Agenda item

The Joint Committee will receive information on the NHS North East and North Cumbria Integrated Care Board (ICB) and Public Health South Tees, including the main duties and areas within the respective remits and an outline of the key priorities, issues and challenges for the year ahead.

The South Tees Health Scrutiny Joint Committee (STHSJC) had been scheduled to receive information on both the NHS North East and North Cumbria Integrated Care Board (ICB) and Public Health South Tees, including the main duties and areas within the respective remits and an outline of the key priorities, issues and challenges for the year ahead. However, it had been advised that unfortunately the Director of Public Health was unable to attend the meeting, due to illness. Subsequently, the Public Health South Tees element of the agenda item would be deferred until the next scheduled meeting.

 

The Director of Place Based Delivery from the ICB was in attendance to present an overview of the Integrated Care Partnership arrangements in North East and North Cumbria.

 

It was advised that, from 1 July 2022, 42 ICBs had been established across England, replacing the former CCGs. Members heard that the Integrated Care System (ICS) included all of the organisations responsible for health and wellbeing, working together across a region, to plan and deliver services for communities.  It was commented that the ICS was not an organisation but worked through the following bodies:

 

·        The Integrated Care Board (ICB), which was a statutory NHS organisation that took on the responsibilities of the former CCGs and some of the functions held by NHS England. The North East and North Cumbria ICB worked with a range of partners at ‘place level’ in each of the 14 local authority areas within its region.

·        The Integrated Care Partnership (ICP) was a joint committee of the ICB and the 14 local authorities in the ICS area. The ICP was responsible for developing an integrated care strategy for the ICS.

 

The North East and North Cumbria ICB was the largest of the 42 ICBs.

 

At a national level, ICBs had been set some key strategic aims by the Government, namely:

 

1.      Improve outcomes in population health and healthcare;

2.      Tackle inequalities in outcomes, experience and access;

3.      Enhance productivity and value for money; and

4.      Help the NHS support broader social and economic development.

 

It was advised that although ICBs were still relatively new, they would soon be subject to further change and reorganisation. Members heard that NHS England had requested that each ICB reviewed its operating model with an aim to reduce running costs by 30%. It was commented that work would be undertaken to examine how each ICB could continue to deliver its statutory responsibilities effectively but with reduced financial resources.

 

Members heard that the ICB’s leadership team included a Chair, a Chief Executive and Executive Directors. It was explained that there was a range of Partner Members, which included representatives from local authorities, primary care and NHS foundation trusts.

 

In terms of the governance framework, the ICB was responsible for the delivery of services and the ICP was responsible for setting strategy at three levels i.e. system, area and place.

 

It was explained that the role of the Strategic ICP complemented the work of the four Area ICPs (North, North Cumbria, Central and Tees Valley):

 

·        The Strategic ICP led and developed an overarching strategy for the whole of the North East and North Cumbria, it promoted multi-agency working across a population of 3 million and determined how health inequalities could be tackled for the population.

·        The Tees Valley ICP was much more focussed on what happened across the Tees Valley, it provided a regular forum for partners to share intelligence, improve health outcomes for the local population, analyse and respond to the Joint Strategic Needs Assessments (JSNA) and collaborate and share best practice.

 

It was advised that the Leader of Stockton-on-Tees Council had been appointed as the Chair of the Tees Valley ICP. Members heard that it had been agreed that the chairing arrangements for the Tees Valley ICP would rotate between the local authorities located in the Tees Valley area.

 

It was commented that work had recently been undertaken by the Tees Valley ICP to mitigate the risk of winter pressures across the health service.

 

Members heard that the establishment of Place-Based Partnerships focussed on understanding and working with communities, joining up and co-ordinating services, addressing the social and economic factors that influenced health and wellbeing, and supporting the quality and sustainability of local services.  It was explained that the 2022 Health and Care Act had not created any legal requirement for Place-Based Partnerships, leaving flexibility for local areas to determine their form and functions. For Redcar & Cleveland and Middlesbrough, the South Tees Place-Based Committee had been established.

 

It was advised that the ICB was able to delegate some of its functions and budgets to the South Tees Place-Based Committee. It was clarified that the South Tees Place-Based Committee was a committee of the ICB, it was not a joint committee with Redcar & Cleveland and Middlesbrough Councils. Therefore, currently, the local authorities had not devolved any resources to the committee.  However, it was explained that the membership of the South Tees Place-Based Committee included local authority directors (adult social services, children’s services and public health) who were able to commit resources by utilising their delegated authority, which allowed the committee to formulate plans and progress service development across South Tees.

 

The key priorities of the South Tees Place-Based Committee were informed by the Live Well South Tees Board and its Health and Wellbeing (HWB) Strategy, in addition to the JSNA. Members were informed that effective working arrangements had been established with the Live Well South Tees Board to ensure delivery of the HWB Strategy, which aimed to improve the health and wellbeing of people in South Tees and reduce health inequalities. It was commented that, in terms of the relationship between the Live Well South Tees Board and the South Tees Place-Based Committee, the board was responsible for setting strategy by identifying the priorities, vision and goals for the area, the committee provided an NHS response for delivery of that strategy. It was commented that meetings of the South Tees Place-Based Committee were held monthly to enable decisions to be made in a timely manner and information on key challenges/opportunities to be shared.

 

Members were advised that the South Tees Place-Based Committee included representatives from the ICB, NHS, local authorities, Healthwatch and the Voluntary Community Sector (VCS). It was commented that the Director of Place Based Delivery chaired the meetings of the committee. The first meeting had been held in May 2023. Members heard the committee was currently working on the development of an agreement to ensure the effective deployment of resources.

 

It was advised that each ICB had a mandate to produce and develop a Joint Forward Plan with NHS foundation trusts. Members heard that the North East and North Cumbria ICB had worked with North Tees and Hartlepool NHS Foundation Trust; Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and South Tees NHS Foundation Trust to develop its plan, along with many other organisations. The ICB’s Joint Forward Plan demonstrated how the ICB and NHS trusts would:

 

·        arrange and/or provide NHS services to meet the population’s physical and mental health needs;

·        deliver the NHS Mandate and NHS Long Term Plan in the area; and

·        meet the legal requirements for ICBs.

 

The North East and North Cumbria ICB’s approach had been aligned to reflect the ICP’s strategy - Better health and wellbeing for all, by focussing on the following priorities:

 

·        Longer and healthier lives;

·        Fairer outcomes for all;

·        Better heath and care services; and

·        Giving children and young people the best start in life.

 

Members heard that the ICP Strategy, the Joint Forward Plan and the NHS Operating Plan were all interlinked:

 

·        The ICP Strategy involved local authorities, the NHS and partner organisations. The strategy provided a long-term vision, goals, priorities and was population outcome-focussed. The strategy was published in December 2022 and was reviewed every December.

·        The Joint Forward Plan involved the ICB and NHS trusts and was a medium term, 5 year, plan. The plan looked at strategic service delivery and was impact focussed, with a partnership context. It was published in June 2023 and was reviewed every March.

·        The NHS Operating Plan, sat alongside the Joint Forward Plan and also involved the ICB and NHS trusts. It was an annual plan that focussed on NHS activity, finance, performance and was workforce focussed. The plan was submitted to NHS England every March/April.

 

In terms of operational planning requirements, there were some national NHS objectives for 2023/24, which focussed on improving access to primary care and improving waiting times for urgent and emergency care, elective care, diagnostics and cancer diagnosis and treatment. Members heard that there were also objectives that aimed to improve the retention of staff and improve access and support for those with mental health conditions, learning disabilities or autism.

 

In terms of Tees Valley priorities, the Tees Valley ICP had collectively identified a number of key pillars that planned to support delivery of its organisational, place and system plans. Under those pillars key programmes, initiatives and ambitions had been identified for delivery by the ICB and its partners. Following feedback, the key pillars had been aligned to the core common elements of the Tees Valley’s collective health and wellbeing strategies. Those were:

 

·        Start Well - giving children and young people the best start in life, focusing on children in care, maternity, complex needs, speech and language, emotional health and wellbeing, children’s mental health and neurodevelopmental pathways;

·        Live Well - supporting people to live longer, healthier lives, focusing on primary care; mental health, learning disabilities and autism, elective recovery, personalised care, musculoskeletal services, diabetes, weight management, cancer, respiratory and Cardio Vascular Disease (CVD); and

·        Age Well - supporting the aging population to maintain independence and reduce dependency on hospitals, focusing on admission avoidance and hospital discharge, enhanced health in care homes, Urgent Community Response (UCR), falls and palliative and end of life care.

 

The Tees Valley pillars reflected and connected with the national NHS priorities, the HWB strategies and the North East and North Cumbria Integrated Care Strategy. There were cross cutting themes that underpinned all of the initiatives and all of the plans. Those themes were:

 

·        Reducing Health Inequalities (understanding local communities, equity of access and equity of outcomes);

·        Prevention (primary, detection and early intervention, management);

·        Sustainability (integration/system thinking, community assets, workforce); and

·        Improving Quality of Services (experience, effectiveness, safety).

 

In terms of the Joint Forward Plan, it was advised that the draft plan had been out for consultation and had been shared with key forums to seek feedback. The key stakeholders consulted on the Joint Forward Plan included - the ICP, NHS foundation trusts, local authorities, health and wellbeing boards, Healthwatch and the VCS. The draft Joint Forward Plan was complementary to the ICP Strategy, it was a delivery plan for the parts of the strategy that related particularly to NHS delivered or commissioned services, but within the broader partnership context. It was commented that the revised final version of the document would be published at the end of September/beginning of October 2023. It was added that the Joint Forward Plan would be reviewed annually, with the first update being published in March 2024.

 

A Member raised a query regarding achieving the proposed 30% savings. The Director of Place Based Delivery advised that there was a degree of complexity with the ICB’s arrangements, given its requirement to support a vast number of organisations and communities across a large region. It was explained that the proposed savings were associated with the running costs of the ICB and, to achieve those savings, the ICB would need to review overall spending on management costs, reconfigure its staffing structure and examine new ways of working.

 

A Member raised a query regarding the arrangements that were in place prior to the establishment of ICBs. In response, the Director of Place Based Delivery advised that previously there had been approximately 240 Clinical Commissioning Groups (CCGs), which were much smaller organisations based on smaller geographical footprints. Although the CCGs had been structured to focus on local population needs, it had been difficult for those organisations to influence pathway changes and service development with the larger NHS organisations. The ICB was now part of a much bigger commissioning organisation, which enabled it to influence service transformation, whilst also focusing on the needs of the local area.

 

AGREED - That the information presented to the South Tees Health Scrutiny Joint Committee be noted.