Agenda item

Health and Social Care Integration Update

A presentation from the Integration Programme Manager.

Minutes:

The Integration Programme Manager gave a presentation updating the Committee on Health and Social Care Integration.

 

The Programme Manager reminded the Committee that the City of London Corporation had entered into integrated commissioning arrangements with City and Hackney CCG in April 2017 to commission together across health, public health and social care. A governance structure was set up at the time and has proceeded. Four workstreams (delivery arms of the programme) were included – prevention, unplanned care, planned care and children, young people and maternity services.

 

The presentation covered the following points:

 

Key areas of work:

o   A neighbourhood model – integrated care at a local level built around GP practice populations of 30-50,000. It was highlighted that the Neaman Practice is part of the Shoreditch Park and City neighbourhood. The Neaman Practice are  part of the wider neighbourhood management group but tthere would be a bespoke operational model for the City. There would be  links across with the integrated care model in Tower Hamlets as many residents on the east side of the City are registered with Tower Hamlets CCGs.  The City were now meeting regularly with Tower Hamlets CCG.

o   Neighbourhood health and care services – The Committee were informed that a project was underway to look at how community health services could be realigned  to deliver the neighbourhood model and how social care services would also link in with this. Extensive engagement had been undertaken with stakeholders and engagement with residents would follow as thinking around this continued to develop.

A Member referred to recent, personal experience with the health service and highlighted that patients in the City wishing to access GP chiropody services were being instructed that they must first visit St Leonard’s. She expressed her concern and confusion around this approach. Mr Maher reported that it was expected that direct access opportunities would open up as part of the new model.

o   Pooling of CHC and ASC budgets – Members were informed that the Integrated Commissioning Board (ICB) agreed to pool budgets for health and social care in February 2018. The Programme Manager reported that, to date, the process of pooling the budgets had been slower than anticipated. Associated infrastructure was also to be developed – for example joint brokerage and decision making panels. There would also be an opportunity to open up the market and ensure equity around costs between organisations. Risk sharing arrangements were also being developed focusing on financial aspects such as overspend/underspend.

 

Other work:

o   Development of urgent care service – looking at what the provision will be for City and Hackney. A Member commented that she was aware that the Managing Director of the Barts Hospital site wanted the City Corporation to install signage informing the public that there was no Accident and Emergency Department situated at the hospital. The Deputy Chairman stated that he was of the view that this was something for the hospital to progress if they felt it necessary. The Member went on to state that she had stressed the need for a critical care centre at the site given that the demand for this clearly existed, particularly when taking into account the half a million workers in the City each weekday and those visiting the City for its night time economy. Another Member highlighted that there was a minor injuries unit at Barts and that it was important that any signage around the lack of an Accident and Emergency Department did not steer people away from this. He was of the view that the minor injuries unit should be better signposted and promoted.

o   Making Every Contact Count (MECC)

o   CAMHS pathways transformation

o   Outpatients transformation

 

Issues and Risks:

o   Governance Review – integrated care vision updated and now more succinct

o   Sustainable Transformation Partnership (STP) and local integrated care systems – looking at how these are structured

o   Risk sharing – following pooled budgets there could be others areas of pooling going forward

o   Future funding landscape – fairer funding, Comprehensive Spending Review (CSR), additional health funding etc

o   City flexibility within larger health and care systems – in terms of the services the City wanted to provide and how it provided them.

 

A Member took this opportunity to highlight a recent experience whereby an elderly neighbour of hers who was resident in the City had had to spend a period of almost six weeks in hospital at UCH because of difficulties around securing an occupational therapist. The patient had to await a therapist from Camden before it was deemed she was able to return home. This experience clearly demonstrated the need to tighten up in terms of co-ordination of care. The Committee were of the view that experiences such as these were wholly unsatisfactory and asked that a strong message along these lines be sent back to relevant Officers. The Programme Manager confirmed that the City had its own Occupational Therapist as did the hospital.

 

In response to further questions, the Programme Manager reported that there was an even split between those requiring acute admissions in the City being sent to UCH or the Royal London Hospital.

 

Another Member referred to the fact that the Neaman Practice was now open for on the day appointments on a Saturday, covering the whole of the City and Hackney area. He questioned whether funding for this had yet been allocated and suggested that the practice themselves had expressed some concern around this. There was also some concern at the fact that there hadn’t been great take up in terms of the Saturday offering due to a lack of awareness about this. It was reported that, whilst the offering had been available for approximately 9 months now, even the local pharmacy had been unaware of this until very recently. It was suggested that this could be promoted in future editions of City Matters.

 

The Programme Manager confirmed that this had been set up in response to NHSE requirements for extended GP surgery hours. In the City and Hackney area, this had been delivered through ‘hubs’ and divided between practices. 111 calls could also direct patients to this service. She went on to confirm that City Resident was planning a health focus for its April edition and that articles for inclusion within this were currently being drafted by Officers.

 

Mr Maher confirmed that the service had also been advertised as part of the City and Hackney’s winter planning/flu literature with leaflet drops to local residents.

 

RESOLVED – That, Members note the contents of the presentation.