Agenda item

Integrated Care Systems Update

Minutes:

The Committee received a report of the Interim Corporate Director of Resources that provided members with an update in respect of the recently published NHS England and NHS Improvement paper ‘Integrating care – Next steps to building strong and effective integrated care systems across England’ and associated calls for views on the options contained within the paper (for copy of report, see file of minutes).

 

The Principal Overview and Scrutiny Officer presented the report that set out the key issues within the consultation report and a response to the report prepared on behalf of the Committee and signed off by the Chair.

 

Councillor R Bell indicated that he was part of a sub-regional joint scrutiny committee that had been looking at this, but they were not informed about it. He was unhappy with the consultation and had just heard about patient reference groups being suspended due to lack of NHS capacity during the pandemic. However, on the 2 December 2020 in the middle of a pandemic running up to Christmas a five-week consultation was launched that he only found out about after the consultation had closed. He commented that the way this had been done given that they had regional scrutiny meetings going on years with very little progress was appalling and asked that this be conveyed. He was concerned about the abolition of the Clinical Commissioning Groups (CCGs) and what replaced them and how this would affect their relationship that they had built up over the years and were able to work closely together. Abolishing CCGs meant they lost the local focus and engagement and local influence.

 

The Principal Overview and Scrutiny Officer responded that he concurred with the sentiments expressed by Councillor Bell. In terms of the both regional joint ICS/ICPs there had been a similar response submitted as part of the consultation on behalf of both ICP Joint Overview and Scrutiny Committee that was managed by Gateshead Council and the “Southern STP” Joint OSC that Councillor Robinson chaired. A more generic response reflecting the views across all the participants of that joint overview and scrutiny had also been forwarded as part of the consultation process. The issue was well made around the potential risks to their already established working relationships with CCGs in County Durham and this was reflected in the submitted response. References were made to the fact that previously discussions had occurred around the potential for the two County Durham CCG organisations merging with Tees Valley CCGs. They made representations around the need to ensure that the CCG and commissioning arrangements needed to reflect the footprint of County Durham and the response made a similar plea as far as the future of CCGs were concerned. They referenced that proposals for a single CCG covering the region was a significant departure from the way that the ICS and ICP was being operated and they had long standing relationships with CCGs in other parts of central ICP. There was a history of excellent relationships and collaboration across CCGs and he shared Councillor Bell’s concern that was reflected in the response. The positive relationships were built up and they had a CCG that was commissioning and delivering services in County Durham for County Durham and ensure that this remained in Durham and services were continued to be delivered for the people of County Durham in an area that had historical health deprivation. They did have a commitment for the OCS leads to attend a future meeting to discuss the feedback of the consultation.

 

The Chair fully agreed with Councillor Bell and the Principal Overview and Scrutiny Officer and indicated that one of the advantages of the lockdown and virtual meetings was that you could record what people were saying and he had assurances that the Durham pound would remain in Durham. He was concerned at the ramifications for County Durham NHS Foundation Trust and the risks that it could be split into two between a North and South ICP.

 

Joseph Chandy, NHS County Durham CCG responded that he was presenting the item on the Primary Care Strategy which was the outgoing County Durham CCG’s way of trying to demonstrate the continued investment that was needed for the Durham patients in primary care and was one of their methods to sustain that funding beyond the current CCG. If he and Dr Stuart O’Neill remained in the structure after the reorganisation they had all practised or practice or professionally work in Durham and had an attachment to Durham and that was partly the motivation they took up these leadership posts in Durham to improve the health and well-being of Durham patients. Assurances from Dr Findley and Dr O’Brien had been given that they would do everything to ensure that they could put into place their ambitions for the Durham residents. Going forward there was going to be a design piece of work and he knew Nicola Bailey was on that task group to look at what would be the new function and the form of the proposed new way of working from an ICS point of view. He envisaged that at the ICP level there would be something like an area team and the ICS footprint was the largest ICS in the country as the distance from local population was too remote to be meaningful. The place based agenda and infrastructure was likely to include Durham, Sunderland and South Tyneside as they did not want to go backwards on the integration work that had been done over the last few years in their respective areas bringing together health and care for the benefit of patients. The delegated authority for money and decisions for patients and residents they would have was yet to be determined.

 

The Chair indicated that this whole organisation was supposed to bring GPs and Primary Care into making decisions and this had been turned on its side.

 

The Corporate Director of Adults and Health Services echoed Mr Chandy’s comments and as chief officers they were really determined that they wanted to continue with their approach to integration and to get the possible outcomes for local residents. Whilst there was some uncertainty their focus was very much on how they continued to strengthen integration locally.

 

Resolved: (i) That the contents of the report be noted.

 

(ii) That the response to the paper submitted on behalf of the committee by the Interim Director of Corporate Resources and Chair of the Adults Wellbeing and Health Overview and Scrutiny Committee be endorsed.

 

(iii) That a further report on Integrated Care Systems be included as part of the Adults Wellbeing and Health Overview and Scrutiny Committee’s 2021/22 work programme.

Supporting documents: