Agenda item

Hilary Fordham, the Integrated Place Leader for Lancashire North, will present an update on the current Integrated Care Board structure and answer questions from members.

Papers to follow.

Hilary Fordham, the Integrated Place Leader for Lancashire North, and Dr Adam Janjua, Clinical Director Place, submitted answers to questions posed by members of the committee in advance of the meeting. They attended the meeting and provided members with a verbal update on the Integrated Care Board structure for Lancashire and South Cumbria.

Hilary Fordham addressed the committee and updated members that owing to the Government's Bill becoming law, from 1 July 2022, the Clinical Commissioning Groups (CCGs) ceased to exist and a new statutory organisation – an Integrated Care Board (ICB) was established. The reorganisation involved the eight Clinical Commissioning Groups across Lancashire and South Cumbria merging into a larger format of the Integrated Care Board (ICB). The ICB will undertake the functions of the CCGs in addition to several functions delegated from NHS England, including optometry, and dentistry from April 2023. Hilary highlighted that the reorganisation did not include provider services and primary care provision. The overall aim of the ICB was to improve the integration of care services. She added that alongside the ICB there was an additional statutory committee – the Integrated Care Partnership (ICP). The upper-tier/unitary authorities and the ICB have the responsibility for convening the ICP.  She questioned the committee how lower-tier authorities, such as Wyre Council, would wish to be part of the development of the ICP and supporting work.  She added that many services that lower-tiered authorities provided were important to the ICB, especially for the wider determinants of health or joining up services such as housing with other sectors. She expressed the reorganisation would benefit from engaging with all tiers of local authority. She also explained that as of April 2023 Lancashire County Council would be the only two tier area in Lancashire and South ICB footprint.

Adam Janjua explained to members the GP clinical structure for Wyre and Fylde, however, this was to be reorganised before 31 December 2023.

The Chair expressed the importance of the new ICB and ICP structures to engage with local district councillors in Lancashire.

Hilary Fordham clarified that the ICB was responsible for overseeing the statutory function of the NHS locally and overseeing provision and the ICP was responsible for the collaborative working across the system including  health and care partners across the region. She updated members that the recent place boundary review resulted in the realigning of the current place-based boundaries to the two upper tier and two unitary local authorities with the footprint Blackpool, Cumbria, Lancashire and Blackburn with Darwen. She explained the concern with the size of Lancashire resulting in the division of Lancashire into three delivery units: East Lancashire, Central Lancashire (including West) and North/Coast. This was to enable better integration. She also updated members on the place leadership appointments. Louise Taylor was appointed the Director of Health and Care Integration for Lancashire. She explained a key matter to consider was how the North area would be able to feed into the partnership of Lancashire.

Councillor Ballard raised concern over the different needs owing to different demographics in Lancashire and the connectivity of services. In response, Adam acknowledge the different needs of patients in different demographic areas and explained the Primary Care Networks (PCNs), which were the neighbourhood element of the Lancashire and South Cumbria Partnership Structures covering a population of 30,000 to 50,000. The PCNs delivered the day-to-day care. He explained that the PCNs had the flexibility to hire staff relative to the need of the area.

In response to a question, Hilary explained that the restructuring aimed to reduce the bureaucracy of the organisation. She expressed that the general premise of integration was the correct direction for the organisation.

In response to a question, Hilary confirmed that funding was to be spent on supporting people on the ground who deliver the services such as district nursing services, homelessness, voluntary sector etc. She added that potential savings could come from things such as reducing the duplication of assessments and amending governance arrangements to allow for more decision making on the ground.

A question was raised about Royal Preston Hospital taking over Finney House care home to help free up hospital wards and improve the flow of patients through A&E. Hilary explained that Preston did not come under the North boundary, however, she could provide more information on this following the meeting. Adam highlighted the importance of the integration between health and social care specifically to address the issue of discharging patients from the hospital.

Adam explained that the ARC in Blackpool offered an individualised tailored programme of support for individuals who were discharged from the hospital but not fit enough to be in their own homes. Thornton House was owned by Lancashire County Council and provided accommodation including personal care and support for people who need specialist care.

Hilary and Adam assured members they did not know of any plans to ask patients to pay for GP appointments and any changes of that sort were likely to be national, rather than local, decision.

Hilary highlighted to members the issue of recruitment of staff across all areas of health and social care. She explained that better integration of these services might assist to relieve some of the issues identified.

In response to a question about telephony issues in GP surgeries, Adam explained the IT equipment for all GPs across Fylde and Wyre was sourced from Blackpool Victoria Hospital; work was on going around the procurement of new systems to hold more calls. He also raised the issue of recruiting GP receptionists to answer calls. He updated members that all GP surgeries had a contractual arrangement meaning they must provide an online digital consultation tool. He highlighted to members the issue around people ringing GP surgeries for non-clinical issues.

In response to a question about the scope and remit of place-based partnerships, Hilary explained that place-based partnerships prioritised an integration programme for community health and social care services and a focus on preventative measures to keep people well. She explained it was important for the place-based partnerships to have a clear understanding of what they will focus on including topics such as housing stock, loneliness, and mental health should be considered. 

Adam updated members on the introduction of social prescribers through the PCNs. Members noted that social prescribers liaise with local authorities such as Wyre regarding social issues such as housing.

Adam updated members that the NHS had conducted a study in one practice locally based on what was coming into a GP surgery on a ‘normal week’. This study highlighted the percentage of inappropriate issues being dealt with by GPs. This data could be shared with the committee following the meeting.

A question was asked about the number of cases in health care settings that were not medical needs. Adam explained that there was work to be done to educate the public on personal health and self-care. He implied that education on the NHS and health could result in less demand for health services.

In response to a question regarding the Lancashire and South Cumbria New Hospitals Programme, Hilary explained that the shortlist of options had been agreed upon as explained in the papers provided in the agenda pack (item 4). The Chair suggested for members read the information submitted and feedback with additional questions and concerns to the Democratic Services Officer, Marianne Unwin, to coordinate and distribute to Hilary and Adam.

Several members asked additional questions regarding the recruitment of pharmacy workers, hospital waiting times, care home places for rehabilitation and end of life and abuse of the NHS.

Adam explained to members the two-hour urgent community response. This was a team of advanced clinicians working in the community who responded to patients whose health or wellbeing had deteriorated at home within two hours. He also explained virtual wards were for patients able to be at home rather than in the hospital but needed to receive acute care, monitoring and treatment. This was aided by technology.

Hilary updated members that the ICB was to be given responsibility for dentistry in April 2023.

Hilary thanked the committee for their contributions. She asked the committee if they would suggest that a senior Wyre Council officer be part of the discussion and thinking regarding what the Lancashire Place-Based Partnership should look like, how it should operate and what the support in each of the 3 ‘sub-places’ should be. The committee welcomed this proposal and recommended for this question be passed to the relevant officers for discussion.

The committee thanked Hilary and Adam for their attendance and contributions.