Agenda item

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

Laura Ambler, Director of Place for Bath and North East Somerset, BSW ICB addressed the Panel and informed them that today she was accompanied by Caroline Holmes, Director of Place – Wiltshire, BSW ICB.

Laura Ambler began by acknowledging that the Panel wish to discuss in more detail the award of the Integrated Community-based Care contract that had been recently awarded to HCRG Care Group and said that if it was felt that a further discussion was needed following this meeting then that could be arranged.

She said that she would attempt to address a number of key themes / questions that have been raised, these being;

·  Engagement / Procurement process

·  Patient / Public involvement

·  Nature of a Private Provider

·  Role of the Council / Panel

She stated that the ICB had a legal duty to proceed with the procurement as the current contract was coming to a conclusion with no scope for it to be extended. She added that this meant that there was no option for a public consultation to take place as it was not optional.

She explained that the ICB are not legally allowed to limit who can make bids for the contract as part of this process.

She said that they were looking for a Lead Community Partner to be established to work in partnership across the system including with our voluntary sector, primary care, mental health and acute providers.

She stated that the process had been followed robustly, in line with national Public Contracts Regulations (PCR) guidelines and that therefore the outcome must be abided.

On the matter of patient and public involvement she explained that they were seeking a transformational approach and that would be achieved by using our priorities to develop outcomes-based commissioning.

She said that it was the ICB’s responsibility, as Lead Commissioner, to stand shoulder to shoulder with the new provider who would engage with service users in discussions on the provider’s proposals. She added that the ICB have previously engaged with the public, service users and providers on their priorities as set out in their Care Model and ICP Strategy. The care model and ICP strategy then informed the commissioning intentions for this procurement.

She stated that the commissioning intentions were also informed, where appropriate, by those with lived voice and service users.

She explained that the Lead Provider and the ICB are looking to engage with service users and broader communities and want to work with the Panel for their views as part of that process.

On the issue of Private Providers within this workspace she reiterated that no block or favour is given to any provider and that a robust process was followed. She said this comprised of the following stages.

·  Selection Questionnaire

·  Invite to Tender (1)

·  Dialogue sessions alongside Local Authority colleagues to probe and test the bidders thinking and their proposals.

·  Once at least one potential successful bidder had been identified we were able to proceed to Invite to Tender (2)

·  Responses were then received and evaluated. There were a broad range of evaluators across ICB, Local Authorities and service users and those with lived voice.

She stated that having followed this process, HCRG were awarded the contract.

She said that HCRG are keen to work with the Local Authority and its partners and attended the recent meeting of the Health & Wellbeing Board. She added that they are willing to collaborate and to shape further engagement.

The Chair said that should it be decided that a further discussion is required on this issue then she would like to invite HCRG to attend. She asked for clarification if the Market Events held were seen as public engagement or were these solely for the commercial operators.

Laura Ambler confirmed that the Market Engagement Events were not an appropriate stage to include patient or public involvement and these were for a range of providers with 255 people across 69 providers in attendance. She added that where appropriate they did hear from those with a lived voice and service users to feed into the commissioning intentions, but this was not part of a formal consultation exercise.

Caroline Holmes added that what had informed the Market Engagement Events was the work that had been carried out as part of the BSW Health & Care Model which had been subject to extensive public engagement. She added that this work had identified the aspects of our care model including the introduction of their Neighbourhood Teams and provision of specialist services within the community.

Councillor Liz Hardman asked if they really thought that they were meeting the needs of the public by going through the procurement process without consulting the vast majority of them. She added that she has concerns about HCRG being the provider of these services.

Laura Ambler replied that the process taken by the ICB was entirely around thinking about our communities and their population health management as that is their statutory responsibility. She added that through their Strategy and Care Model work they had an understanding of the broad needs of the area which had informed the commissioning intentions.

She stated that there is still an opportunity now to work with the provider to shape with service users what the services will look like. It was also noted that HCRG have a very good record with 97% of the services provided by them being either good or outstanding.

Caroline Holmes added that one of the requirements of the provider going forward is that they work using a population health management approach to understand the needs of their local communities. She said that this will involve working with local neighbourhoods and their GPs to design services and keep them relevant.

The Chair asked if the Panel could view the types of questions that were set as part of the tendering process.

Laura Ambler replied that they could seek to set out the nature of the types of questions that were asked.

Councillor Ruth Malloy asked how many bids were received and who were they from.

Laura Ambler replied that they had received more than one bid and that they had come from a range of providers.

Councillor Paul Crossley asked if before the contract had been awarded to HCRG had they spoken to other areas where they hold contracts about their work to gain feedback on the services they provide.

Laura Ambler replied that they had not done so as part of this procurement process as they need to be even handed in their decision making and base this on the process and regulations to be followed which did include appropriate questions on due diligence.

Councillor Crossley replied that he was not satisfied with this response and that he would expect due diligence to be carried out when awarding a contract of this size and magnitude. He added that he would have expected those involved in the decision to hear how their services work on the ground. He said that he would like to see that in the process of awarding future contracts that they do state that they will enquire with other organisations prior to the contract award.

Councillor Lesley Mansell said that she echoed the feelings expressed by Councillor Crossley. She stated that she was still waiting for an answer from the ICB to a question on physiotherapy services provided by HCRG asked around six months ago.

She asked what questions were asked as part of this procurement process around the quality of services that will be delivered and what was known about the quality of services that HCRG currently provide in the area.

She also asked how the access to care will be improved and what benefits will be seen across our communities as part of this contract.

Laura Ambler apologised in relation the physiotherapy data, which she said was available and would send to the Panel. She added that the quality of care that HCRG provide has been rated by the CQC as either outstanding or good.

She said that it was within the contract that the transformation of services needs to be met and that any release of funding would be reinvested into community services. She added that HCRG have already provided significant investment to enable a safe transfer of services to take place.

She stated that HCRG would be working to a Stepped Care Model and that this would hopefully lead to improved access to services and relieve pressure on our Primary Care.

Caroline Holmes added that the Chief Nursing Officer, Gill May, oversees a team that monitors the quality of services from all providers across the BSW area and that team were involved in creating a series of quality measures that will be used to assess the services going forward. She said that this would also include patient feedback.

Councillor David Harding asked if an explanation could be given for the term ‘Outcomes Based Commissioning’.

Caroline Holmes replied that this is a different way of managing contracts and that instead of looking at them from a micro level, individual service by service, they will be looked at from the needs of the local population as a whole. She added that performance indicators were then allocated to these outcomes so that they could monitored against delivery.

Councillor Harding referred to a case study from HCRG into an integrated Autism and ADHD Assessment Pathway and said that he would welcome seeing the outcomes based framework and the performance indicators as this would enable further scrutiny.

Laura Ambler replied that they would welcome the Panel’s involvement and challenge. She added that HCRG’s work on ADHD was already beginning to have a positive effect on waiting times and access to services.

Councillor Joanna Wright commented that the ICB were aware that the contract was nearing an end and have mainly used the updates to the Panel as a tick box exercise when they should have involved us at an earlier stage.

Laura Ambler replied that she saw the updates as a way to bring to the Panel relevant and timely information. She stated that the contract process was conducted under procurement regulations that did not allow for the Panel to be involved. She said that it was never the intention to not be forthcoming with information and was open to changing the format of the updates that are provided.

Councillor Wright asked for an explanation of the term ‘Inappropriately located building’.

Laura Ambler replied that this term was used for buildings in a state of disrepair, not fit for purpose or inappropriately located and that there is a commitment to providing access to services where people need them.

Councillor Wright asked for more Panel inclusion on this to establish whether these buildings are of community value.

Councillor Hardman commented that HCRG state that they will be operating a new model of community health and asked to what extent will our communities be involved in the development of the specification of care.

Laura Ambler replied that the ICB are looking to work with HCRG to look at what the service design will be and that will include hearing from service users and those with a lived voice.

Councillor Mansell asked if more detail could be provided to the Panel regarding the new LDAND mental health unit being built in Bristol, as well as the Partnership in Neurodiversity in Schools (PINS) project.

Laura Ambler replied that they could bring further information to the Panel and said that the building of the unit was meeting its timescales and was an integral part of their work.

The Chair, on behalf of the Panel, thanked Laura and Caroline for attending and their commitment to holding a future discussion in relation to the Integrated Community-based Care contract.