Agenda item

To receive a report on the development of Shropshire, Telford & Wrekin Integrated Care System from Nicky O’Connor, STP Programme Director, Shropshire Telford & Wrekin STP.

The Committee received the presentation of the STP Programme Director from Shropshire, Telford & Wrekin STP.

It was expected that the legislation would begin the parliamentary process in May 2021 with integrated care systems (ICS) becoming statutory bodies from April 2022. The proposal would be that there would be two bodies forming the ICS – a statutory body made up of the existing NHS bodies and local authorities and another, broader, partnership bringing together partners from across the system. The second body would likely be focussed on population health.

There were four purposes of an integrated care system:

1.    Improving health outcomes in the general population

2.    Tackling inequalities in outcomes, experience, and access

3.    Enhancing productivity and value for money

4.    Helping the NHS to support broader social and economic development

System pledges had been drafted as an integrated care system on areas to improve. There was the potential to work together with the Committee to improve things. In terms of place based working, people had worked together locally to generate ideas on how to improve. A commitment had been made to tackle ill health and health inequalities as well as to improve mental health services.

Commitments had been made with local government on working together on climate change and to regenerate economies.

The sense was that the legislation intended for work to be undertaken locally as much as possible.  

Members posed a number of questions:

Concern was expressed at the creation of a two tier integrated care system in which democratic bodies, such as the Joint Health Overview & Scrutiny Committee, formed the lower tier.

The primary body would be the partnership board, the one including the democratically elected; it would then be for the statutory body to take the nucleus of what they asked for into action.

There was an engagement and accountability plan due in March 2021, where could that be found?

This had been delayed; it was expected in May 2021. However, the individual responsible would likely be interested in consulting with the Committee on how to pull that report together.

In terms of integrated care systems, would you agree that the system should be simple, local, and evolutionary?

Yes.

Does the workforce stream look at all workforce (including nursing staff, care staff) or just within the NHS?

This may be something to consider in a specific session, as a standalone item. Conversations on the issue were ongoing; workforce strategy covered all of the health and care workforce.

Given the challenges faced by the local health economy, are you confident that you can move forward in the way presented?

The pledges aimed to address these challenges; working together presented an opportunity to achieve goals.

Was there an agreed understanding of what health inequalities were within Shropshire, Telford & Wrekin?

In the next steps for place-based working, health inequalities were central. They were categorised in three ways, what could be done at a civic level? What intervention could be made in communities? And what could be done around services to improve them?

When would the ICS meet in public?

Board meetings would be held in public but work was being done on how they would be held. Initial plans were for an annual general meeting in September 2021.

How did you ensure that departments all speak to one another?

There was a long way to go on this issue, people needed to be enabled to work closer. Digital working was key. A digital work stream was in place, but pump priming was needed. Sharing of information was critical to success.

What was being done to help primary care be a part of this?

Primary care had a mandated seat on the board, but they needed to be enabled to engage and attend. It was critical that primary care were at place based boards, which they were, as this was where they could have most impact on what was happening on the ground. The place-based boards would be where real change could be made, not the ICS. The ICS would be policy and strategy focussed.

Did place based boards meet in public?

No.

Was there an opportunity to take part in the place-based boards for members of the public and elected Members?

They developed from local health and care staff working together and were chaired by senior individuals. They were ultimately, where pathways of care would be determined, informed by what was happening in primary care networks and the health and care issues in specific communities. HealthWatch and the voluntary sector were involved.

Where did scrutiny fit in? How could scrutiny play a part?

There were officers on the board from both authorities, as well as Councillors and they had served to link the board up to date.

Could the Committee see the board minutes?

Yes, this could be arranged.

How would SEND sit within ICS?

An outline governance schematic was within the presentation, that would evolve, but there was a children’s and young people’s delivery board proposed. SEND would be central to that.

On wider determinants of health, education and housing for example, was there a platform for those areas and professions to be involved?

There was.

Members made clear that they believed scrutiny’s role in the new system had to be clearly identified and enhanced.

There was a consultation document out for review on the accountability of the ICSs; it was felt that local authorities should assess and respond to the document.

Members thanked the STP Programme Director for their attendance.

RESOLVED that –

-       The Committee request both local authorities draft a response to the Government consultation document.

-       The Committee write to the LGA to ask for their response to the consultation.