(i) ICS Update – Presentation by Sarah Burns, Director of Place (County Durham), North East and North Cumbria ICS and Central Integrated Care Board
(ii) North East and North Cumbria Draft Integrated Care Strategy - Presentation by Sarah Burns, Director of Place (County Durham), North East and North Cumbria ICS and Central Integrated Care Board
The Committee received a presentation by S Burns, Director of Place (County Durham), North East and North Cumbria ICS and Central Integrated Care Board which provided members with an update on the Integrated Care System (for copy see file of minutes).
An Integrated Care System (ICS) includes all of the organisations responsible for public health and wellbeing working together to plan and deliver services for communities. The ICS is not an organisation, it works through the following two bodies:
1. Integrated Care Board (ICB) – a new statutory NHS organisation that will take on the responsibilities of the eight Clinical Commissioning Groups (CCGs) and some of the functions held by NHS England. The ICB will also work at ‘place level’ in each of the 13 local authority areas with a range of partners;
2. Integrated Care Partnership (ICP) – a joint committee of the ICB, and the 13 local authorities responsible for developing an integrated care strategy for the region.
Councillor Earley highlighted some of the issues of concern amongst residents including wait times at accident and emergency (A&E) and delayed discharge and asked whether the ICB could help to address these concerns. The Director of Place confirmed that developing a new A&E department was a priority for the University Hospital of North Durham, but that national funding was required to do so. S Jacques, Chief Executive of County Durham and Darlington NHS Foundation Trust (CDDFT) confirmed that the ICB had recognised the issues at the A&E department and were treating this as a priority.
In response to concerns expressed by Councillor Earley regarding delayed discharge, the Director of Place noted that whilst there was no simple solution, Place would continue to manage the concern and further discussions would take place with the relevant teams.
Councillor Gunn noted that whilst some residents praised the services of the NHS, a lot of residents lacked confidence in the system and social media often emphasised the areas for concern. She stressed that there needed to be a focus on restoring the confidence that had been lost by residents and that communication was key in doing so. The Director of Place advised that a plan which had been informed by residents had been developed by the former CCGs, she confirmed the ICB were now responsible for the plan and that the concerns and views of residents would continue to be heard and carried forward. She highlighted the challenges that the NHS faced, particularly following the COVID-19 pandemic, and explained it would take some time for the service to fully recover.
Councillor Quinn expressed concern regarding wait times for A&E and the damaging effect that social media had on the NHS. She gave examples of poor communication from hospitals when patients were discharged to nursing homes and stressed that the issues with communication needed to be addressed urgently. The Director of Place agreed that communication was vital and confirmed that a member of the ICB would contact Councillor Quinn outside of the meeting to discuss her concerns further.
In terms of dentistry, Councillor Quinn emphasised the difficulties residents were experiencing booking appointments and that this had led to residents presenting at A&E. She felt that dentistry, instead of advancing forward, was in her opinion going backwards. She also noted the importance of pharmacies, and that people must be re-educated to contact pharmacies in the first instance.
Co-opted member R Gott gave an example of delayed discharge due to a patient waiting for medication and stated there was no joined up working between the different teams, particularly the teams for mental health and physical health. She also noted that the presentation the Committee had received did not include any information on public involvement. The Director of Place clarified that residents’ concerns and views had informed the plan that had been initially developed by the CCGs and it was important for the ICB to continue to get the views and experiences from residents to further enhance the plan.
Councillor Howey asked given the high levels of health deprivation and existing health inequalities within County Durham, how can the Committee be assured that Durham will receive its fair and required share of funding it has previously been allocated across health and social care. The Director of Place referred to the upcoming presentation on the North East and North Cumbria Draft Integrated Care Strategy and noted that it included the Core20PLUS5 approach which is designed to support ICSs to drive targeted action in healthcare inequalities improvement. She noted that funding had already been targeted at areas of deprivation, and although this had caused some controversy, it helped to reduce inequalities. Councillor Howey expressed concern that large amounts of funding could be given to the bigger hospitals.
The Chair noted County Durham had an excellent track record for health and social care integration including joint NHS and Local Government officer appointments, integrated team working and pooled budgets and asked if this good practice would be retained and enhanced within County Durham and stated that all want the best for their own area. M Laing, Director of Integrated Community Services clarified that this underpinned the report that was submitted to Cabinet in September 2022 and included information on acute commissioning and mental health commissioning. He explained the members of the group confirming they were responsible for overseeing the work and that additional appointments were being made. He noted that focus was on services that made a real difference to residents, and that this helped bring services closer together. He advised the Trust was shared with Darlington and highlighted the good work that had recently been done with them.
Councillor Hovvels was pleased to hear about the positive work with Darlington as some residents in County Durham often travelled to Darlington hospital for appointments and procedures. In terms of care and challenges with the workforce, she gave an example of some residents that no longer received their early morning care and that families were providing this care instead, demonstrating the current pressures on the NHS and that the pressure had the potential to impact on staff mental health. The Director of Place accepted that workforce challenges were a national problem but gave assurances that strong relationships existed between the ICB, health and social care, and independent providers, and that all were working together to find a solution.
Councillor Higgins commented that in his opinion, patients received poorer service from the larger hospitals. He stated that some of his residents felt the NHS system was broken when expressing their difficulties in making GP appointments. He expressed further concern with the social care team and his frustration that the team had only one contact telephone number. The Chair asked if Councillor Higgins had a question to ask the Director of Place. Councillor Higgins advised the Chair that he did not have a question but that he wanted to voice the concerns of his residents. The Chair clarified that she did not want stop Councillor Higgins from asking a question but suggested that any further concerns he wanted to raise be e-mailed to the Director of Place. Councillor Higgins felt that he had not been given sufficient time to raise his points fully and confirmed his intention to leave the meeting if he was unable to voice the concerns of his residents. Councillor Gunn and Councillor Crute supported Councillor Higgins viewpoint.
Councillors Crute, Gunn, Higgins and Hovvels left the meeting at 10.20 am.
Councillor Stubbs whilst appreciating the positives of the ICB, noted it was a costly model and requested further information regarding costs. The Director of Place explained that there were previously eight CCGs and that these had been replaced with one organisation that served the whole of the North East area. She offered to seek the comparative costs from the ICB.
The Committee received a further presentation by S Burns, Director of Place (County Durham), North East and North Cumbria ICS and Central Integrated Care Board which provided members with information on the North East and North Cumbria Draft Integrated Care Strategy (for copy see file of minutes).
The Integrated Care Partnership (ICP) is a statutory committee, established by the NHS and local government as equal partners, and involving partner organisations and stakeholders and forms part of the arrangements for the ICS. Each ICP is required to develop an integrated care strategy covering the whole ICP population by December 2022. The structure of the draft strategy focusses on the following areas:
· Vision, Goals and Enablers
· Building on Assets and the Case for Change
· Longer, Healthier Life Expectancy and Fairer Outcomes
· Health and Care Services and Enablers
· Involvement and Delivering the Strategy
Councillor Quinn asked if the draft strategy should include information on COVID-19 as many people were suffering from long covid and some had life-long conditions. The Director of Place stated this feedback was helpful and would be considered.
Councillor Andrews referred to the statement ‘a skilled, sufficient, compassionate and empowered workforce’ and noted the shortage of professional staff and the number of years that were involved for professionals to be fully qualified. She asked how this was being managed and whether the ICB was working with universities to help with this. The Director of Place confirmed that the ICB worked closely with Health Education England to plan, recruit, educate and train the workforce and explained there were opportunities for hybrid roles across health and social care which were more attractive jobs for some people. Councillor Andrews asked if additional funding was planned. The Director of Place clarified that unfortunately there were no plans for additional funding and that current funding would have to be prioritised accordingly.
Councillor Howey asked if the ICB were to reform any departments within the NHS to avoid wastage with staff. The Director of Place advised that the ICS needed to be made aware of any issues where staff were not receiving their full allocation of work.
Councillor Earley asked if there was anything that could be done to attract more GPs to work in County Durham and if more investment was needed to be put into practices. The Director of Place advised that there was a range of schemes to help encourage GPs to work in County Durham and included the GP Career Start Scheme. She confirmed that the number of GPs in County Durham was more than other Local Authority areas but that one of the problems was partnership working explaining that support was currently being given to single practices to help them work together and pool their resources. She further noted the Additional Roles Reimbursement Scheme (ARRS) which enabled practices to recruit a wide range of staff.
The Chair asked if it was possible to obtain a directory of key contacts within the ICS/ICB across service disciplines and including commissioning responsibilities. The Director of Place agreed that this information could be provided.
That the presentations be noted and the comments raised by members be submitted as the formal consultation response from the AWHOSC to the draft Integrated Care Strategy.