Agenda item

The Panel will receive an update from the B&NES, Swindon & Wiltshire Integrated Care Board (BSW ICB) on current issues.

Laura Ambler, Place Director for Bath and North East Somerset, BSW ICB addressed the Panel, a copy of the update will be available as an online appendix to these minutes, a summary is set out below.

Delegation of accountability for commissioning of pharmaceutical services, general ophthalmic services and dental services to BSW ICB from April 2023.

For BSW this covers: 147community pharmacies, 83 ophthalmic services contracts and 126 dental services contracts.

To support the transition of commissioning services for these groups and to provide stability, a new Commissioning Hub called the Southwest Collaborative Commissioning Hub is being formed which will provide the daily operational commissioning support for Prescription Ordering Direct services from April 23 for two years. The Commissioning Hub will be staffed by the existing NHSE commissioners for these services.

BSW ICB with NHS England and Improvement has carried out a pre-delegation assessment to determine readiness to assume responsibility for these services and to set out the minimum criteria BSW ICB will be expected to meet prior to delegation.

This has now been signed off by the NHS England National Moderation Panel, and this will now make the appropriate recommendations to the NHSE National Board for final approval on 1st December 2022.

The benefits for local people of BSW ICB taking on responsibility for commissioning these additional services include improved care quality, reduced health inequalities, improved health prevention, improved use of resources and clinical leadership in place to lead and collaboratively work to identify and oversee clinical improvements in services.

Temporary ward at St Martin’s Hospital for recovering patients to provide extra winter capacity.

A temporary ward has opened at St Martin’s Hospital in Bath to support people who are well enough to leave hospital but not ready to go home. The ward has opened to help relieve pressure on local acute hospitals and free up beds for the most ill patients.

The community ward, which also opened to help provide extra capacity to the local health and care system during the winter of 2021-22, has twenty three beds and offers a peaceful and relaxed environment in which patients can take time to recover before being discharged to home or to a care home.

Bid submitted to Barnardo’s Health Equity Collaboration.

BSW ICS has submitted a bid for the Barnardo’s Health Equity Collaboration to design a Children and Young People’s Health Equity Framework, with support from children and young people, and VCSE partners in the ICS region.

This will gather the right information to focus resource on the development of emotionally, mentally and physically healthy children.

Barnardo’s and the Institute of Health Equity will lend their expertise in developing supporting interventions to take evidence-based action on equity indicators over a three year programme.

Winter planning and virtual wards.

We are monitoring the impact of our capacity improvement plans at both a System and Place level and will take the learning into the development of our plans for the coming winter.

One important aspect of our future plans is the delivery of a Virtual Ward model. A virtual ward is a safe and efficient alternative to going into hospital for people who are unwell. By being in their own home, people are enabled to recover and

rehabilitate in familiar surroundings, which can be a benefit to people who become less orientated or less mobile in a hospital environment.

The virtual ward service in BSW will deliver a range of interventions, tailored to meet the needs of the individual, to help prevent hospital admissions and to accelerate discharge from hospital.

In BANES this will build on the successful Hospital at Home model which is already in place and currently focuses on those already in hospital, enabling them to be treated at home.

Councillor Liz Hardman asked how resource intensive would the virtual ward work be.

Laura Ambler replied that resources for the virtual wards would be blended alongside other initiatives. She added that all patients would be under the supervision of a clinical lead and where appropriate, personalised digital technology such as healthcare apps, wearable symptom tracking devices and telephone or video consultations may also be used by the team to remotely manage and monitor the person’s condition until they are well.

Kevin Burnett said that he believed that the main problem in relation to the shortage of dentists were issues around contracts and money. He asked if the ICB were going to be able to change anything in this regard.

Laura Ambler replied that they were currently waiting to see exactly what the delegated responsibilities will look like and would therefore have to take that question away and seek a response.

Councillor Joanna Wright asked if the Southwest Collaborative Commissioning Hub was to be seen as a form of flexible commissioning.

Laura Ambler replied that the intention behind the Southwest Collaborative Commissioning Hub is capacity and capability and is not intended to remove any flexibility that can be achieved locally. She said that she would ask colleagues in commissioning to confirm this position.

Councillor Wright asked if this work would lead to further dentist appointments being available locally.

Laura Ambler replied that she felt that this was a scenario that we are going to need to see how it evolves through the delegated process. She added that she would attempt to find out some further information and respond to the Panel.

Councillor Wright informed the Panel that through the webinar she had recently attended she had been made aware of a third sector group named Dentaid who provide mobile dental units that travel the country with volunteers offering free dental treatment for the most vulnerable people in society. She asked if they could be approached to visit B&NES.

Laura Ambler said that she would pass this information onto colleagues to see if they are able to contact Dentaid about their work.

Councillor Paul May asked if there was any imminent threat to services for children provided by the voluntary sector, given that those services are provided through the contract held by HCRG which is soon to come to a conclusion.

Laura Ambler replied that the key thing going forward would very much be about looking for stability and said that locally there are many voluntary organisations who are engaged. She added that felt that there would be no reason for this to change under any new model that is established.

The Director of Children’s Services & Education added that B&NES was very fortunate to have a number of well-established Voluntary Organizations locally and would hope to retain that provision in the future.

Councillor May asked what measures were in place to help young people in crisis that were not already receiving care generally or with regard to any mental health concerns.

The Director of Children’s Services & Education replied quite a lot of work was taking place across B&NES, Swindon & Wiltshire, including a BSW Children & Young People Transformation Programme that has identified areas of priority to be progressed. She added that a new Key Worker role for the ICS has been established which will see that role, when in post, help young people with complex health needs.

She said that the work of the CYP Transformation Programme had helped to expose the challenges and pressures faced by our young people.

The Chairman thanked Laura Ambler for the update on behalf of the Panel.