Meeting documents

To receive the report and presentation.

The Somerset Health and Wellbeing Board & Integrated Care Partnership:

·       Received the information about the requirement to develop an integrated care strategy  

·       Endorsed the Fit for my Future strategy as our Somerset Integrated Care Strategy 

·       Agreed that they will receive the Somerset strategy at the January 2023 meeting 

·       Agreed that the five-year joint forward plan will be a system plan inclusive of health and care 

The Chair invited Maria Heard, Programme Director-Fit for My Future, Somerset Integrated Care Board (ICB), to give the presentation on Health and Care Strategy. 

Integrated Care Strategy - It was noted that this report provides an overview on the requirement to develop an integrated care strategy and a five-year plan.  The Health and Social Care Act requires the Integrated Care Partnership (ICP) to write a strategy which sets out how the needs of the population are assessed through the Health and Wellbeing Board, and this can be met through the joint exercise of functions between the Integrated Care Board (ICB), the County Council, and NHS England.  The Health and Wellbeing Board (HWB) remains responsible for producing the Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy, which for Somerset is the Improving Lives strategy.  This strategy should set the direction for the system and how the HWP will work together across the system to join up, and it should build on the existing plan and strategy in Somerset, Fit for My Future, which came into effect in 2018 and has been developing.  We should be able to use this strategy to deliver system-level, evidence-based priorities for the short, medium, and long term. 

Production of the Strategy - The Integrated Care Partnership (ICP) has the responsibility for publishing the strategy, considering how it is being implemented and ensuring that it is.  The strategy will have input from many partners (SFT, ASC/CSC, Primary Care, VCSE and Healthwatch) to meet the needs of local people and assess gaps in care, disparities in health and care outcome/experiences, and opportunities for action.  This Committee (HWB/ICP) will need to sign off the strategy in January 2023. 

Five-Year Joint Forward Plan – This is created from a health perspective but covers all aspects of health and care; it is a statutory requirement for the ICB and their partner NHS Foundation Trusts to prepare a plan before the start of each financial year.  The draft will be shared with the HWB, who will be consulted on whether it takes proper account of the JSNA and Improving Lives strategy.  The Joint Forward Plan will describe how the ICB and Foundation Trusts intend to meet the needs of the population through NHS services.

Statutory Requirements for the Joint Forward Plan – The plan needs to describe the health services for which the ICB proposes to make arrangements, explain how they intend to discharge certain duties, set out any steps proposed to implement the Joint Local Health and Wellbeing Strategy (JLHWS) as required, set out any steps proposed to address the particular needs of children and young persons, and set out any steps proposed to address the particular needs of victims of abuse.  This will be done in consultation with partners, will be reviewed by NHS England and the HWB, and will be updated annually.

Expected National Timescales – 2022-2023 will be a transition period; ICPs will want to refresh and develop their strategies as they grow, taking into account the updated JSNA and national guidance.  There will be a two-year operational plan in March 2023 as well as the five-year joint forward plan at the same time. 

How Are We Delivering This in Somerset – Somerset is in a strong position, as Fit for My Future has been built on for years.  SCC and the Somerset ICB are working jointly to prepare the strategy, with a cross-system stakeholder working group taking the strategy forward. 

Development of Fit for My Future – This has utilised learning from Covid, changed from adults only to all ages, and is based around community models of care.  There has been the development of new models regarding mental health and out-of-hospital care, as well as consultation with the public on service changes.

Our Somerset ICS Vision and Strategy – The aim is for the people of Somerset to live healthy independent lives, supported by thriving communities with easy access to high-quality, efficient public services.

Obstacles – These include lack of focus on prevention, inefficient processes, too many resources spent on hospital care, inequalities, of poor coordination of care for complex needs.

Fit for My Future Aims – These include improving the health and wellbeing of the population, providing the best care and support to children and adults, strengthening care and support in local communities, reducing inequalities, and responding well to complex needs.

Our Approach to Working Together in Somerset ICS – Everyone playing their part, removing barriers, living within our means, using resources wisely, having trusting and collaborative relationships, engaged colleagues driving innovation, getting things right the first time, focusing on and measuring what matters to the people, carers and colleagues.

Enablers – Excellent communication, the right people, a single agreed strategy, the best use of collective assets and resources, connected digital technologies, working in partnership with communities, volunteers, and carers.

Next Steps – November has seen strategy development work, December will see the draft strategy produced, January 2023 will involve sign-off of the ICP strategy and engagement on the Joint Forward Plan, February will see the draft JFP being reviewed by the NHS Executive and the organisation review, while in March the HWBB will review the JFP before a collaboration forum signs off on it and it is published (along with the strategy).

The Chair then invited Board members to comment.  Cllr Keen referenced Page 21 of the agenda, noting that she had written to Maria Heard of the ICB regarding the health and care strategy and had pointed out that the word "explore" is not strong enough with respect to gaps in care.  She suggested that the term be changed to "urgently identify" these gaps, as accountability is needed.  She added that having seen the current makeup of the Board, she felt that elected Members are vastly outnumbered by representatives of statutory services; therefore, she questions the accountability of putting any strategy into practice, especially if something goes wrong in the future. The Chair replied that the nature of the board will move forward and there will indeed be good governance; he understands the anxiety, but as the unitary council is completed, the representation will develop.  It was advised that the wording in the plan comes from the statutory guidance. 

Cllr Trimnell asked if the five-year plan is a rolling plan and commented that engagement should be listed as one of the obstacles to living better lives.  It was responded that it is indeed a rolling plan with an annual refresh and adjustment according to the needs of our population.  As far as engagement, there is the need to look at how we talk to people, but engagement is one of our enablers, as excellent communication is at the heart of our work, but she will take that point into the next iteration of the strategy. 

Lou Woolway, Deputy Director of Public Health, addressed Cllr Keen’s concern by saying that this was a joint committee comprising the HWB and the ICP.  But in the new government guidance going forward, it will be the HWB to have oversight of this plan, the operational plan, and the joint capital resources.  Agenda items will be marked as either HWB, or ICP, or HWB/ICP.   As formation of the Somerset Board moves forward, work will be done together will colleagues in the ICB on the Terms of Reference and the Board membership.  It was noted that in the new guidance that came out last week, Somerset was listed as a case study for good practice with respect to the work done so far. 

Cllr Shearer, Adult Social Care lead in Somerset, said she was very pleased with all of the progress and asked with respect to the delivery of the strategy (Page 25 of the agenda) what the likelihood was of coming back with the answers to those questions.  Maria Heard of the ICB replied that with regard to difficult questions, they were working through them now and will give an update in January; measuring is very important, especially as regards outcomes and impact. 

Cllr Chilcott referenced Fit for My Future, which has been a four-year process with many consultations, saying that, given how much time it has taken to develop that, will it be possible to achieve the right set up and review it annually?  She also enquired if our obstacles would be specifically monitored and brought back to future meetings, perhaps using a performance dashboard.  Finally, she asked whether there would be enough time during meetings to discuss everything necessary, given that this board has a lot of subjects to cover.  It was replied that the right conditions exist now to deliver with system partners around the table, and there is the right set-up and governance and joint working.  With respect to monitoring, there is a performance dashboard, and they will be looking at how measurements are made and displayed.  As for the time necessary for bringing everything before this Board, that remains in discussion; a new body called the Collaboration Forum will be responsible for delivering and overseeing the strategy, so there will be another body scrutinising these matters before they come to the Board. 

Lou Woolway elaborated that she and the Director of Public Health are discussing how the Somerset Board will work, how often it will need to meet, what the membership is, and how workshop development sessions will be used.  There are many boards in Somerset, so we need to make sure that the strategic direction is going up and down across all of them; the HWB has more statutory functions than the ICP does, so it needs to be discussed how those would be discharged while still allowing for governance to go upwards and downwards. 

The Director of Public Health noted that we have come a very long way in bringing these two boards together over just six months and have been recognised nationally already, despite it being very tricky to do so nationally.  It is a work in progress but has been very productive, while other groups in other areas have not been so successful.  The past six months have been a real watershed moment, as we’ve potentially got a grip on the system and have really focused on prevention, tackling inequalities, and improving the health and wellbeing of our population.  It’s a testament to all of the conversations we’ve had over the last 10 years which have got us to this point; now we need to translate all of it into action. 

Jonathan Higman, ICB Chief Executive, agreed with this assessment of how far they had gone with the high-level strategy and governance structure, while he noted that the workshop about the impact of health and housing had been very useful and the workshop model would be the way forward.  Cllr R Woods agreed, stating that she was very grateful for the workshops with Maria Heard of the ICB and other members from the health service regarding the way people can improve their health to avoid getting ill.

The Chair summed up that this is a new way of working and has been quite a journey for both the NHS and local authorities.  He has been delighted by the fact that so many different partners have been open to taking part, and we need to make the most of this.  There is some anxiety about governance and monitoring, but those will be taken into account as we move through to the formal committee in April.  The strategy is a live issue and there will be ongoing development; we need to be outcome focused rather than focusing only on what someone did or didn’t do, and we need to make the most of it.

The recommendation was that the Somerset Health and Wellbeing Board & Integrated Care Partnership:

·       Receive the information about the requirement to develop an integrated care strategy  

·       Endorse the Fit for my Future strategy as our Somerset Integrated Care Strategy 

·       Agree that they will receive the Somerset strategy at the January 2023 meeting 

·       Agree that the five-year joint forward plan will be a system plan inclusive of health and care 

The Board approved these recommendations.