The Board received an update presentation from the Corporate Director of Adult and Health Services, Jane Robinson and the Director of Integrated Community Services, Michael Laing on progress relating to Health and Social Care Integration (for copy see file of minutes).
The Director of Integrated Community Services explained as regards local progress, including work on the Joint Committee noting 10 workstreams looking at streamlining pathways for the public. He explained as regards the quality workstream, looking at how partners work together to identify improvements and pick up issues. He noted that there was a need for a quality lead across County Durham and an issue would be how to resource that lead.
The Director of Integrated Community Services explained as regards winter planning, noting the work together between partners in terms of operational arrangements and the ‘battle rhythm’ He explained as regards the daily Accident and Emergency briefings, and work with partners such as those from housing, looking at which patients could be discharged and noted that demand was not predictable.
He noted there were two types of winter plan, surge planning and the cold weather plan. He explained the cold weather plan involved Public Health and the County Council, with the recent experience in tackling issues as a consequence of Storm Arwen helping in terms of such planning. He noted plans were regularly updated, with submissions to NHS England and the Integrated Care Board (ICB). The Director of Integrated Community Services explained in detail as regards the key aims: to support the health and wellbeing of the workforce; to safely manage surges in demand for health and care; to safely embed infection prevention and control principles; protect elective surgery; safe and effective discharge; and to care for people in the community and avoid admissions.
In respect of key risks, the Director of Integrated Community Services noted they were: demand growth beyond model; workforce availability; industrial action; and public expectation of the NHS.
He noted that partners were working together to prepare for winter and that we were currently in a period of sustained demand, with Public Health projections suggesting future challenges. He concluded by noting additional investment across partners including the NHS, social care and in support for communities, adding it was important that all of the system was working well and working together.
The Chair asked how residents could play their part in supporting the NHS and Social Care this winter. The Director of Integrated Community Services noted residents should continue to self-care to help ensure they are fit and well, remembering the ‘hands, face, space’ message from COVID campaigns. He noted another way would be to check on neighbours that may be old, frail or live on their own to ensure they too are well or are directed to any help they may need. He noted the information and advice available from the County Durham Together service, local GP surgeries and the NHS 101 contact number that may be able to help before escalating to secondary care. He emphasised that, however, if people needed to attend accident and emergency they should.
Councillor T Henderson noted that the importance of timely hospital discharge to free up NHS beds was widely documented and asked how the County was geared up in this regard for the winter planning period. The Director of Integrated Community Services noted that in terms of Local Authority areas, County Durham was one of the best in terms of discharge. He noted that patients would have an expected date of discharge and set of likely needs, for example a care package or a move to intermediate care, such as a care home. He added that GPs and Social Workers can help plan discharge and gave an example relating to a palliative care pathway where suitable domiciliary care was not available and therefore flexible domestic care had been provided. He noted that more domiciliary care was needed.
Councillor T Henderson noted the closure of the ward at Richardson Hospital a number of years ago and asked if there were any plans to bring those beds back into use to help reduce demand elsewhere. The Director of Integrated Community Services noted the Richardson had been looked at in terms of non-medical beds, for use in a crisis situation.
Integrated Care Board Update
The Joint Head of Integrated Strategic Commissioning, Sarah Burns gave an update presentation relating to the ICB, including setting out its strategic aims to: improve outcomes in population health and healthcare; tackle inequalities in outcomes, experiences and access; enhance productivity and value for money; and help the NHS support broader social and economic development.
She explained that some ICB functions would be discharged regionally whilst some would be discharged ‘at place’ across Local Authority areas with partners, adding that it was important for the Health and Wellbeing Board to work closely with the ICB to inform local decisions. The Director of Public Health, A Healy explained as regards the role of the ICB in tackling health inequalities and healthcare inequalities, and in terms of prevention work. She noted the Healthier and Fairer Advisory Group that would feed into the ICB and noted funding as regards Fresh and Balance in terms of consistent approaches going forward. The Corporate Director of Adult and Health Services noted the work of the Association of Directors of Adult Social Services (ADASS) with the Integrated Care Partnership (ICP) along with Directors of Public Health and noted that meeting of the Joint
Management Executive Group (JMEG) in the new year would look at the interface of ICB and place.
Draft Integrated Care Partnership Strategy
The Board noted that all ICPs were required to publish an Integrated Care Strategy (ICS) by December 2022 and the Joint Head of Integrated Strategic Commissioning gave a presentation on the draft ICS for the North East and North Cumbria. She referred to the structure of the draft strategy; vision, goals and enablers; assets and case for change; draft key commitments in relation to healthy life expectancy, smoking prevalence, inequality in life expectancy and suicide rate; fairer outcomes, delivering ‘Core20PLUS5; excellent health and care services; and delivering the ICS, with detailed delivery plans and the NHS Joint Forward Plan by the end of March 2023.
The Corporate Director of Adult and Health Services explained that feedback from the Health and Wellbeing Board, and individuals too, would be important, noting the next strategic meeting being 15 December 2022. D Gardner asked as regards the ‘Core20PLUS5 and the Joint Head of Integrated Strategic Commissioning noted that the Joint Strategic Needs Assessment (JSNA) focus on County Durham would be retained, with the ICB focussing on areas of challenge for the North East and Cumbria. The Director of Public Health noted that in terms of ‘Core20PLUS5, there would be outreach to other workstreams, such as mental health, noting a ‘Core20PLUS5’ for Children and Young People. E Mireku explained that the ‘Core20 plus5’ for Children and Young People had been published last week and noted the priority framework, with a focus on place with the JSNA and Health and Wellbeing Strategy.
The Partnerships Team Manager noted she would pull together a response on behalf of the Health and Wellbeing Board.
Councillor T Henderson asked how local people across the area had been involved in shaping the ICS. The Joint Head of Integrated Strategic Commissioning noted the December deadline for responses and limited opportunities for response. She added that there was some reassurance for Durham in that there were many mechanisms to engage with people. The Chair asked as any areas left behind and if funds were enough, given the large geographic area. The Joint Head of Integrated Strategic Commissioning noted that there were ambitions to go further, however, the very good partnership working in County Durham, where people were put first above organisations, meant County Durham was well placed.
That the presentations be noted.