcare NHS Trust and Neil Flint from Buckinghamshire Clinical Commissioning Group.

Better Care Fund Bi-Annual update – to be presented by Tracey Ironmonger, Service Director, Integrated Commissioning.

Recommendations:

•       To note the Better Care Fund update for 2020-21 and 2021-22.

•       To note the current position in relation to Better Care Fund and performance.

•       To note the plans to review the Better Care Fund.

Integration and Innovation: Working together to improve health and social care for all - DHSC White Paper, Feb 2021 – to be presented by Gillian Quinton, Corporate Director, Adults and Health.

The White Paper:

·       Sets out proposals for a Health and Care Bill

·       Builds on the NHS Long Term Plan, on the collaborations seen during Covid, and on a recent consultation on the future of ICSs. Also ties in with the current consultation from CQC on the way it works

·       Focuses on improving integration in two ways:

Ø  Within the NHS to remove barriers to collaboration; and

Ø  Between partners in the health and care system to improve health & wellbeing outcomes for local people.

Recommendation: Members of the Health and Wellbeing Board are asked to note the content of the Government’s White Paper, particularly in relation to the Health and Wellbeing Board.

Elective Surgery Backlogs and Recovery

The Chairman welcomed Isobel Day, Director of Business Recovery, BHT and Neil Flint, Head of Commissioning for Planned Care, Buckinghamshire CCG.  I Day advised that urgent and emergency surgery P1 had continued throughout the pandemic.   Cancer surgery had also continued and the number of referrals and treatment of people within two weeks of referral had been maintained.  The overall waiting list had increased by approximately 1,000 since March 2020 with those people waiting for routine elective surgery or outpatient appointments had had a longer wait.  Patients waiting for diagnostic services, MRI scans or CT scans had been maintained and there was no backlog.  A number of actions were being taken to address those waiting for outpatient and follow up appointments to allow patients to manage their condition.  Remote monitoring in changes in conditions was being carried out and it was possible that this would be extended to virtual outpatients.  Virtual appointments had worked well in the first wave of the pandemic with an increase of virtual outpatients to 60%; it had now decreased to 30-40% as more patients were being seen overall.  A lot of activity was suspended during the first wave; whereas it had continued throughout the second wave.  65-70% of day cases and inpatient activity had been delivered along with approximately 85% of outpatients.

The following key points were raised in discussion:

• In response to being asked about communications issued to manage patients’ expectations, I Day advised that all patients on the waiting list had been provided an explanation of the process in writing.  Signposting was provided to those patients who had concerns over a change in their condition and patients were given the opportunity to delay their appointment if they preferred not to visit the hospital due to Covid-19.  Patients had been categorised as P1-P6 with the high risk categories being P1-P3.  Each high risk patient case was reviewed by a lead consultant and offered a consultation to discuss the implication of a delay.  Those classified as ‘routine’ were offered phone consultations with a nurse or consultant.  Work was now being undertaken with Comms and patient engagement to build on activities already carried out.  Videos of patient journeys had been shared.
• The Chairman asked for clarification on the number of people on the waiting list. I Day explained that there were approximately 31,000 on the active waiting list with roughly 8,000 waiting for an inpatient procedure.  Approximately 5,000 had been on a waiting list for 52 weeks. The remaining patients were waiting for an outpatient appointment to determine their treatment.  There was also a number of patients waiting to be referred.  However, there was a concerted effort to reduce the number of patients who had been on the waiting list for more than 52 weeks.

The Chairman thanked Isobel and Neil for attending the meeting.

Better Care Fund Bi-Annual update

Tracey Ironmonger, Service Director, Integrated Commissioning, provided a presentation, appended to the minutes and highlighted the following key points:

• The reporting on the Better Care Fund (BCF) had been impacted by Covid-19 and it had been agreed that formal plans for 2020-21 would not need to be submitted for approval but would be an extension of the 19/20 plan.
• Formal reporting would be needed for reconciliation of the funding. 
• Expenditure had been discussed and agreed by the Integrated Commissioning Executive Team.
• BCF activities needed to deliver the High Impact Change model. Currently Bucks had self-assessed as ‘established’ against the 9 domains, meaning that systems were in place and operating for each area.  The future three year plan would look to improve these ratings to ‘mature’ or ‘exemplary’.
• An additional domain was expected on ‘admission avoidance’.
• A new Hospital Discharge Policy had been implemented in March 2020.

·       Examples of projects within the BCF were shared.

• The funding for 2021-2022 had been confirmed and planning guidance was awaited.

The following key points were raised in discussion:

• R Majilton acknowledged the huge amount of work that had taken place and advised that there was still a relatively high number of people in hospital; the main discharge points were Wexham Park Hospital and BHT and the focus would remain on how to support the BCF sustainably.
• It was noted that the CCG was a key partner in the BCF and when asked, in view of the new White Paper, whether this would continue; T Ironmonger stated that the BCF would be ongoing, but the infrastructure around it might change.  Gill Quinton, Corporate Director, Adults and Health, added that the BCF funding was significant and that an announcement was expected shortly.

RESOLVED:  The Health and Wellbeing Board noted the Better Care Fund update for 2020-21 and 2021-22, noted the current position in relation to Better Care Fund and performance and noted the plans to review the Better Care Fund.

Integration and Innovation: Working together to improve health and social care for all - DHSC White Paper, Feb 2021

Gill Quinton, Corporate Director, Adults and Health, provided a presentation, appended to the minutes.  G Quinton advised that several national bodies had commented on the White Paper, which concerned the future of integration between health and social care and proposals on how integration could be improved across the system, and these had been included in the agenda pack on page 39.  G Quinton summarised the key points of the White Paper:

• The Integrated Care Systems (ICS) would become statutory bodies and would have new powers and budget.
• Two boards would be required; a statutory board and a partnership board to engage with all the partners.
• The HWB would be the place-based planner and would have a significant role in setting the place priorities.
• The CQC would assess the Local Authority’s delivery of adult social care duties. 
• There would be no changes to Public Health within local authorities.
• The implications for Buckinghamshire were that a strong place-based footprint would be required for the HWB with clarity on place-based commissioning and expectations.

The following key points were raised during discussion:

• The Chairman advised that the Government was not inviting comments, but it would be useful to share partner feedback.
• David Williams stated that the Paper endorsed the journey and provided a framework for greater collaboration; it was a positive Paper for BHT and followed what had been carried out in Buckinghamshire in recent years.
• Jenny Baker, Chair of Healthwatch Bucks, advised that Healthwatch England had called for increased inclusion of the ‘voice of the patient’.  Healthwatch Bucks would be working with Healthwatch England on this area.

Resolved:  The Health and Wellbeing Board noted the content of the Government’s White Paper, particularly in relation to the Health and Wellbeing Board.