Agenda item

Integrated Care System Development Update

Presentation of the ICB Chief Executive Designate, North East and North Cumbria.


The Board received an update presentation from the Chief Executive Designate of the Integrated Care Board (ICB), Sam Allen on the progress with the Integrated Care System (ICS) development (for copy see file of minutes).


The Chief Executive, ICB set out the key aims of the ICB:


·        Improve outcomes in population health and healthcare

·        Tackle inequalities in outcomes, experience and access

·        Enhance productivity and value for money

·        Help the NHS support broader social and economic development.


She set out the architecture of the ICS and explained as regards development of the ICB membership, functions, and delegations to place.  It was added that guiding principles for ICB development had been agreed with partners and set out appointments that had been made so far. 


The Board noted the guiding principles:


·        Secure effective structures that ensure accountability, oversight and stewardship of our resources 

·        Create high quality planning arrangements to address population health needs, reduce health inequalities, and improve care

·        Ensure the continuity of effective place-based working between the NHS, local authorities and our partners

·        Recognise our ICP sub-geographies as a key feature of our way of working across multiple places

·        Design the right mechanisms to drive improvements in geographical areas larger than place-level

·        Highlight areas of policy, practice and service design where harmonisation of approach might benefit service delivery

·        Maintain high and positive levels of staff engagement and communication at a time of major change 


The Chief Executive, ICB referred to a High Level ‘Functions and Decisions Map’ for the North East and North Cumbria ICB and noted the expectations as regards place based-working within the Government White Paper and associated timescales.  She noted the forward plan relating to place-based working and referred to an operational diagram for the governance model for the ICB. 



She noted the role, membership and relationship to our places in terms of developing the Integrated Care Partnership (ICP) and building up an ICP from each of our places: North Cumbria ICP; North of Tyne and Gateshead ICP; Durham, South of Tyne and Sunderland ICP; and Tees Valley ICP.


The Chief Executive, ICB explained that it had been agreed with partners that one Strategic ICP supported by those four ‘Sub-ICPs’, recognising our position as the largest ICS area in the country and our long-established sub-region partnership working arrangements between CCGs, Foundation Trusts and Local Authorities.  She noted the sub-ICPs would build a needs assessment from each of their Health and Wellbeing Boards (HWBBs), which would then feed into the ICS strategy setting process overseen by the strategic ICP.  She added that planning meetings were taking place ahead of the first formal meetings of the ICP from July 2022.  She noted the statutory members of the ICP in terms of the ICB and those from Local Authorities, with potential members from usual partners including: Primary Care; Patient Groups; Schools; Police and Fire; Public Health; the Business Sector; and the voluntary sector, amongst others. It was noted that there is a place on the Board to represent elected members.


The Chief Executive, ICB noted the development of the ICP and timescales and noted next steps included:


·        Gathering views and expertise on the operating model with a further iteration to be developed by May 2022

·        To include proposals on transitional place-based working arrangements, and work with our places to develop a route map to more formal place governance by 2023 (as required by the Government’s Integration White Paper).

·        To test our operating model against a range of scenarios.

·        Review our ICB committee roles and structures, and the governance of our ICS workstreams, with our Executive Directors as they are appointed.

·        The final operating model will shape how we deploy our most senior staff, but we envisage that the vast majority of our staff will continue to work in the way they do now.

·        Ongoing engagement with key partners on the development of the ICS, including with HWBBs and local and sub-regional scrutiny committees.


The Chair thanked the Chief Executive, ICB and asked the Board for their comments and questions.


Councillor T Henderson asked as regards the benefits for North East Communities as a result of the ICS.  The Chief Executive, ICB noted the large structural changes, explaining she had worked in health for 25 years and added that reinventing the wheel would potentially miss opportunities to work to tackle inequalities and provide real benefits for the region. 

She added that while such change at scale would take time to bed-down, it would be important not to lose previous place-based approaches, citing the benefits shown by greater collaboration during the pandemic.


In response to a question from Dr L Murthy, the Chief Executive, ICB noted the operational model would be finalised mid-June.  Following a question relating to the Joint Committee from F Jassat, the Chief Executive, ICB explained that the ICP would set strategy and delivery.  She added work relating to place would be worked on and be co-produced over the next few months, F Jassat welcomed the opportunity to comment on place.


Councillor R Bell asked as regards the nearest equivalent to the outgoing CCGs and the Executive Director of Place Based Partnerships (Central and Tees Valley), Dave Gallagher noted that the eight CCGs would disappear however the people and working relationships represented the strength and noted those people from the CCGs would largely be working for the ICP.  The Chief Executive, ICB noted part of the operational model being consulted upon would be the roles and place-based governance.  Dr S Findlay noted the concerns from GPs in terms of the ICB being more remote and having less representation than CCGs.  The Chief Executive, ICB noted consultation on leadership roles and the continuation of place-based teams and noted she would speak with Dr S Findlay as regards that level of involvement.


Councillor T Henderson noted funding was a large concern and asked as regards guarantees that Durham would not be disadvantaged by the new arrangements.  The Chief Executive, ICB noted while she could not guarantee, she noted allocations would work as they did currently through CCGs but expected a real term reduction due to inflationary costs.  She added she expected announcements nationally and noted she would fight for a fair share for the North East and Cumbria.


M Stenton entered the meeting at 10.15am


Councillor R Bell noted money was not the only issue, but also recruitment, especially in areas such as health and social care.  The Chief Executive, ICB noted the appetite from social care partners in terms of planning relating to workforce and cited the Heath and Social Care Academy in Durham as an excellent platform to build on. 


The Corporate Director of Adult and Health Services noted the helpful discussions which gave clarity on issues relating to co-production and discussions with the Chief Executive, ICB as regards regional issues. 

She added she would meet with the Corporate Director of Children and Young People’s Services and the Director of Public Health on cross-cutting issues. 

The Strategic Manager (Partnerships) noted some development time was set aside relating to the Joint Health and Wellbeing Strategy and the Director of Public Health noted that the Chief Executive, ICB had visited previously and the place-based approach in Durham had impressed.  The Director of Public Health noted the issues in terms of health inequalities in the area, exacerbated by the pandemic and noted those conversations would take place, giving tobacco as an example of regional working at scale. 


In response to a question from Dr L Murthy in terms of the cost of implementing the changes relating to the Health and Care Act, the Chief Executive, ICB noted that restructures do come with a cost attached but it would take some time to understand local implications.


The Chief Executive, ICB referred to place based event in June taking place at the Riverside where 200 people are expected.




That the presentation be noted.


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