Agenda item

Report of the Integrated Care Board

The Chief Executive ICB and Director of Communications provided context and detailed data relating to NHS services performance in Staffordshire and Stoke-on-Trent. Senior representatives from ICB commissioning and provider organisations attended virtually to respond to members questions on the eight portfolios based on current priorities: 

• Population Health, Prevention and Health Inequalities
• Planned Care
• Children, Young People and Maternity
• Frailty and Long-Term Conditions
• Primary Care
• Mental Health
• Learning Disability and Autism
• Workforce

Members had discussed several of the priorities and performance issues in the previous agenda item relating to systems pressures.

Committee noted the following comments and responses to questions:

·       Text Reminder Service: All providers operated a text reminder or support service to patients on a waiting list and this was recognised as good practice to reduce the number of people not attending appointments (DNA’s). Specific reminders were sent where appointments were in high demand to make best use of resource. Members asked for further evidence to be circulated relating to how consistent text reminders usage was across health and care services.

·       Reaching people when their main language was not English. The Communications Manager advised that a lot of lessons had been learned through Covid and there had been work with partners and community leaders to reach many diverse communities.

·       Free standing midwifery units for Samuel Johnson and County hospitals. Due to staffing pressures in maternity services, it was unlikely that the units would be open by December 2022. Safety and quality of service was paramount, and the staff shortages as a result of sickness had recently meant temporary closure of the main maternity unit. The Chairman advised that maternity matters were scheduled for the agenda on 17 October and would be taken up at that time.

·       The Frailty Action Plan was moving forward. The strategy was agreed in 2020-21 by Clinical Commissioning Groups CCGs;  the ICB operating model in the system had recently been signed off and frailty and long-term conditions was one of the seven portfolios. This enabled a change in ways of working in the Integrated Care System and assurance was given that this would be moved forward. The end of life programme would also be moved forward in the same portfolio in an effectively and timely manner.

·       Primary Care face to face appointments: Challenge around access, the level of appointments offered equated to pre-pandemic numbers approx. 4,000 a month in Staffordshire. Challenges were around workforce and workload. Workforce - Recruitment and retention of GPs, digital locum appointments and primary care teams supporting practices with care of patients. Workload – complexity and acuity were issues, it was a mixed economy two-thirds face to face appointments, community pharmacists and some through patient choice and care at home e.g., blood pressure monitoring.

·       Concerns were raised on consistency of practices to deliver same day appointments and flexibility for patients. This was part of the design feature of the contractual arrangements, the majority of practices did offer same day urgent offer appointments. There was also an enhanced access programme contracted at PCN level, this was an extended access offer provided by a number of practices.

·       Management of referral to diabetes prevention service – the distance travelled to undertake assessments would be provided to members by written response.

·       Communicating changes to community pharmacies: There was a campaign underway to explain to the public about changes to GP services. District and Borough Councils were assisting in delivery of  the message and toolkits had been developed and shared with Communications teams in District and Borough Councils which would also be circulated to members.

·       Concerns were raised about Mental Health Access Practitioner roles conducting telephone consultations. Members were advised that feedback and measuring success was underway to understand the success of operating telephone and video services. Assurance was given that questions had been clinically developed and that findings would be provided to members. Re-assurance was given that some feedback had been given that a telephone conversation was not felt to be an effective consultation.

·       Mental Health:

o   Staff levels and CAMHS Service. Challenges around workforce, looking at diversifying workforce, there had been Government investment in mental health, ringfenced money for mental health was helpful. CAMHS was seeing the impact of mental health coming out of the pandemic.

o   Mental Health and wellbeing training for further discussion when the draft mental health strategy was considered.

o   Community mental health projects where was the funding, members requested a simple explanation of the paragraph in the report that confirmed mental health funding was ring fenced.

o   Mental health additional clinics for staff were arranged to respond to demand of staff, these could be accessed by staff as required, some are permanent others bespoke. A written response of where the clinics took place would be circulated to members for information.

o   Mental health support in schools would also be covered in the mental health session.

·        The time between booking and receiving an appointment in primary care was of concern, with several red indicators being flagged. It was confirmed that further information sat below the figures submitted and these would be circulated for information.

·        Comparisons between accident and emergency departments and four-hour trolley breaches.  Members questioned the variance between providers and were advised that each service had unique circumstances that created a level of variation i.e. Royal Stoke was a National Trauma Service and the pressures in Stoke were significant, others sites had community services integrated with acute. They were all unique and unmappable and therefore could not be compared like for like.

The Chairman thanked the ICB representatives for the presentation and for the work they were doing. The data had enabled drilling down into the detail and provided an understanding of the action plans that sit behind the data

Resolved:

1)  That Health and Care Overview and Scrutiny Committee note the performance update report.