Agenda item

Integrated Care Across Northamptonshire (ICAN)

To scrutinise progress made with the development of ICAN and the position on key risk factors.

Decision:

RESOLVED that: the People Overview and Scrutiny Committee:

a)     Agreed to establish a task-and-finish panel to scrutinise the delivery of iCAN programme outcomes, linked to the gateway review points in the contract.

b)     Agreed that the task-and-finish panel should produce the scope for the scrutiny review, with input from the Executive Director Adults, Communities and Wellbeing.

c)     Agreed that the iCAN programme task-and-finish panel should consist of 7 councillors, made up of Councillors Emma Roberts (chair), Wendy Randall and Sue Sharps and others to be identified through an invitation to all non-executive councillors.

Minutes:

The Executive Director - Adults, Communities and Wellbeing introduced the report, which gave an update on progress with the iCAN programme in particular areas identified by the Committee at its previous meeting.

 

The Director of Newton Europe outlined the development of the new Target Operating Model (TOM) for Adult Social Services in Northamptonshire, which provided the foundations for the iCAN programme.  iCAN was one of the four major transformation programmes supporting development of Northamptonshire’s Integrated Care System, recognising the need to provide effective frail and elderly care.  There were opportunities to improve in this area and secure better outcomes.

 

The iCAN Delivery Director gave an overview of the benefits that the iCAN programme was intended to produce for service users in terms of maintaining independence and autonomy, for care staff and for the overall care system.

 

The Director of Newton Europe and the Executive Director - Adults, Communities and Wellbeing commented further on the outcomes that the iCAN programme should produce for WNC, highlighting the following points:

·         There were clear opportunities for iCAN to produce financial benefits from reducing admissions to acute care and enabling people to remain independent.  Up to £13.3m savings per year were anticipated by 2024.

·         The TOM programme had already demonstrated a track record of achieving good outcomes from pursuing similar principles, which provided reassurance.

·         The iCAN programme would include strong quality assurance and contract review processes.  NHS England Improvement would be involved in contract review.

·         The initial focus within iCAN was on supporting the response to winter pressures causing increased demands on acute care at admission and discharge stages.  Work was being done to fast-track some iCAN measures.

·         Some local authority areas were currently experiencing pressures on domiciliary care staff resulting in local social care staff needing to be redeployed.  The iCAN programme provided a context of whole system working that would assist West Northamptonshire to plan for risks such as this. 

 

The Committee considered the report and members raised points as follows:

·         Concern was expressed at the number of areas of uncertainty that could affect the iCAN programme.  It was highlighted that Voluntary and Community Sector (VCS) organisations in Daventry working with clinically vulnerable people had not yet received funding expected in May 2021.

·         More people ended up in hospital because they could not see a GP and remained in hospital because of a lack of support available in the community after discharge.  Carers were leaving the role to take better paid jobs.  The iCAN programme looked positive but would it deliver the intended outcomes in practice.

·         Concern was expressed that domiciliary care packages were reliant on delivery by care staff and it was questioned how the situation was managed if care visits were missed.

·         The iCAN programme was a massive project to implement.  The report seemed to be presenting a proposition as well as referring to previous work.  The Committee should seek more information about actual progress with iCAN. 

·         How was holistic care being implemented?

·         The iCAN programme seemed to involve benefits for the NHS but increased costs for the local authority.  Would reducing delayed transfers of care result in WNC having unsustainable costs?

·         Concern was expressed regarding winter pressures this year and how far iCAN would contribute to addressing these.

 

The Executive Director - Adults, Communities and Wellbeing, the Director of Newton Europe and the Assistant Director - Safeguarding and Wellbeing made the following points in response:

·         Funding for VCS groups would be provided by the end of that week.  There had been a delay of around 6 months.  It was difficult to quantify exactly as different funding streams were involved but it was acknowledged that WNC needed to resolve this matter.

·         Issues that could affect service provision highlighted at the current meeting had been identified in work by Newton Europe.  The iCAN programme was designed to address these.

·         It was recognised that the care market was currently very volatile, particularly given that other jobs paid more and carers were required to be vaccinated against COVID-19.  The iCAN programme would not solve these problems but would help.

·         Domiciliary care staff causing issues were in a minority.  Missing out a care visit was a safeguarding issue and WNC and the Care Quality Commission should be notified.  This would trigger a visit to the organisation to look at the structures and interventions in place.  The vast majority of care providers used an electronic case monitoring system that logged when visits were made.  WNC had good oversight of the delivery of care.

·         The TOM programme had been operating for a year and would shortly be subject to its first annual review.  The Committee could consider including this topic in its work programme.  However, the fact that different organisations were involved would affect the information that could be shared.

·         The design process for the iCAN programme would identify how holistic care would be implemented.

·         The iCAN programme would produce a benefit for WNC not just for NHS bodies.  Building community resilience would produce a benefit.

·         The next winter was expected to be challenging.  Mobilising the first part of the iCAN contract would assist in the response but iCAN could not address the situation alone: local service providers were developing a wider winter plan.

 

The Committee considered the potential to appoint a scrutiny panel to scrutinise progress with the delivery of the iCAN programme, which could be linked to the gateway points built into the contract.

 

The Cabinet Member for Adult Care, Wellbeing and Health Integration advised that he also wished to see the iCAN programme deliver the outcomes intended.  He had confidence in Newton Europe: the iCAN contract was also structured to ensure that they were not paid until results were delivered.  It was right for Overview and Scrutiny to seek ongoing reassurance about iCAN and he would be doing the same as Chair of the Health and Wellbeing Board.

 

RESOLVED that: the People Overview and Scrutiny Committee:

a)     Agreed to establish a task-and-finish panel to scrutinise the delivery of iCAN programme outcomes, linked to the gateway review points in the contract.

b)     Agreed that the task-and-finish panel should produce the scope for the scrutiny review, with input from the Executive Director Adults, Communities and Wellbeing.

c)     Agreed that the iCAN programme task-and-finish panel should consist of 7 councillors, made up of Councillors Emma Roberts (chair), Wendy Randall and Sue Sharps and others to be identified through an invitation to all non-executive councillors.

Supporting documents: