Alan Foster / Mark Adams, Leads for NE & Cumbria STP will provide the Joint Committee with a verbal update.
Minutes:
Alan Foster, Lead for Combined Cumbria and NE STP, noted that a communications pack had been circulated to the Joint Committee in relation to the proposed Integrated Care System and provided an update on current thinking on this issue.
Alan noted that the language had changed since the publication of the draft STP two years ago. Since that time there had been reference to Sustainable Transformation Partnerships, Accountable Care Organisations and then Accountable Care Partnerships and now what was proposed was an Integrated Care System.
Alan stated that he was a great believer in an Integrated Care System which would bring health and social care together. Alan noted that a Green Paper was due to be published this summer setting out how adult social care would be funded which was crucial.
Alan noted that work was taking place right across Cumbria and the NE with a view to improving population health and key to this was a focus on prevention to help people live longer and healthier lives. Alan provided the Joint Committee with information on life expectancy levels in the region for men and women/ mortality levels as a result of smoking/ cardiovascular disease and cancers.
Alan noted that there had been some improvements as a result of the work progressed so far but much more work was needed, particularly in the areas of childhood obesity and screening programmes and a key area of focus was helping to support the local population to look after themselves.
The Joint Committee was advised that an Integrated Care System was needed across Cumbria and the NE for the following reasons:-
· A long-established geography, with highly interdependent clinical services
· Vast majority of patient flows stay within the patch.
· Strong history of joint working, with a unanimous commitment from NHS bodies to go further as an ICS
· High performing patch, with a strong track record of delivery
Challenges
· Fragmentation following the 2012 Act has made system-wide decision-making difficult
· Significant financial gaps, service sustainability issues and poor health outcomes
· Maximising our collective impact to delivery the triple aim whilst reducing duplication and overheads.
Developing an Integrated Care System for our area will:
· Create a single leadership, decision-making and self-governing assurance framework for CNE
· Coordinate the integration of 4 Integrated Care Partnerships – building on the learning from North Cumbria
· Establish joint financial management arrangements
· Aspire to devolved control of key financial and staffing resources
· Set the overall clinical strategy, standards, pathways and enabling workstreams to reduce variation
· Coordinate ‘at scale’ shared improvement initiatives
· Arbitrate where required and hold the Integrated Care Partnershipss to account for the delivery of FYFV outcomes
The Integrated Care Partnerships will be commissioned to :-
· Deliver integrated primary, community and acute care (aligned to the overall ICS strategy).
· Ensure critical mass to sustain vulnerable acute services within their geography
The Joint Committee was advised that whilst work would take place at a system level to do some pieces of work at scale once place based working would continue and needed to be built upon.
The Joint Committee was advised that the work around Integrated Care Systems and the proposed options around service planning and delivery were under development and were not set in stone. The Joint Committee was also advised of a proposed governance process to facilitate collective decision making within the current legislative framework and it was noted that this might lead to structural change over time.
The Joint Committee was informed of the following headline clinical strategy:-
· Was driven by extensive clinical engagement and informed by insights from population health management
· Involved shifting the emphasis of care to prevention and early intervention in the community
· Involved collaboration and networking of acute services around four centres of population
· Would mean service consolidation and organisational change only where necessary
· CNE-wide solutions for Pathology and Radiology
· Building on CNE-wide coordination arrangements: UEC Vanguard & Cancer Alliance
· Developing new models of primary care to meet the needs of an ageing population
· Industrialising our approach to prevention focused on screening for atrial fibrillation and osteoporosis
· Delivery of ambitious ‘No Health without Mental Health’ programme
The Joint Committee also received information on acute hospital vulnerable services.
The Joint Committee was informed that it had taken a significant length of time to get to this point and matters had not been helped by the changing language in relation to STPs and Integrated Care Systems but there was now a real opportunity to move things forward.
Councillor Hall noted that the expectations of local people would need to be managed if more services were to be delivered in individuals’ homes going forwards as often individuals considered they were better off in hospital and would receive more appropriate care. Councillor Hall considered that there needed to be an education campaign around this.
Alan acknowledged that educating local people on this matter would be important.
The Chair stated that she was really pleased with the emphasis on prevention and also on mental health and she considered that it would be helpful to have an update on the latter issue going forwards. However, the Chair stated that she had not seen any mention of where local government fit in and whilst acknowledging that matters were at an early stage she would like some reassurances around that as she was sure local government could assist.
Alan indicated that there were good links with Public Health and Directors of Adult Social Care and discussions had been taking place at Chief Executive level and there was a focus on working in partnership at all levels to get things right going forwards.
Councillor Schofield noted that a lot of the information outlined was at a very high level and she queried what this would mean for local communities and the quality of care that they were going to receive. Councillor Schofield stated that she was still not reassured that what was outlined was not something similar to the ACO model.
Alan stated that the system he was outlining was about working to ensure safe quality healthcare for local people and avoiding preventable deaths and keeping more funding in the system. It was not about privatising the NHS. Alan also reminded the Joint Committee that some elements were already privately operated for example the care sector and GPs but were still seen as key elements of or supporting the NHS.
Mr Whalley,(Keep Our NHS Public North East), noted Alan’s comments but indicated that it was his belief that if the direction of travel continued then privatisation of the NHS would happen within the next five years.
Councillor Mendelson considered that what would be important was involving and engaging local communities and councillors in the development of the Integrated Care System.
Councillor Taylor thanked Alan for the helpful presentation and supported hospitals working more together to sustain effective quality services. However, Councillor Taylor queried how the private cancer centre which was coming to the region would be encouraged to co-operate with this approach and how local people’s views would be taken into account as attending the centre may not be something patients want to choose.
Alan agreed that it would be important to take on board the views of local communities and stated that it would be important to offer a choice and this might be linked to Palliative Care. Alan stated that he could not change the position in relation to the private elements of the healthcare system already in place but the work taking place was aimed at sustaining the NHS.
Councillor Taylor noted that health teams work well across a lot of specialities and considered that the proposals for networking for Radiology and Pathology sounded positive but she considered that if clinicians did not know and trust the individuals they were dealing with then there could still be a level of duplication. Alan stated that there had to be a level of trust amongst all clinicians across the system.
Clare Williams, Unison, noted that everyone was focused on achieving good outcomes for local communities and she considered that patients would do well if they have a good workforce. Clare acknowledged that there are issues in recruiting staff generally and that vacancies are high due to issues such as the removal of bursaries and there are particular problems recruiting specialist staff into the area. Clare considered that it was important to develop a response locally to these issues and she considered that the universities and Unison could have a role in helping to grow our own staff. Unison also had something to offer in terms of supporting staff who might need to provide care in individuals own homes although it would be important to look at individual needs as care in an individual’s home where they may become isolated may impact detrimentally on mental health and may not always be appropriate. Clare indicated that collectively they are able to work with the whole workforce to identify some of the changes that need to be made going forwards.
Councillor Robinson agreed that it was important to have the right level of workforce in the area and he considered that given the significant level of cuts to public health funding that local government was facing in local areas such as Durham, that it would be important for the NHS to support local government and social care going forwards.