Meeting documents

To receive the verbal update from the NHS ICB and to receive the report on proposed future Health and Wellbeing Board and Integrated Care Partnership arrangements (report to follow the agenda).

The Somerset Health and Wellbeing Board approved the following recommendations:

1.     That the Somerset Health and Wellbeing Board considers the proposals and endorses the approach to align the Health and Wellbeing Board and the ICP.

2.     That the Board endorses the transition arrangements for the period October 2022 – March 2023, the appointment to the Board of additional members as identified in 2.5 of the report and revised quorum arrangements as detailed in 2.6.The Board agrees to recommend the proposed changes set out in the report to Full Council to consider and approve.

3.     That the Board notes the timescales associated with the Integrated Care Strategy and agrees to set up a working group to support the ICP’s refresh and further development of the strategy.

4.     That the Board agrees a significant refresh of the needs assessment under the JSNA to support the development of the strategy.

The Chair invited Jonathan Higman, Chief Executive of the Integrated Care Board for NHS Somerset, and Paul von der Heyde, Chair of the Integrated Care Board and the Integrated Care System for NHS Somerset, as well as Co-Vice Chair for the Health and Wellbeing Board, to introduce themselves.  The Board was advised of the current pressures and the priorities of the ICB during the initial period which began on 1^st July after being formed as a result of the Health and Care bill passed earlier in the year.  The ICB had taken on all of the statutory responsibilities of the Clinical Commissioning Group (CCG) beginning first of July, but there is a broader remit, including:

·         focusing on improving outcomes for the population

·         identifying and tacking inequalities

·         demonstrating and delivering value for money for the public 

·         requirements around social and economic development 

With the NHS being a major employer in Somerset, they have a responsibility to buy locally, think locally, support sustainability plans for the local population, etc.  One of the things being done at the moment is putting an approach to ‘population health management’ right at the heart of all they do; therefore, they are working to identify the data which will pinpoint where there is inequality within the county, as well as working through new care models to improve the care of the population in those areas.  A new approach to engaging with the public must be part of that. 

Over the last few months, the executive team was established for the ICB; a summary of the executive members will be circulated to the Health and Wellbeing Board.  In terms of the major accountabilities, these will transfer seamlessly from the CCG to the ICB from April 2023, when the ICB will have responsibility for optometry, dentistry, and pharmacy.  The ICB will have more responsibilities as they move forward, including specialist commissioning for more specialist services of the tertiary type.  This has all led to significant pressure currently, but great strides have been made in terms of improving elective waiting lists and delivering governmental requirements.  They achieved the 104-week wait target at the end of July and are now moving on to deliver a maximum of 78-week waits.

Work has been done on determining their objectives as an organisation and what they hope to achieve over the next six months; they have put this into three categories:

·         Delivering the best possible outcomes for the population of Somerset through the winter, which will be challenging on all fronts;

·         Taking action on inequality and building our public health capabilities by system working with social care and children’s groups, as well as developing joint commissioning;

·         Developing our health and care interim strategy by the end of December, followed by our five-year forward plan and development of the ICP.

The Chair of the Integrated Care Board added that the essence of the work going forward would be fundamentally different than it was in the past; it will involve working together as a whole community to help find solutions rather than commissioning and telling people what they are going to do, then checking that they’ve done it.  It is an opportunity to really help people from grassroots level all the way up to complex intervention care.

The Director of Public Health in Somerset presented a report on Proposed Future Health and Wellbeing Board and Integrated Care Partnership Arrangements.  The Board was advised that elements of the ICS (Integrated Care System) include the ICB (Integrated Care Board) and also the ICP (Integrated Care Partnership) involving the Health and Wellbeing Board and the Integrated Care Board.  There were three different sets of guidance which came out as result of national conversations, and the Somerset Health and Wellbeing Board held a workshop dealing with both the HWBB and the ICP, as they are both statutory boards but there may be considerable overlap between the two as far as responsibilities.  Responsibility for the ICP sits within the Health and Wellbeing Board’s overall responsibilities, so it is a complex situation.  Therefore, it was concluded after much discussion that, because Somerset already has a very tidy, functional system, there should not be separately operated Health and Wellbeing/Integrated Care boards, as this would have created duplication of effort and would have been confusing for the recipients of services in the population.

The report being presented today takes that conversation further, noting that the HWBB and ICB will operate together, aside from rare instances where they may have to meet or operate separately.  In order to support bringing together the HWBB and ICB, it was proposed that there would be a transitional period to set up the Integrated Care Partnership (ICP), which will include developing a strategy by the end of October as required statutorily.  The Local Government Reorganisation, with vesting on 1^st April, will also have an effect on this.  So the two boards will begin working together over the next six months to develop their vision for one strategic partnership board for all of Somerset beginning next April, which may be called the Somerset Board.  In order to achieve this, there is a need for three more positions on the board as well as altering the quorate requirements (from the previous two local authority members and one ICB member, to two local authority members and two ICB members).  Because there is a need to expedite work on the strategy, there will be a formal working group to do this; HWBB also has the authority for the Joint Strategic Needs Assessment, which will need to be refreshed this year.

The Board raised a number of issues, including:

·         Mel Lock asked if a representative from the Care Providers Association could be included on the board; Prof Grant agreed with the logic of such an inclusion and advised that the Board could add this to the recommendations. 

·         Lou Woolway, Deputy Director of Public Health, stated that the board will have to be much more stringent regarding the work programmes in future, so there will be task and finish groups and more people will be brought in for those. 

·         Jonathan Higman raised the importance of how we engage with the population at the same time as developing the health and care strategy, and how we bring together the engagement functions of the ICP and the local authority.  Cllr Booth questioned the means by which information on the ICP would be communicated to the public; Prof Grant replied that over the transitional period it will be determined how the board will put this into practice and ensure it occurs.  She noted that the ICP will only ever be just a Board, whereas years ago the HWBB establish a connected network to work alongside the Board and deal with public engagement, and this type of structure is again required going forward. 

·         Cllr Janet Keen suggested that there needs to be more detailed scrutiny in order that the board knows when something has gone wrong and can act on it; she opined that when there is dissatisfaction, which elected Members are made aware of, these issues are seldom brought to the Board itself, perhaps because of a lack of communication between service providers.  Jonathan Higman responded that different organisations have different processes, but we do need to have input from the population, as complaints are usually about communication and the interface between services, and that will absolutely be a part of the strategy development. 

·         Cllr Chris Booth enquired how a representative from the VCSE sector would be selected; Prof Grant responded that they generally approach SPARK regarding the whole VCSE sector, but the sector could also come forward with a representative of their choice. 

·         Cllr Brian Hamilton enquired if this situation with formulating the ICP was unique in Somerset; it was responded that there are three others in the South West, including Cornwall and Gloucestershire, with whom they have been in touch, and a few more nationally.  The governance arrangements have been agreed quite quickly in Somerset compared to other areas which are still struggling.  This positive situation is due to our good and long-standing relationships in Somerset, as well as to the workshop that was held. 

·         Cllr Lucy Trimnell said that she welcomed this new board, as there were previously many issues with having too many groups working in similar ways; she asked who would be on the working group, when it would be formed, how often they would meet, and what its aims would be.  Jonathan Higman replied that they are in the process of setting up the health and care strategy from an NHS perspective, and they need to deliver an interim strategy by the end of December; they will meet monthly, with there then being an annual review based on the JSNA data.  It will build on what they already have, such as the Fit for My Future strategy; but they are still awaiting new guidance, which was supposed to have arrived in July.

·         Cllr Mandy Chilcott asked if this change in governance and structure was a slight pulling away from the County Council, saying that it felt like a two-tier situation was developing; she also questioned how public accountability would be handled, given that the County Council is responsive to the public while the NHS is not so much; and finally, she asked if future agendas and papers would still be on the SCC website.  Prof Grant acknowledged the validity of these questions and expressed the hope that in the transition period the board members will be the same for HWBB and the ICP.  The HWBB will remain a committee of full Council even while working with the ICP, so it is actually a move closer together, and HWBB and ICP will always be open to health scrutiny, with possibly even more scrutiny in future, which Cllr Chilcott said needed to be as open and transparent as possible.  Paul von der Hyde stated that the word ‘partnership’ denotes pulling closer together, and the Local Authority and the NHS in Somerset are in it together to look after the population.  Cllr Slocombe observed that anything that reduces complications for the public is very welcome.

The Chair noted the consensus of the Health and Wellbeing Board members that this is a very welcome development and one that is needed to bring committees together, maximise engagement with the public, and strengthen democratic scrutiny.  It was agreed to slightly amend the membership in the reports to include a representative for registered care providers; this membership is referred to in Recommendation 2 below.

The Somerset Health and Wellbeing Board approved the following recommendations:

1.     That the Somerset Health and Wellbeing Board considers the proposals and endorses the approach to align the Health and Wellbeing Board and the ICP.

2.     That the Board endorses the transition arrangements for the period October 2022 – March 2023, the appointment to the Board of additional members as identified in 2.5 of the report and revised quorum arrangements as detailed in 2.6.The Board agrees to recommend the proposed changes set out in the report to Full Council to consider and approve.

3.     That the Board notes the timescales associated with the Integrated Care Strategy and agrees to set up a working group to support the ICP’s refresh and further development of the strategy.

4.     That the Board agrees a significant refresh of the needs assessment under the JSNA to support the development of the strategy.