Agenda item

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

The Panel noted the report and presentation that had been circulated with the agenda papers and raised the following questions which were answered by Val Scrase, Regional Director of HCRG and Laura Ambler, Executive Director of Place, B&NES BSW ICB):

1. Cllr Hardman – I’m concerned about the large cluster arrangements for ICBs.  How will you focus on day-to-day care?  ICBs have been directed to reduce running costs and to look at clustering.  BSW has now formally been recognised as a cluster with Dorset and Somerset but there will be a focus on maintaining day to day operations.  Any formal changes in governance will require legislation.  There was guidance that ICBs would still be responsible for winter planning but there was an expectation that ICBs identify how they will reduce operational running costs by the end of quarter 3.
2. Cllr Pankhania – are you being clear that ICB clustering arrangements are taking place to save money?  We have been clear that ICBs have had a directive to make these changes to cut costs and there will be redundancies as a result.
3. Cllr Hardman – Residents have advised me that the RUH appointments system is not working; people are not receiving notification of an appointment until the day of the appointment and there was no coordination between different departments.  This concern will be fed back.
4. Cllr Pankhania – I agree that there is a lack of co-ordination in organising appointments.  Appointments are sent out at the last minute and phone calls from patients trying to rearrange are left unanswered.  As part of the new contract there will be a digital front door and an opportunity for patients to manage their own appointments if they are able to do so.  Alongside this there will be a care co-ordination centre and neighbourhood teams to allow for direct contact for those who need it.
5. Cllr Pankhania – there is a concern that the non-digital service will be wound down.  Will there be an independent audit for this service?  We will have care co-ordination centre and care navigators as part of the model in addition to the digital front door.  There will be an assurance process by commissioners. ICB and the 3 Local Authorities.
6. Cllr Hardman – is there any data about Health Passports?  I will bring this back to a future meeting with case studies.
7. Cllr Auton - How are you engaging with minority communities in relation to the Health Passports? What is your definition of a minority community?  We have focussed on people with learning disabilities, autism and the traveller and gypsy community.  We recognise it can be used as a template for good practice and so would appreciate feedback if any other minority communities will benefit.
8. Cllr Auton - How will you engage with 40-year-olds around health checks?  This followed a campaign in June and there will be feedback at a later date.
9. Cllr Auton – in relation to the Big A&E survey, how do the statistics about people going to hospital compare with previous years? There hasn’t been a survey like this before but will report back on any comparable data.
10. Cllr Auton – I’m concerned about the Digital Front Door as I know a lot of elderly people do not have access to technology and have to wait 6 weeks for a letter as they are unable to download an app.  It feels like there is a disconnect between people delivering the service and vulnerable people?  Is this just about saving money?  The digital front door is important, people are asking for this service, but we know we have to provide other support.  We have a care coordination centre, and we monitor calls and how long people have to wait, we know it is an important service, and we will build on that, we recognise we need mixed access.
11. Cllr Mansell – What will be in the new centre in Trowbridge? Some facilities from the community hospital will be moving there but it won’t be a bedded unit.
12. Cllr Mansell – I’d like to see future feedback on men’s health checks, health passports and equalities monitoring for the Big A&E survey. 
13. Cllr Harding – have you yet worked out details of levelling out of resources across the BSW area?  Harmonisation was part of the bid, and we are currently in the discovery phase looking at data, policy, procedure, etc.  It is difficult to say what areas would level up at this stage and this will become clearer over the next two years.
14. Cllr Harding - How long is the contract?  7 plus 2 years
15. Cllr Harding – You previously said that this would be an outcome based contract and you were going to come back with outcomes/milestones?  This will be a different type of contract in that we will be reporting outcomes as well as normal KPIs.  We are working on outcomes and we need to measure and will report back on these in the longer term.  The outcomes framework is referred to in the slides circulated with the agenda and we could also circulate the framework document after the meeting.
16. Cllr Harding - Have you had chance to look at referral patterns with GPs – can they still refer to Bristol?  Which elective referrals will be rationed and how (as mentioned in HSJ article to be forwarded to Laura Ambler)?  GPs could still refer patients to cross boundary providers, e.g., Bristol.  There will be a report back to the next meeting on elective recovery plans including changes around the elective recovery cap.
17. Kevin Burnett – I welcome the new facility at Trowbridge, but what is the state of the NHS estate under your care and what measures are in place to make buildings climate proof?  There is a mix, but some buildings are in a state of disrepair and there were significant challenges.  There was a capital programme which prioritised works, but this was limited and there was a need to move forward in a partnership way and consider options such as co-location.  From a policy and strategic perspective there was a sustainable green plan in place.
18. Kevin Burnett – The Community based contract mentions charities are involved – how are they commissioned, and which charities are involved?  We have appointed Phil Walters as Head of Partnerships and Engagement, he has a background in the voluntary sector and will be linking with communities and voluntary sector, working with community hub and 3SG as well as communities not linked with voluntary sector.  We have subcontracted elements of services to voluntary sector in recognising the importance of the voluntary sector to deliver these services.
19. Kevin Burnett – what safeguards are in place for the digital service in view of recent high profile cyber-attacks?  There will be heightened security and HCRG is constantly reviewing and managing.
20. Cllr Hardman – there is a commitment to engage Councillors but how?  Have you coordinated transformation plan with public health team?  Every stage of our governance has local authority representation, including public health.  We welcome additional feedback on how Councillors can be engaged.
21. Cllr Romero – Can you give details of the overview group?  As part of our governance, we have a collaborative oversight forum. 
22. Cllr Romero - Healthwatch is being discontinued, will it be replaced?  Healthwatch and some other patient groups are not being taken forward as part of the ICB/NHSE changes, but we don’t know timescales or who would provide the patient voice function in the future.  Healthwatch representatives have continued to attend meetings and give a professional commitment to their role. 
23. Cllr Mansell – is there an equalities impact assessment?  There was an assessment as we went through the procurement process and there is now one for HCRG to take forward.  This information could be circulated.