Agenda item

[A Question and Answer Session on the Integrated Care System Strategy and Priorities including One Wolverhampton]. 

[Government guidance to Heath Scrutiny Panels is attached, along with four articles taken from The King’s Fund website.  The King’s Fund is an independent charitable organisation working to improve health and care in England]. 

The Four King’s Fund Articles are:-

1)    Integrated Care Systems explained: Making sense of systems, place and neighbourhoods.

2)    The first days of Statutory Care Systems: Born into a Storm

3)    Placed Based Partnerships Explained

4)    Social Care Providers and Integrated Care Systems: Opportunities and Challenges

The Chair invited Brendan Clifford, who is leading on the development of Integrated Care Partnership (ICP)for Councils in the Black Country, to make some introductory comments on the report to the panel.  The ICP has representatives from its partner authorities who will be responsible for developing an integrated care strategy to address health, social care, and public health needs of its area.

The Chair invited Paul Tulley, Wolverhampton Managing Director Integrated Care Board (ICB), to give more details on progress of the development of the Wolverhampton ICP since they were introduced nationally in July 2022.

The Managing Director advised the panel nationally the timescale for completing the development phase of the local ICP was the end December 2022.

A development working group was set up with representatives of local authority directors. The Managing Director outlined the range of representatives from different local and national organisations who were consulted earlier in the year about the plans for the ICP and the development of the priorities.

The following areas were agreed in facilitated consultation events as being the top four issues for ICB in order of priority, workforce, children and families, social care, and mental health.

The 42 ICBs nationally will take on the commissioning functions of previous 106 clinical commissioning groups which have been abolished by Government.  In each ICB there will be partnership of local authorities who will form the ICP. The ICP will be tasked with developing an integrated care strategy to address local health, social care, and public health needs that follow national legislation and related guidance.

The panel were invited to comment on the presentation.

The panel asked for the update on progress of developing the ICB and a view about how the new arrangements will differ from that provided under the CCG and work being done to bring different organisations together.

Paul Tulley, Managing Director, Black Country Integrated Care Board, reassured the panel that organisations in Wolverhampton already had well established partnership working arrangements before the recent legislative changes were introduced. The Managing Director advised the panel that key partner organisations responsible for either commissioning or providinghealth and care services to Wolverhampton residents are represented on the ICB. There is also representation fromHealthwatch and local community and voluntary groups.

The Managing Director advised the panel that the ICB operates at the both the system and place level in Wolverhampton. There are six strategic working groups under the ICB who are responsible for coordinating the work based on priorities set by the ICB.

The work of the working groups is supported by a management team to help drive forward the changes and improvements the ICB want to achieve.

Brendan Clifford, Working for Councils in Black Country Integrated Care System, commented on the progress made to bring different health and community services together and suggested that a report be presented to the panel in six months to update the panel on progress in response to the issue raised.

The panel expressed concerns about the level of funding to deliver the priorities and highlighted the financial pressures on the adult social care sector, and changes to national funding plans for the sector recently announced.

Becky Wilkinson, Director of Adults Services, advised that there are discussions ongoing with the ICS to consider the implications of the policy changes.

The Director commented on the work being with colleagues at RWHT to better understand the gaps in homecare and residential care provision and develop plans.

The Director commented on efforts to improve joint working with other commissioners of services which focus on their respective strengths. The Director acknowledged the financial pressures facing the adult social care sector and highlighted the importance of partner organisations budgets working in a more aligned way in the future, to benefit the residents in Wolverhampton.

The panel expressed concerns about the financially and strategically dominant position of health sector partners and how this might impact on efforts to build strong working relationships with voluntary and community groups who are in weaker position. The panel wanted assurance of work being done to build a shared vision of the health and social care sector.

Simon Evans, Chair OneWolverhampton, commented that the development of the ICB will formalise the current working relationships and build on existing good practice. The Chair highlighted the benefits of the ICB plans and reassured the panel that there was no desire from an organisational perspective for the health sector to be the dominant partner and there was a commitment to work positively with all the organisations around the table. The Chair accepted the challenges of partnership working but highlighted the value of engaging with all groups as equal partners.

The panel welcomed the changes the tendering procurement procedures and the removal of the requirement for mandatory competitive tendering. The panel queried of the implications for the ICB as result of this change.

Paul Tulley, Wolverhampton Managing Director, Black Country Integrated Care Board, confirmed the change to procurement contracting regulations and advised the panel that they will be replaced by a provider selection regime. In this new arrangement there will be a set of rules that the ICB will be required to apply when determining which organisations will be responsible for providing services. At present waiting for final guidance from the NHS to be published on the provider selection regime.

The panel expressed concerns about impact on family carers when decisions made to remove care in situations where there is either a late payment or the person is discharged from hospital which can impact on the continuity of their care and will require a re-assessment. The panel wanted reassurance that the issue of continuity care is prioritised in the future wherever possible and a review of the process for recovering care fee debts.

The Director of Adult Social Care agreed to investigate the issue of delays in completing the financial assessment when people are assessed for care and will report to a future meeting. The Director advised the panel that when a person’s needs changes then their care package may need to be reassessed. In this situation the existing private care provider may decide that they can no longer meet the new care needs of that individual and when this happens then a new assessment will need to be done, which could lead to a change in a person’s carer.

The Director advised the panel that existing care packages remain open for two weeks when someone is admitted into hospital before their care needs are re-assessed.

The service is required to review a person’s care needs when they are discharged from hospital. The Director commented on the added challenges of delivering continuity of care at a time when the sector is experiencing high levels of employee turnover in the care sector workforce.

The panel commented on the challenges facing the public when trying to access adult social care for support wanted to reassurance that the new ICP would be working to address these issues.

Brendan Clifford, Working for Councils in Black Country Integrated Care System, commented that the issue of culture change was identified as an issue at a recent meeting of the ICB. The importance of listening to views of local communities and their experiences of health and social care services was highlighted.

The panel expressed about the quality of public engagement and level of awareness of the work being done by the ICB. The panel highlighted the short response times to consultation documents asking for public feedback as an example and stressed the need for greater efforts to engage with the public about the planned changes.

The panel also highlighted concerns about access to GP and the problems residents were experiencing in trying to make appointments and queried role of ICB in trying to address the issue of long call waiting times.

Paul Tulley, Wolverhampton Managing Director, Black Country Integrated Care Board, advised the panel that primary care development is one of six priority areas referred to earlier which provides a forum to look at how partners can support general practicein its development. The importance of not looking at primary care in isolation from other services was highlighted.  Paul Tulley suggested that the issue of issues of GP access could be discussed at the panel meeting on 19 January 2023 where a report from Healthwatch Wolverhampton survey could also be presented.

Paul Tulley outlined the work being done to engage with the public and the principal that members of the ICB should be having conversations with the public to find out what their priorities are. There was recognition that involving local people in the way services are delivered is key to the way that the ICB works in partnership with the local communities.

The panel discussed the need for people who may have difficulty in using health care services which often rely on them having access to the internet and that it was important to provide alternatives, particularly when using this method to consult with residents about planned changes to health and social care provision.

John Denley, Director of Public Health, commented on work done to find out the issues which are important to residents and that the overwhelming response was the issue was access to GP’s and the quality of care. The Director of Public Health commented about the important role in community pharmacists and that working with communities will help to develop new models of improving the situation and the chances of delivering quality, accessible care at the point in which people need it.

The panel queried in terms of health and social care that representatives considered that residents were most concerned about. The Director of Public Health commented that while there has not been a formal survey to find out the views of the public there is a range of work being done to find their priorities. The Director of Public Health commented on the potential for social prescribing that can help support emotional resilience.

The panel queried what the biggest challenges facing the Black Country ICS.

Paul Tulley, Wolverhampton Managing Director, Black Country Integrated Care Board, commented that the following issues where biggest challenges, restoring services to pre pandemic levels, workforce recruitment and retention, balancing the finances and the immediate challenge of high demand and the pressures on ambulance services and other front-line services.

The Director of Adult Services commented that issues highlighted were similar challenges facing the social care sector. The Director highlighted the challenges of increasing demand and complexity of needs and getting service to pre-pandemic levels. The Director highlighted that the Council were providing 15,000 hours of homecare per week pre pandemic, which has now increased to over 20,000 hours of homecare per week post pandemic. The Director also highlighted other challenges to the service such as the 30 per cent increase of social workers involved in end-of-life care and the impact of the increase in alcoholism levels since the end of the pandemic and workforce recruitment and retention challenges. The Director commented on the strategic challenge presented by the lack of long-term commitment around which makes it difficult to plan and work in a more joined up way with local partners and to deliver a consistent level quality of care.

The panel queried the priorities for the Integrated Care Partnership in the Black Country. Paul Tulley, Wolverhampton Managing Director, Black Country Integrated Care Board advised the panel that an interim strategy has been developed. The strategy builds on the priorities agreed by the Health and Wellbeing Board. The Wolverhampton Managing Directors added that work is being done to develop a joint forward plan with a five-year time horizon. The work will consider the wider priorities of the wider partnership, and the aim will be to publish the integrated care partnership strategy early in 2023.

The panel queried the role of provider collaboratives in the ICS and how they will be working together.

Professor Steve Field, Chair Royal Wolverhampton NHS Trust, and Walsall NHS Trust reassured the panel different health organisations in the NHS across the Black Country region have been working on a collaborative basis for some time. The Chair added that there is an executive board and a Chairman that covers the four trusts in the region which look at how they can collaborate to improve care provision.

The Chair gave further details of integrated working and details of successful changes which have led to reduced waiting times and delivered better care to patients.

The panel queried the role of the ICS in supporting public health to address these local priorities and how should residents judge the success of the ICS and One Wolverhampton plans.

The Director of Public Health commented that the NHS Plan is embedded within the ICS plans which gives it a strong preventative responsibility which supports the efforts of public health in improving health outcomes.

The Director of Public Health commented that the impact of the ICS will be judged on whether people feel they can get the right care at the right time, and they can access services in whatever way that meets their needs. The Director of Public Health commented on important role that community pharmacists can have in helping to keep people as independent in their homes as possible and this will be supported by efforts to recruit local people into health and care roles.

The panel queried the priorities of OneWolverhampton and how the ICS will support them.

Paul Tulley advised the panel about the development of One Wolverhampton priorities and the involvement of colleagues in Public Health in helping to understand the health needs of the City and the issues that are driving these priorities. Paul Tulley added that other health data sources will be used to understand the interactions of primary and adult social care in a person’s journey to hospital, which will help to inform the priorities of One Wolverhampton.

Paul Tulley commented that priority will be reducing health inequalities which is central to the work being done to improve health care, supported by a culture of innovation and research.

Paul Tulley suggested that a report is presented to the panel in six months’ time to think you should hold OneWolverhampton to account and challenge about whether the changes have made a meaningful difference to the lives of residents and to make sure the right things are being done for local people.

The panel thanked the presenters for the report.

Resolved:

1.    The panel agreed to receive a progress report on the ICB plans to a panel meeting in in June 2023.

2.    The panel comments on Integrated Care System Strategy and priorities to be noted.

3.    The panel to be given details of the timeline for key publication dates on the work of the ICB.