Representatives from TVCCG will be in attendance to provide an update to the Committee in respect of the following:-
- The development of the North East and North Cumbria Integrated Care System (NECS ICS), the Integrated Care Board (ICB) and the proposed sub-regional Integrated Care Partnership’s (ICP’s)
- Opioid prescribing rates across the Tees Valley and actions taken to reduce overprescribing
- Learning Disabilities Respite Review
Representatives from TVCCG were in attendance at the meeting to provide an update to the Committee in respect of a number of items. The first of which was the development of the North East and North Cumbria Integrated Care System (NECS ICS), the Integrated Care Board (ICB) and the proposed sub-regional Integrated Care Partnership’s (ICP’s). The Chief Executive of the Tees Valley CCG and the Executive Director at NENC ICS were in attendance to provide this aspect of the update.
The Chief Executive of the Tees Valley CCG advised that Samantha Allen, the Chief Executive Designate of the NENC ICS, would welcome the opportunity to attend a future meeting of the Committee to discuss its establishment in more detail. It was advised that recruitment to the ICB had commenced and work was underway to describe the operating model of the ICB. Feedback had been sought, particularly from CCG staff who were affected by the change, as the CCG’s morphed into the ICB, as well as a range of partners and stakeholders. A number of issues were being considered particularly in terms of what would happen at what level. For example, there would be issues that would be addressed at ICB level, either because it was high level commissioning i.e. the North East Ambulance Service, which worked across the whole of the North East but not the North East and Cumbria but also the annual report and annual accounts, which again would be produced at an ICB level.
A new organisational structure was being drawn up for discussion with staff, as the ICB would take over formally from the CCGs on 1 July 2022. Consideration was currently being given to a number of issues including whether all the functions presently undertaken by the CCG’s would continue to be delivered by the ICB, were there any issues of concern around safety, was there anything specific that needed to be considered in terms of the committee structure and what aspects of work would be undertaken more locally and fed into the ICB?
Reference was made to the white paper on integration and it was advised that efforts were being made to pick up on the links in that white paper to ensure these were implemented as part of the establishment of the ICB. The good news was that the overriding proposal in the white paper was for there to be a focus on place (13 upper tier local authorities in the NENC ICS). In the new ICB proposed organisational structure place was key and having leadership of place was included, along with oversite of budgets and working with existing Health and Well-Being Boards were also included.
The Executive Director advised that she was really keen to work with the Chair of the TVJHSC and Scrutiny Officer to consider the Committee’s forward work programme and how the ICB’s attendance at future meetings would be really helpful from a system perspective.
The second element of the update focussed on the opioid prescribing rates across the Tees Valley and the actions taken to reduce overprescribing by GPs. A Medicines Optimisation Pharmacist for North East Commissioning Support (NECS) was in attendance to provide an update to the Committee.
In terms of the work being undertaken across the TVCCG to reduce the high levels of opioid prescribing it was advised that a significant amount of work had been undertaken by both GP practices and Foundation Trusts. It was noted that number of initiatives had taken place including the CROP initiative – the Campaign to Reduce Opioid Prescribing, which originally commenced in Leeds. The North East Academic Network had adapted that programme and all of the GP practices within the Tees Valley had taken part in that initiative. A series of report had been produced for GP practices to highlight where they sat both locally and nationally in terms of opioid prescribing. This initiative had originally been due to commence in April 2020, however, owing to the Covid-19 pandemic was delayed until June 2020. In November 2020 a couple of four hour education sessions had been delivered to PCN and practice employees, pharmacy staff and GP’s by Professor Eldabe from South Tees NHS FT’s pain clinic, alongside specialist Nurses, a pain Pharmacist and Behavioural Psychologist from Warwick University. The education session was based on the i-watch programme, which was a national opioid reduction pilot. There had been 40 Pharmacists on the calls, together with consultants from North Tees NHS FT and specialist Nurses who were keen to replicate the work undertaken by the pain clinic in respect of opioid reduction clinics at South Tees NHS FT.
In addition to the education session the CCG had funded a one day per week specialist pain reduction Pharmacists resource to assist Primary Care Prescribers. This had led to a reduction in the waiting time for patients to access the opioid reduction clinics from 11 weeks to 4 weeks, which had a huge impact on the delivery of care to more complex patients requiring opioid reduction input. The CCG funding would be continued into 2022/23, which was fantastic to maintain that level of support for Primary Care Clinicians. Work continued in respect of drug related deaths across the Tees Valley and it was hoped that some further revision education sessions would be provided. A trend graph for the national indicator for high dose opioid prescribing volume showed there had been a 47 per cent decrease in prescribing rates across the Tees Valley compared with a 39 per cent decrease nationally.
The final aspect related to the Learning Disability Respite Review and the Head of Service for Adult Learning Disabilities in Tees at Tees, Esk and Wear Valley NHS Foundation Trust was in attendance to provide the committee with an update.
Reference was made to the current review and current arrangements for respite, which it was acknowledged was challenging for families and service users. It was advised that in January 2020, following the CQC inspection, the Trust had received a must do action relating to compliance with the Mixed Sex Accommodation (MSA) regulation. The Covid-19 pandemic had then hit and owing to the vulnerability of service users had impacted significantly on the provision of respite offer. It was explained that currently the two respite units Aysgarth in Stockton and Unit 2 in Middlesbrough were open and functioning. However, a reduced bed base was in operation. In autumn 2021 families were consulted about a range of options available, which resulted in a varying number of respite nights the families were able to access.
Architects were subsequently commissioned to explore various options and this work was completed in January 2022. Subsequently an options paper was developed by the project group and the paper was due to be considered by the Board in April 2022. Further consideration was currently being given to how respite was being delivered at present to optimise capacity. Families were fully involved in the discussions and efforts were being made to build in additional flexibility. It was noted that pre-pandemic if a service user attended Aysgarth they would have received an average of 41 nights within a twelve month period. Those that attended Unit 2 at Bankfields would have received 33 nights. It was highlighted that in respect of the modelling work that was currently taking place regarding future respite provision some of the options would enable service users to receive additional days, as well as added flexibility. The immediate goal was to achieve stability for the families.
AGREED that an invite be extended to the Chief Executive of the NENC ICB to attend a future meeting of the TVJHSC.