Agenda item

Integrated Care System and Integrated Care across Northamptonshire (iCAN)

Meeting of People Overview and Scrutiny Committee, Tuesday 20th July 2021 6.00 pm (Item 7.)

Purpose of the Report

To enable the Committee to scrutinise matters relating to the development of the Northamptonshire Integrated Care System and Integrated Care across Northamptonshire (iCAN).

Decision:

RESOLVED: That the People Overview and Scrutiny Committee:

a) Noted the report.

b) Requested to receive a further report on progress with the iCAN programme to the Committee meeting on 21st September 2021 covering the following matters:

· How the Council is ensuring that iCAN is consistent with the way it works in Adult Social Care.

· How risk around iCAN is being managed.

· How iCAN is supporting the Council to manage winter pressures.

· The rationale for the Council investing in iCAN and the latest position concerning the resources secured for it.

c) Requested that representatives from Newton Europe be invited to attend the Committee meeting on 21st September for the update on the iCAN programme.

d) Agreed to seek to engage with the iCAN People Advisory Group as part of further work on this matter.

Minutes:

The Executive Director – Adults, Communities and Wellbeing presented the report, which outlined the aims of the Integrated Care System (ICS) model and key issues involved in bringing it into operation in Northamptonshire from 1^st April 2022. He highlighted the following points:

· The ICS model was based on the three key principles of taking decisions closer to communities; working at place level to produce effective care and support; and collaboration between the NHS, local authorities and other providers and partners.

· The ICS model was central to the new Health and Wellbeing Bill. This proposed to establish ICS statutory bodies that would be accountable for performance and the use of resources and to enhance the oversight role of Health and Wellbeing Boards.

· The Bill did not specifically define the concept of place and this would be shaped locally. It was proposed that the Northamptonshire ICS would involve services operating at four different levels: regional, county, place and neighbourhood.

· The Bill also proposed to reintroduce a national inspection regime for adult social care. It was hoped that the government would take a pragmatic approach to future inspection requirements.

Members discussed the development of the Northamptonshire ICS and raised the following points:

· It was important that there was collaboration between health services and the police in the future arrangements.

· Where did social housing providers fit into the future arrangements?

· Who would sit on the ICS statutory body for Northamptonshire when it was established? Integration was the right way to proceed but could be affected by the balance between different organisations involved.

· The model for Clinical Commissioning Groups (CCGs) had not allowed much local involvement in their governance. It was important that the same situation was not repeated with the ICS.

· Experience of working in a neighbouring health system had shown that the aim of achieving greater collaboration could still be prevented by barriers between different organisations. This situation needed to be addressed. The ICS approach also needed to address the fact that the NHS was focussed on treatment rather than prevention and needed to be integrated better with Public Health.

· How and when would the chair of the Northamptonshire ICS be recruited? The chair of the Oxfordshire ICS had already been in place for two years.

· The ICS model represented a bottom-up approach to health provision, contrasting with the direction of travel of the NHS over recent decades. This created a potential need for the concept of place to be defined differently in different areas, to represent local characteristics.

· Which body was responsible for holding the ICS to account if it was not set up effectively?

· The Committee should return to the question of how the Health and Wellbeing Board was ensuring that health and social care services were making integration a practical reality, including how staff were being involved in the development of future approaches. The scope for Committee members to keep in touch with business coming to the Health and Wellbeing Board meetings was also highlighted.

The Executive Director – Adults, Communities and Wellbeing and the Assistant Director, Safeguarding and Wellbeing provided additional information in response to questions from members as follows:

· The ICS approach aimed to produce more effective engagement and collaboration in service delivery with partners such as the police. It was hoped that social housing providers could also be involved in its development.

· The ICS statutory body would be made up of the Leader of the Council and chief executives from other relevant organisations. This would be the first time that a local authority representative would be directly involved in decision-making relating to health services.

· The Leader of the Council’s involvement in the ICS statutory body would help to address any previous lack of local involvement in health service governance. There was also an opportunity to establish the Health and Wellbeing Board as a visible body with which the public could engage. The new approach should represent more than just a reorganisation of existing health structures.

· Robust conversations would be needed to make the ICS concept a reality. Councillors could help to ensure that local plans were sufficiently bold; the Health and Wellbeing Board would have a key role in preventing obstacles from affecting progress. A more rounded overall approach to Public Health was required, to connect up relevant functions and understand the levers that could cause people to change their lifestyles.

· The appointment of an ICS chair and chief executive were subject to national guidance. This specified that when the chair of the Health and Care Partnership and the chief executive of the CCG for an area had been appointed through a national recruitment process within the past two years they would move into the equivalent roles in the ICS. The Chair of the Northamptonshire Health and Care Partnership was in this position; the Chief Executive of the CCG was not.

· Each ICS would need to decide how it defined place, recognising factors such as the non-alignment of GP practices and local authority ward boundaries. The approach should be about identifying the best solution for the ICS area.

· There was not a single agency that was solely responsible for holding the ICS to account. WNC would have a role in influencing how the ICS was established; the Health and Wellbeing Board would scrutinise the ICS; and the People Overview and Scrutiny Committee would also be able to scrutinise health and social care issues and how the Board was acting to produce outcomes in the county.

The Assistant Director, Safeguarding and Wellbeing subsequently gave an overview of the development of Integrated Care Across Northamptonshire (iCAN), which was a joint transformation programme intended to improve the provision of care in the county and the outcomes achieved for people. This approach recognised pressures on the local care system that needed to be addressed and had been informed by a study across five health and care communities that identified missed opportunities to improve care and make better use of resources. The iCAN programme would support the aim of provision that focussed on supporting independence and that wrapped around people at point when they first came into contact with the care system.

Members discussed the overview and made the following points:

· Responsiveness by service providers should be a key part of the future approach.

· Suggested key scrutiny questions relating to iCAN included in the report were endorsed with the exception that the Committee should ask that an update be brought to its meeting in September on how iCAN was already supporting WNC to manage winter pressures, given that it needed to be having an effect by that point.

· It would be beneficial for representatives of Newton Europe to be asked to attend the meeting when the Committee revisited progress with the iCAN programme.

· It was questioned how WNC would proceed if resources required to support the iCAN programme could not be secured.

The Executive Director – Adults, Communities and Wellbeing advised that £8m was required to deliver the iCAN programme in full, with £5.4m coming from health partners. WNC would not commit its contribution until it could clearly show that iCAN would produce quantifiable benefits. It was aimed to get a resolution on this matter by August 2021, given the need to mitigate winter pressures.