Presentation by Tim Golby - Locality Director for Northern Local Care Partnership. Representing the Health and Care system.
The Chair welcomed Tim Golby, Locality Director for Northern Devon Local Care Partnership. Representing the Health and Care System to the meeting.
The Locality Director for Northern Devon Local Care Partnership outlined his role and background to the Committee.
He highlighted the following points to the Committee:
· On 6 July 2021, the Health and Care Bill was published with proposals to promote more joined-up services and to ensure more of a focus on improving health through Integrated Care Systemsrather than simply providing health care services.
· It contained new powers for the Secretary of State over the health and care system, and targeted changes to public health, social care, and quality and safety matters.
· The Bill proposed substantial changes to how the NHS in England was organised. There were proposals to abolish Clinical commissioning groups and introduce new Integrated Care Boards (ICBs).
· The Bill had not yet been approved, and as such the system was preparing to implement changes as the Bill made its way through parliament.
· Integrated care systems (ICSs) were new partnerships between the organisations that met health and care needs across an area, to coordinate services and to plan in a way that improved population health and reduced inequalities between different groups.
He added that in Devon they had been building the foundations towards an ICS for the past four years. This work included the following:
· Built strong partnerships between organisations –including joint posts between the NHS and local authorities.
· Established a new collaborative agreement between three of the hospital providers.
· Merged two of the CCGs to enable them to commission services more effectively across the whole county.
· Forged strong links with their Voluntary, Community and Social Enterprise (VCSE) partners.
He explained that the Integrated Care System in Devon would be led by the NHS Devon Integrated Care Board and the Devon Integrated Care Partnership that was currently being developed.
Each ICS would have a Partnership at system level established by the NHS and local government as equal partners.
The Partnership would operate as a forum to bring partners together across the ICS area to align purpose and ambitions with plans to integrate care and improve health and wellbeing outcomes for their population. The partnership role would include:
· Bringing together NHS, local government and others to integrate care and improve health and wellbeing.
· Development of an Integrated Care Strategy.
· Must include local authorities in Integrated Care System area and local NHS, but wider membership for local determination.
· Chaired jointly selected by NHS and local authority.
· Role in hearing lived experiences, building on existing engagement.
He added that this also included the collaboration of the NDDH and R&DE hospitals to form an integrated Health Partnership.
He outlined the benefits of an integrated care system, as follows:
· Setting strategic objectives and outcomes to improve the health and wellbeing of the Devon population.
· Determining the allocation of resources to “places” through Local Care Partnerships.
· Ensuring that health inequalities were addressed across Devon.
· Seeking to influence the application of resources from areas outside health and social care that have a direct impact of the health and well-being of the population (such as housing, employment and education).
· Supporting the spread and adoption of best practice.
· Assuring delivery of expected improvements in outcomes, within their resources and to agreed performance, quality and regulatory standards.
· Ensuring active and effective stakeholder engagement and public participation at system level.
He explained how the Integrated Care System would work and explained that it worked on three tiers, which would work together at different levels with the majority of the work delivered locally.
There were 31 neighbourhoodsof 20,000–60,000 people, which was defined by their Primary Care Networks (PCNs) which were groups of 3-6 local GP practices that worked together. At that level, general practice would be strengthened by working together in PCNs.
Local Care Partnerships – There were five locationswith populations between 160,000 – 370,000. At that level, health and social care would work together more closely. A sixth Local Care Partnership would be focused on Mental Health.
There was one systemwith a population of 1.2 million. At that level, strategic planning and improvements could take place for the benefit of all as well as having an overview of system finance and performance.
The Integrated Care System in Devon was a partnership of health and social care organisations working together with local communities. The partnerships did not end at their borders. Collaborative provision and commissioning in physical and mental health included longstanding relationships with the Cornwall and the Isles of Scilly ICS and at a regional level.
One Northern Devon was a partnership of public and voluntary sector partners working together to improve wellbeing in North Devon and Torridge.
The aim was to reduce health inequalities through co-ordination of the activity of all partners involved in the wider determinants of health and an approach that was person-centred and place-focussed.
There was a programme of activity coordinated by the One Northern Devon Board around health and wellbeing.
One Northern Devon had a 10 year wellbeing strategy agreed with all partners in 2020.
One Northern Devon strategy was aligned to Devon Health and Wellbeing strategy and developing Devon Long Term Plan.
Work streams were already in place led by range of partners (not just NHS).
He explained that they were currently working towards the following:
· The safe and legal transfer for CCG functions and establishment of ICS governance.
· Refresh of and engagement on Devon’s Long Term Plan.
· Support to the development of Local Care Partnerships to enable delegations from System to Plan at an appropriate and realistic pace.
· Sustaining and supporting the Health and Care workforce.
· Integrating our infrastructure (digital, estates, workforce, finance).
· Broadening their professional leadership and inputs beyond the emphasis on ‘clinical’ to greater inclusion of multi-professional expertise.
The Chair invited each member of the public attending the meeting virtually to introduce themselves.
In response to a number of questions, the Locality Director for Northern Local Care Partnership advised the following:
· There would still be a National Health Service in place from February 2022 and that would not change. The service would continue to be free at the point of delivery. However, there was currently a shortage of healthcare workers to undertake the workload. The aim of the Integrated care system was to provide an holistic service across the country.
· Primary Care Networks (PCNs) were groups of 3-6 local GP practices working together. An appointed Clinical Director would ascertain what could be delivered together through their work with individual practices and would allow them to work together for mutual benefit.
· Acknowledged the pressure that the primary care sector was currently under and explained that the objective of the Bill was to bring coherence to the planning of services. The intention of the Bill was to be a devolution to local communities to assist and shift working within the policy framework that already existed.
· The whole package of terms and conditions of employment for healthcare workers was currently being reviewed and salaries would form part of that review.
· Decisions taken in relation to infrastructure and tendering were overseen by Devon County Council, Plymouth City Council and Torbay Council, who were all fully engaged in the consultation process. He added that he would feed back the question of District Council’s involvement as consultees to Devon County Council.
· He explained that his role was to work as a local officer within a set policy and to deliver what he could at local level within that policy.
· In terms of the procurement process and what could be done to make it more transparent, he explained that they were looking to collaborate to provide services at local level.
· One of the main issues with attracting people to roles within the healthcare provision in the North Devon area was the levels of pay and the high living costs. Many roles were filled by people who were already based in the area. In order to attract people to come and work within the local area, the right package needed to be presented and this would involve a review of values and terms and conditions to address a shortage in all areas of the healthcare system.
· He agreed that even the prices of affordable homes were too high for local people to afford and that it would add to the recruitment problem.
· One North Devon was funded through partnerships working together and investing in schemes from the Care budget.
· The systems for mental health, disability and autism would be incorporated into one single county wide system with the work being done at county level through the partnership trust. He advised that he could report back to the Committee in relation to timescales.
· Questions related to pay and working conditions would need to be put to the local MP for political representation at national government level and then onto the pay body responsible.
The Director of Resources and Deputy Chief Executive added that raising salaries alone wasn’t going to solve the problem and that the provision of key worker housing was a vital element to ensuring the supply of affordable property. He explained that the Council was already engaged in the early stages of facilitating Housing forums with key stakeholders to start to address the challenge.
The Chair added that the Council was working hard to solve the housing problem within the North Devon area.
Questions from members of the public:
Sue Matthews, representing the Save our Hospitals Group addressed the Committee.
She requested clarification in relation to the payment of health and social care people of Devon in an expanding population and how could services be delivered without rationing?
The Locality Director for Northern Local Care Partnership advised that they were currently looking at different models for support and care. He added that one option was a greater support in the community rather than within the acute system. This would involve looking at a best fit model for support services within Devon, rurality was also an issue in Devon and an example of this was the current requirement for many people to travel long distances for medical appointments.
Dr Finola O’Neil addressed the Committee.
She requested clarification as to whether there was a plan in place for diagnostic facilities and a method to escalate issues to government that could not be addressed at local level?
The Locality Director for Northern Local Care Partnership advised that the Nightingale Hospital in Exeter was to be re-purposed to as a diagnostic centre to address the backlog of waiting patients.
Elisabeth McElderry addressed the Committee regarding the regional structure overarching seven ICS’s in North Devon.
She questioned how independent North Devon would be in making its own decisions?
The Locality Director for Northern Local Care Partnership advised that services would operate within the parameters set by the Secretary of State.
He added that he was happy to attend a future meeting of the Committee if required.
The Chair thanked the Locality Director for Northern Devon Local Care Partnership for his attendance at the meeting.
(a) That the presentation be noted;
(b) That the members of the public provide their email addresses and that the presentation be circulated to them;
(c) That the Locality Director for Northern Devon Local Care Partnership be invited to attend a future meeting of the Committee; and
(d) That the minutes of the meeting be made available to the Local MP for North Devon.
Councillor Spear declared a personal interest as an owner of rental property.
Councillor Walker declared a personal interest as a PPG member at Fremington Medical Centre.