Health Serious Violence Needs Analysis Workshop – July

Voluntary sector perspective

Before we develop new projects that often have externally imposed deadlines, it is important to find out what is already happening and to hear the voices of the individuals and communities that may be impacted by the work, and at the same time, take time to familiarise yourself with what other organisations are doing in that area of work.

Introduction

This blog has been written to share the experience of attending the first ‘Health Serious Violence Needs Analysis Workshop’. CCVS attended on behalf of Support Cambridgeshire but also as a member of both the Cambridge Community Safety Partnership and the Souths Cambs Community Safety Partnership. The workshop was held in July 2023.

Serious violence duty

This meeting was set up to look at the health response to serious violence duty. More info can be found on this on the government website

In essence, this duty makes councils and local services work together to share information and target interventions to prevent and reduce serious violence. The Secretary of State issues it as statutory guidance under Chapter 1 of Part 2 of the Police, Crime, Sentencing and Courts Act 2022. As a significant statutory organisation, this applies to the Cambs and Peterborough ICS who have to have a strategy in place that addresses their actions against the duty.

The meeting

There were a lot of health people at the meeting who had different roles around safeguarding and a scattering of attendees from other statutory partners. My feeling was that there were far too many gaps in the wider attendance, possibly due to a mixture of who was invited and who prioritised and attended the meeting.

It was unclear what the Integrated Care System[1] (ICS) was trying to achieve and the impact they wanted to come from the meeting. There was a commitment to a ‘public health’ approach to reducing serious violence that I believe means that it is about looking at the causes and how we can prevent the violence from occurring. Despite this the solutions presented did not reflect this and were very much more reactive after the incident.

The meeting presentation was excellent and did cover a lot of ground around the causes of serious violence and also included some case studies, both national and local, that looked at real-life stories of people who had been impacted by violence. There was also some good discussion during the meeting, especially in the Teams chat.

At the end of the meeting, there was a chance to move into breakout rooms to look at specific project ideas. This gave the opportunity to suggest and discuss options other than the ones presented, and the room I was in was productive.

My impressions

My overriding impression was that the ICS need to spend some time getting up to speed with what others are doing around serious violence before they commit to anything. There seemed to be little understanding at this stage of the work that Community Safety Partnerships (CSP) were doing and especially since the Cambridge CSP has serious violence as a continuing priority and has been working on this for a number of years. More info on the council website

The ICS were keen to do more research to get the figures and data that helped to understand serious crime, and it was pointed out this would be a waste of time and money given the work of the county council research team and the excellent reports they provide on this for the different CSPs. Other attendees pointed out that the ICS could best contribute to the research by encouraging the sharing of data from the bits of the health system that have traditionally not been shared. In this area, this would mean getting appropriate data from the East of England ambulance service and data on serious violence from Hinchingbrooke Hospital.

We spent a good deal of time looking at violence and young people, and again the importance of youth work and the first 1000 days of life were pointed out. I pointed out that we have seen statutory youth services slashed over the years and that the excellent work of charities such as Romsey Mill or Connections Bus Project can not replace this.

We spoke of the wider impact of serious violence on mental health etc and again there was talk of the difficulty of getting support, in one case study used the only totally positive experience of the victim was the service they received from a charity – Victim Support. At all other points of contact whist there were good parts there were negative experiences as well. It is essential that we recognise the work of local charities working with younger people to support them with wider impacts of serious violence and when I mentioned Centre 33  and the wider Fullscope partnership  it appeared that too few in the ICS knew of these essential services.

My over riding fear from attending this meeting was that.

  • There was insufficient understanding on the part of the ICS on what impact they wanted.
  • There was no understanding of what the wider system was doing and had been doing for a long time.
  • There was a danger of reinventing the wheel and duplicating work around research.
  • There was a preferred set of outputs that were an easy win but that I, and other professionals in the meeting, believe would have little impact even if they could be implemented.

I think that the ICS had been backed into a corner on this due to ridiculous timetables imposed on them. I believe that they would be interested in a more radical approach that had a greater impact if they could have more time. I also believe that time constraints withstanding the ICS and the staff leading on this were totally aware that they need to find out more and were more than willing to work in partnership across the wider system and with the voluntary sector.

What I would like to see happen

These are the author’s thoughts and ideas and have not been discussed with the wider sector or partners.

There is a lot being done to address all aspects of severe violence by statutory partners and local charities, but we are not seeing any real decrease in number of incidents in many areas. It is vitally important that we all work together to address all forms of serious violence, but I think we have to embrace the public health approach and look to some more innovative solutions that start to address some of the causes and triggers to the violence. We have to understand that these solutions may not have the same ability to measure the impact and savings that many funders and organisations crave. We also have to recognise that not everything tried will be a success and that projects will need to be able to adapt or even end and that there is learning in that. Finally there has to be a commitment to be in this for the long term, a one-year or two-year project or programme is not going to be enough, we need to invest in the long term and to embed these innovative ideas into business as usual.

I think that given the time frame of this funding, the ICS would be setting itself up to fail if it introduced a project that had no sustainable future. Instead I think it could best use the funds and the time in two ways.

  1. Help the system to understand.

This would be about research and information. It should include making sure all parts of the health system are supplying the data to a central place (I think the county council research team) and that there are funds to help enhance the analysis and reporting of this data so that it can be used by all partners. In other words, build on the reports that the CSPs already get and use.

I also think that there is an opportunity to do more work with those impacted by serious violence. This is about real listening and understanding and about building trust and relationships that help to examine what are the causes and what those impacted think needs to change for them and their communities to address the issue.

  1. Design a new approach to solving the problem.

This is potentially a risk if continuation funding can’t be found or if the approach can’t become business as usual. I think that this approach should build on listening, should be about that preventative public health approach and should be truly multidisciplinary. They must do the work with individuals, families, and communities with support from the team. It has to be based on real relationships and trust, it has to be non-judgemental, and it has to work in a voluntary and not mandatory way.

I don’t think that the approach has to be developed from scratch as there are undoubtedly examples to learn from, but it has to be something that local partners can sign up to and that is tailored to and appropriate for Cambridgeshire.

Conclusion

Once again there are issues of unfeasible timeframes, short-term funding leading to short-term ideas, and a complex system which has seen unprecedented change and broken relationships. These lead to a lack of opportunity to radically innovate and a missed opportunity to start to do things differently.

We know that more of the same won’t work. We know that throwing good money after bad is not sustainable. We know siloes only make problems worse and positive outcomes less likely.

We also know the power that communities and individuals have to make changes if they are supported and resourced. We know the difference that working together can make in sharing expertise and understanding. We know that relationships are essential both across services but more importantly, with those that the services are working with.

There is an opportunity here to take a bit of a risk and to do things differently, and if we don’t things will get worse and not better.

[1] https://www.cpics.org.uk/

Volunteering – 6 points you need to think about

Introduction

A lot has been written about Volunteering over the past few months as we have seen the results of the Community Life Survey published in February and now we have seen NCVO release their update to the Time Well Spent survey last carried out in 2019. Report here 

For those of us working in the voluntary sector, these reports do not make great reading, but at the same time, they are not really telling us much that we didn’t already know.

This local knowledge has been echoed at the national level and we have the Vision for Volunteering in England and Scotland has their Volunteering Action Plan both these are about how we can get more people to volunteer more time, and this has to be about the opportunities matching the volunteers as well as persuading more people to volunteer.

What others are saying

Lot’s have been written about some of the above that will give you more information and background on what is happening.

What are our key points

We have pulled out some of the key points and given them a local slant.

1. The pain you are feeling is real.

We have heard from many local groups that volunteer recruitment, and retention is an issue, and this is reflected in the findings we have from our research (full report to come soon). But a sneak peek shows that 73% of respondents have issues recruiting volunteers, slightly up from 2019. One comment included

“People who have returned to work post-pandemic are time-poor, reducing the amount of time they are able to spend volunteering or caring for their elderly relatives. This impacts the group who are fewer in number whilst being asked to help more frequently.”

The Community Life Survey results show that volunteering levels have decreased since records began.

The issues are not impacting all organisations the same way, but there is no doubt that who and how the pandemic has impacted people’s volunteer.

2. It really is about local.

The Time Well Spent results show that people want to volunteer locally. Again we are seeing this locally.

We have to ensure that funders and policymakers recognise the local focus at all levels and that big national schemes actually make things worse in many ways, so less involvement in expanding the volunteer schemes from RVS, and less Big Volunteering things and more local support and support for local campaigns.

3. We have to be aware of the reasons that people don’t volunteer

A lot of the Time Well Spent survey looks at why volunteers might not continue or why non-volunteers don’t volunteer. We ignore these findings at our peril!

4. What do you mean you don’t pay expenses?

So only 55% of volunteers say that they will have expenses reimbursed. This has to change, and more importantly, all volunteers should be ‘made’ to claim even if they don’t need or want to so that it does not seem as a stigma to claim expenses. If paid people don’t want them, they can donate them back to the organisation (and add gift aid if they are eligible). Organisations should also ensure that the definition of what expenses they offer is as wide as possible so that as many people can volunteer as possible.

Money is a barrier to volunteering, and organisations must do all they can to remove it and ensure that claiming expenses is visibly seen as the norm.

5. Volunteering is a whole organisation issue.

Senior leaders in larger organisations and trustees need to engage with this.

I am sure that none of the findings in these surveys will be news to those who work closely to recruit and retain volunteers. I am also sure that many of those in these roles recognise that we as a sector need to offer something different to attract new volunteers. But too often, we hear that those in charge do not see this as a priority or that they are not able to see how new ways of working work.

If the decision-makers in organisations don’t change their views and ensure that volunteering becomes fit for purpose, they will see their volunteers leaving and new ones failing to sign on. Given how vital volunteers are to many charities, we have to see fundamental changes in the near future.

The Time Well Spent report was clear about the importance of flexibility in how volunteers are used.

6. Volunteering is unequal

This has many facets, and we need to start to unpack and address them and to cover all the issues we will write a separate blog. But for now, we know that local people volunteer less in Fenland as fewer organisations offer opportunities. We have to find ways to ensure that the opportunity to volunteer is there for everyone interested and that there are various opportunities to let people pursue their passion.

We also see from the Time Well Spent Survey that ‘Satisfaction continues to be lower among volunteers who are…’

  • Younger vs older
  • Public sector vs civil society organisations
  • Disabled vs non-disabled
  • Volunteers from ethnic minority communities vs white

And that 67% of recent volunteers agree those volunteering alongside them come from various backgrounds. – This figure has fallen from 73% in 2019.

NCVO plan to release a more detailed report looking at who volunteers but we need to find ways to attract people regardless of their age, race, where they live, or background. Not addressing these issues means that a wealth of possible talent is being lost to the sector.

We can help

The Support Cambridgeshire partners can help you to look at your organisation’s volunteering and help you connect with others who may be able to help or share good practices.

  1. We are developing a website allowing volunteers and organisations to register and find one another across Cambridgeshire and Peterborough.
  2. We can offer training and support on aspects of managing volunteers, check out the website to find out what is coming up from CCVS or from Hunts Forum
  3. Join our Volunteer Managers Network and meet others who manage volunteers. This group meets quarterly to discuss different issues and to share their experience. More info from the Support Cambridgeshire website

Conclusions

We have to be happy that volunteers are giving some positive responses – 92% very or fairly satisfied with their volunteering. This is true for traditional in person volunteering and for those doing remote volunteering. But this has dropped from 96% in 2019.

We can’t simply hope things will improve again when the crisis ends. We have to find ways to get more people to volunteer, look at how we embed volunteering as the ‘normal’ thing to do, and wake up to the fact that more than half the problem is us in the voluntary sector.

 

VCSE Health Alliance – Update Bulletin – August 2023

August 2023

Getting our voices heard

The funding we have received for representation offers an opportunity for Health Alliance reps to join several of the Integrated Care System decision-making committees. Reports from these reps are on the Health Alliance webpage (see link at the end).

We are also writing guidance so we can all be clear about what are the expectations around representation and how we support better engagement and listing who is doing what. We’ll let you know when this is available. It will be reviewed on a quarterly basis.

Please contact Debbie if you are interested in taking on a rep role. Training is available to help upskill people. We are always looking at ways to expand the funding and so offer more reimbursed opportunities.

Using voluntary sector data

Our sector gathers and processes an enormous amount of data about our services and the people we work with. Over the past months Cambridge CAB have been leading a piece of work to see how this data can contribute to Integrated Care Board (ICB) data at a local level. Initially, focused on an area of Cambridge, what we learn about the different types of data and how to combine and analyse will help us replicate in other areas. Jeremy Lane, Associate Director of Business Intelligence at the ICB said:

 ‘The more we know about local people and their needs, the better we can design services and make a difference. It’s vital therefore that we work closely with all our ICS partners across health, local authority and VCSE organisations to share and explore data together to build a clearer picture and improve care.’

The Hewitt Review

Published in April this year, The Hewitt Review, looked at how Integrated Care Systems are working and sets out recommendations for the next stage. Thinktank, Carnall Farrar have summarised the findings on this visual. Over the coming months we will be looking at the recommendations and how these read across to current plans. We will be circulating our conclusions and inviting ideas and discussion.

Keeping people safe

With thanks to everyone who has signed up so far to the Health Alliance Safeguarding Statement. Colleagues at Hunts Forum are now starting to develop a set of policies and guidance. After that we’ll be compiling training resources and opportunities for further advice and support. Email Sandie if you would like to commit to supporting the statement sandie@huntsforum.org.uk

Health Alliance branding

We are delighted to have received some ICB funding to develop a clear brand for the Health Alliance. Peterborough CVS are leading this piece of work and will ensure that the views of the sector are taken into account. Christina Alexander, PCVS CEO, said:

‘We’re very excited to be part of the Health Alliance representing Peterborough and Cambridgeshire and look forward to working with our VCS partners to develop a clear and recognisable identity for the group’

We are looking for groups to join the steering group for this work. If you are interested please email Kalai at PCVS  kalai.short@pcvs.co.uk

Our meetings

Here are the dates of our future meetings, please do put them in your diary. We have tried to get a mix of times, locations and formats to help as many people as possible get involved. The September meeting will have a workforce focus.

  • 13th September 2-4 Cambourne Hub
  • 18th October 9.30-11.30 Zoom
  • 6th December 1-3pm Zoom
  • 17th January 1-3 March Library
  • 28th February 9.30-11.30 Zoom
  • 17th April 1-3 Peterborough (venue TBC)
  • 22nd May 10-12 St Ives Corn exchange
More members please And lastly, please do pass this newsletter onto your team and other groups and organisations who may not yet be Health Alliance members. Anyone wishing to join should email Debbie Debbie@huntsforum.org.uk    See here for more information about the Cambridgeshire and Peterborough Health Alliance

Health Alliance online meeting — July 2023

This month’s well attended Health Alliance meeting invited Heather Noble (South Place MD) and John Rooke (North Place MD).

Heather explained that they were not NHS but were all partners from across the patch. As well as North and South Place there is Mental Health and Learning Disability, as well as Children and Maternity business units. It is an evolving landscape with a matrix of activity. The South Place covers all of Cambridge, South and East Cambs, as well as touching on Royston

The aim is to align the system so that care becomes personalised and proactive and to work with the priorities that have been agreed by the Integrated Care System (ICS). Having “what matters to me conversations” to ensure that the population voice is heard.

The voluntary sector, as well as having some representation on some ICS boards, can be actively involved at Integrated Neighbourhood (IN) level. Integrated Neighbourhoods are based around a PCN footprint. At this level there is better understanding of the population- hyper local and this can enable a reduction in health inequalities.

John explained that the North area covered Peterborough, Hunts and Fenland but due to the nature of the landscape there is some relationship with Lincolnshire and Norfolk too.

The North aim to keep vulnerable people healthy and well for longer but this applies to general population too. They are looking at where people work and live to see what can be brought to them the aim being to bring equity of access.

A broad spectrum of partners are focussing on older frail people, complex children, learning disability (ensuring good quality health checks are undertaken) and childhood immunisations.

Alliance members were then given the opportunity to ask questions.

What does it look like for the individual? Some examples were given:

  • GPs attending some faith groups to discuss issues.
  • Homeless Health bus is just about to be launched.
  • Online GP registration that can be translated.

Heather told the group about the winter wellness project where 100 people were highlighted from PCNs who were at risk during the winter. ‘What matters to me’ conversations were had with those people and support was offered where needed re heating grants etc , connecting lonely people and one person had a vacuum bought upstairs so it lessened the risk of her falling whilst carrying it up and down the stairs.

How can we optimise contact with the voluntary sector who are often the most trusted people for individuals?

There is a need to make sure the voluntary sector is meaningfully engaged at IN level. In the North Place there are good links but it’s not so good for prevention. South Place are finding capacity is a problem for organisations and some neighbourhoods are yet to be established.

It was suggested that neighbourhoods could produce a newsletter to report what is happening in each area. At present the public have little knowledge of what is happening and what is there for them.

It was suggested that the Health Alliance might want to keep an open invitation for Heather or John to attend future meetings. Heather and John both asked to be invited to meetings and would attend whenever they could.

JOY/Social Prescribers

Debbie fed back the results from JOY/Social prescriber questionnaire that was sent around and feedback from Meet Your Social Prescriber Event. There are still not many organisations signing up to JOY. There is lack of understanding of its benefits/use, some hesitancy about getting many referrals, some organisations that have signed up have heard nothing since.

Social prescribers are referring into organisations but not always appropriately. There doesn’t appear to have any follow up system (ie did the referred person make use of the service/organisation). Social prescribers often refer people in and that person has not been told of waiting lists etc and thus are disappointed if they do not get helped immediately. There is no extra funding for the extra referrals.

Sandie will write up a report and meet with a few organisations for fully case studies. There will be a repeat of the “meet your social prescriber” event later in the year.

Winter Monies planning

There has been some talk about planning ahead for this this year however John Rooke thought that there probably wouldn’t be any extra this year due to monies that had been put through the system for unplanned care.

The group thought that it would have been some stock projects that could have been picked up and ran with at short notice if this, or other funding streams became available at short notice. Sandie agreed to devise and circulate a form to gather interest and ideas.

Healthier Futures fund

Andrea Grosbois reported that there had been a fair bit of interest in this. The process will be as follows:

CCF will review the applications and make sure they are applicable- they have been regularly updating the Q&As on the website to help organisations.

The district and county councils will then make some recommendations.

There will then be a judging panel- they will be given some support in what being on a panel means. The voluntary sector will be represented on the panel.

Tree council, Branching Out / Planting trees, hedgerow & orchards / 3rd December

Grants available: From £250 to £2,5000

Applications close: 3rd December

Who is the funding for: Anyone apart from private landlords, businesses or groups outside the UK

Link: https://treecouncil.org.uk/what-we-do/planting-and-care/our-grants/branching-out/

About

Guidance Notes

New FUND – The Community Organisations Cost of Living Fund

Grants available: You can apply for between £10,000 and £75,000. If you need £10,000 or less you could try the National Lottery Awards for All fund.

Applications close: 16 October 2023 at 12 noon

Who is the funding for; Voluntary or community organisations within the UK

Link: https://www.tnlcommunityfund.org.uk/funding/programmes/community-organisations-cost-of-living-fund

About

This funding is for organisations that support people and communities under severe pressure because of the increased cost of living.

By community we mean people living in the same local area.

TNLCF main priority is to fund organisations supporting low-income households and individuals.

To apply your organisation must already run critical services around at least one of the following:

  • food and emergency supplies – like food and baby banks or the provision of hot meals, clothes or toiletries
  • emergency shelter – like night shelters or other accommodation for people experiencing homelessness
  • safe spaces – like domestic abuse services and youth services
  • warmth – like warm rooms and spaces
  • financial and housing advice – like giving people advice because of the increased cost of living.

Your organisation must also be facing both

  • increased demand for these critical services

and

  • increased costs of delivering these critical services

We’re more likely to fund small and medium-sized front-line organisations

With an annual turnover of between £10,000 and around £1 million.

Larger organisations can also apply if they do both of the following:

  • show that they work closely and effectively with local communities
  • fill a gap in essential local services.

 

You can get funding to pay for:

  • costs of delivering, expanding or adapting your existing critical service(s) from the date you are funded until 31 March 2024. The date you are funded will be around 12 weeks from the time you submitted your application.
  • retrospective costs of running the existing critical service(s) you’re applying for between 24 July 2023 and the date you are funded.

To find out more read the section What you can spend the money on found the the main website.

TNLCF want to support a range of critical services that reach as many local communities and groups of people as possible. This will be one of the things they think about when deciding which applications to fund.

The deadline for applications is 16 October 2023 at 12 noon

Funding organisations will start in October 2023, and finish in January 2024. If you get funding you must spend it by 31 March 2024.

 

Quality, Performance and Finance Update – June

 

Title of Group Quality, Performance and Finance
Date 23-6-23 Reps name  Rachel Talbot
Summary of agenda items / key themes discussed:
System story – cancer alliance patient partnership group example.Finance & performance update:

•      Finance: Running leaner than comparative ICBs. Predicting a break even position at end of year (significantly fewer junior docs and nurses taking action); Particular areas of risk include Prescribing and Continuing Healthcare where there are challenging efficiency programmes to be delivered as well as managing cost-pressures and run rates within the budgets planned for.

•      Performance: Community Paediatric services –  Recent rapid increase in referrals for preschool children on top of a similar long-term trend for all services. Several children with complex physical disability needing to be held in the community with the increasing input from the multidisciplinary team due to lack of specialist support in the local district general hospital and long wait for this specialist respiratory, gastroenterology and paediatric surgical input from specialist hospitals. Prioritisation process identified and in place.

•      Mental Health Inappropriate Out of Area placemats continue to be of concern with the number and length of stay for patients continues to rise with 1080 in Mar 23 ( 2,660 bed days Jan-Mar 23)  There are routinely 5 patients with a LOS greater than 91 days. CPFT have plans in place to recommence opening some inpatient beds in July 23.

•      Clearance of 78 week waits by end of June – performance is reported weekly through NWAFTs tiering meeting and CUHFT reporting. The system is expecting,  based on unvalidated data, 143 >78 weeks worst case at the end of June, broken down as below:

•      39 breaches due to patient choice, clinical complexity or unfit for treatment

•      104 capacity breaches (23 CUHFT and 81 NWAFT)

•      Industrial action (April and June) has impacted on clearance rates. 68 long wait patients (>78 weeks) have had their appointment rescheduled directly as a result of IA during Q1, which accounts for 65% of our worst-case capacity breaches. Nationally, the expectation is clear that all long waits are expected to be eliminated before the end of June 23 but locally we do not expect to achieve this, rather we are aiming for clearance by the end of July 23.

•      C&P ICS performance remains below national ambition for health checks for people aged 14+ with a learning disability. The achievement for 2022/23 was 72%, while lower than the national ambition was considerable improvement from previous years. Current performance places C&P as third in the region by the end of 2022/23 though EoE performance remains significantly below national average performance

 

Dementia tour bus has been V successful

Children and Young People with Complex Behavioural Issues and Children’s Multi Agency Safeguarding Hub (MASH). Children’s speech and language therapy has long waiting lists. New Paediatric programme starting soon.  (Duplicated boards have happened with the “de coupling” from the LA). Community paediatrics = 65 week wait.

Dentistry Services Overview. (biggest area of complaint for Healthwatch)  Severe shortage because most want to work near or in London. Pandemic halted a  lot of new initiatives to try to address this. Neighbouring ICB having same issues but looking to set up a dentistry school. Brexit has had a very negative impact because a lot of dentists worked here and in the Eu during the week before this. Noted that you do not have to register with a dentist unlike a GP so should be able to go anyone but most have closed their doors – especially to complex children’s cases. Noted that the funding system is basically flawed – it encourages dentists to see people for 6 month check ups when in fact they only ned to be seen every 2 years. There is no financial incentive to do the more complex work.  The way that funding is allocated is a national matter so out of local hands.

QPF Feeder Groups Overview – Ethical Framework for Clinical Policies Forum and Cambridgeshire and Peterborough Joint Prescribing Group. These make decisions on what interventions/medicines are available to the local population e.g. should we pay for the new obesity drug or not? They need to make £15mill savings.

“Digitech” group: looking at AI but have not yet got to grips with using photos to help with diagnostics – especially about skin cancer.

Implications for the VCS

Will the need for savings impact on community care initiatives i.e. is that an easy route to take to make cuts?

Can we help with the digital agenda/ why are they not looking to neighbouring authorities that are readily using these systems? If they do become more digitised we need to beware of the digital poverty/ exclusion agenda

 

Actions

Need to be making the case for the negative impact that cutting any community funds will have in £s

Feed in case/system studies to illustrate the impact of what we do and what great partnerships we have from primary care to community and back

Date, time and venue of next meeting and name of representative who will be attending

28-7-23    Rachel Talbot

 

 

 

 

C&P ICB Commissioning & Investment Committee / Improvement & Reform Committee Update – June

Title of Group C&P ICB Commissioning & Investment Committee and improvement and reform committee
Date  16th June 2023 Reps name  Miriam Martin, Michael Firek, Rachel Talbot
Summary of agenda items / key themes discussed

Please note that this was the first meeting combining the commissioning and investment committee and the improvement and reform committee.

  1. Minutes of the previous improvement and reform committee

Michael noted that there still hadn’t been a response to regarding VCSE contribution to the Digital Enablement Group or just a general consideration as to how we can contribute to the digital strategy. This was acknowledged by the chair as an outstanding action.

  1. Terms of reference

New terms of reference for the combined committee (investment and commissioning/improvement and reform) were discussed. Given the scope and scale of decision making some concern was expressed about membership and voting rights to ensure that it wasn’t the same people making decisions about the same items multiple times. Concern was also expressed about the depth and breadth of the clinical leadership of the committees. These were noted with a request for more information to be brought back to the next meeting.

  1. Cambridge Children’s Hospital

This is a CPFT, CUH, Cambridge University and Cambridgeshire education authority collaboration. If achieved it will be first hospital in the country to integrate mental and physical health and early detection of chronic conditions. Positioned as a regional hub for the East of England. Also intended to provide outreach and training and become an anchor institution for the ICS. There is a £165m gap in the business case with no agreed funding to fill it. The collaboration is seeking additional support from the ICS of around £5m per year for the next three years. They have reduced costs and are seeking alternative funding. The philanthropy element of the funding is doing well.

There were questions as to how the system is prioritising capital spend across the system. Apparently there is no current prioritisation plan as capital spend has only recently been passed down to ICS’s as it was previously held nationally.

There was a request for the project team to revisit the long list of outcomes in light of the revised business case and for some direction to be given as to how we prioritise all capital projects in the pipeline with limited resources.

Michael raised the issue of the eye-watering sums of money going into this development and we shouldn’t forget the brilliant work of the VCSE in supporting the mental health of young people and how we are relatively under resources given the impact we can have in communities particularly further away from Cambridge.

  1. Briefing paper on 2023 delegations for specialist services

This was an update from the agenda item at the last meeting. Terms of reference for a working group were agreed.

  1. High intensity users

This item was about high intensity users of GP services, 111 and A&E. It has been calculated that the high intensity users across Cambs and Peterborough cost the system around £32m per year. The proposal is to create a two tier service model; tier one – specialist service and tier two – targeted service model. Approximate costs: An annual estimated cost of £600,000 for establishing the Tier 1 HIU service. An annual cost of £825,800 for establishing a system wide Tier 2 HIU service. There is some concern that this service may create overlap or duplication with other services. Stacie Coburn will be looking at this. I mentioned that I think the voluntary sector could have a key role to play in this. The proposal was strongly supported especially by the GPs on the committee.

  1. Electronic patient record system

The committee were requested to review the business case for new EPR’s for NWAFT and Hinchingbrooke. Ideally would be for all three hospitals to use the same one currently in situ at Addenbrookes as it represents best in breed. However that is simply not affordable. The business case mentioned the use of APIs and integration of systems. The committee felt unable to support any particular case given it is a knotty issue and funding will dictate the decision so it was deferred to the ICB. Concern was expressed about the level of risk.

  1. Capacity funding

The system received a significant increase in funding for 22/23 which was made recurrent in 23/24. This is added to the additional funding from the national team and the better care funding. All this funding has been allocated. Since then it has been discovered that £8m of it has been used to fund a gap in funding and therefore savings need to be made from the allocations made. This is on top of the £100m gap in the budget so there is little appetite to simply add it to that. Some projects that have been started won’t use the entirety of the funding allocated and taking this into account there is around £2.5m still to find. A couple of options were put on the table which the committee were not fully supportive of as they are both transformational and bring about change and relieve pressure on the system. (Urgent care response and virtual wards) It was agreed to make the £5.5m savings already found, maintain the investment in urgent care response and virtual wards and to find the remaining £2.5m from elsewhere in the system.

  1. Restoration and recovery financial support

This was more about process as the investments had already been made. The committee were asked to support retrospectively. The committee noted the report.

  1. March project

This paper covered issues being faced by GP practices in March although is similar to others across the county. Issues largely due to a reduction in GPs in the area. The ICB are actively working with them to come up with solutions for the demand in services that they are struggling to provide. Report just for noting.

  1. Tobacco control across Cambridgeshire and Peterborough

A paper was presented to the committee to review before going to public health. There was nothing to disagree with. The focus of this work is to encourage women to cease smoking during pregnancy and to reduce the number of children who start to smoke. There was also a plan to cease illegal sales of vapes.

  1. Feeder group update

Michael suggests that we seek VCSE membership of the Population Health Equity Board which wasn’t covered in the TOR.

 

Implications for the VCS

  • An opportunity for members to participate in the service designed for high intensity users.
Actions

  • Could an approach be made by the Health Alliance team to seek VCSE membership of the Population Health Equity Board?
Date, time and venue of next meeting and name of representative who will be attending

18th August 2023: Miriam Martin and Michael Firek attending

Attendees:

Ged Curran                         –           Chair

Dorothy Gregson               –           Vice Chair (ICB NEM)

Jan Thomas                         –           ICB CEO

Louis Kamfer                        –          ICB Managing director – strategic commissioning

Nicci Briggs                          –           ICB CFO

Martin Wheelhan               –           Representative of the chief of staff

Simon Barlow                      –           Representative of the chief of staff

Dr Gary Howsam               –           ICB Chief clinical improvement officer

Wanda Kerr                         –           Assistant director special projects

Amanda Duffin                  –           Senior commissioner mental health

Stacie Coburn                    –           Executive director of performance and assurance

 

Staff Accommodation Forum Update – June

Title of Group Staff Accommodation Forum
Date 27 June 2023 Reps name  Sandie Smith
Summary of agenda items / key themes discussed

Housing Strategy (to include VCS) to set out some solutions. The meeting discussed the difficulties staff have accessing affordable housing. Districts, County and ICB are all committed to finding solutions. Need for subsidies discussed but no solutions.

Some long term plans from NHS England re key worker housing. However, nothing immediate. Workshop to discuss further in July.

Housing providers set policy and group agreed it is within their power to plan in housing for key workers but very long term. Everything comes down to a shortage of housing for everyone. Short term solutions extremely challenging.

Financial models discussed. Trust-based model and Key-worker model being trialled by the SouthWest. Lots of complicated discussions about developers and local authority housing provision. Might be potential for VCS to access key worker housing but very long term. Group agreed ‘follow with interest and adopt at the right time’.

Staff housing survey – 417 responses therefore extended deadline.

I am not sure that representation at this group is a priority for the HA as the focus is very much on health staff and international recruits.

Implications for the VCS

Staff travel and congestion charge proposal was touched on. Agreement to make one response from ICB, I gained agreement that the VCS be included. Jess Pickman/Iain Green taking forward.

Actions

  • Jess Pickman introduced to Kirsten at ACRE re including findings from rural housing needs in Housing Strategy (completed by SS)
  • SS to link in with Jess and Iain re congestion charge response
  • SS to further promote staff housing survey
Date, time and venue of next meeting and name of representative who will be attending         Suggest a keep in touch approach.

Local People Board Update – June

Title of Group
Local People Board
Date 23 June 2023
Reps name  Sharon Allen, Arthur Rank Hospice Charity
Summary of agenda items / key themes discussed
Leadership Compact, ICB wanting to ensure this is socialised and lived throughout the system to proposed we use a simple scoring mechanism to provide an on-going Meeting Assessment. At the end of the meeting we reviewed and scored each component of the compact and how we had evidenced this throughout the meeting – a useful exercise we may wish to replicate at Health Alliance meetings?
ICB Board Assurance Framework 2023/24, there was discussion around how dynamic this is eg able to respond to today’s announcement about extended industrial action
Enabler Group Update, Health and Wellbeing (HWB), Giles Wright gave a presentation. There was a lot of discussion about the Staff Mental Health service, which received very positive feedback from those NHS organisations that pay for and use it. There was discussion about how this valued service could be available to the system and also how the voluntary sector could potentially be part of provision of a service that has a wider focus. Also confirmation that the Staff Support Hub has been funded until March 2024 by the ICB now that NHS England has ceased funding all staff support hubs (although see next item on proposal for regional hub).  Helpful analysis of what needs to be done at national, regional, local and provider/employer level.
Regional Staff Support Hub Options 2024/25: the ICB level staff support hubs across East of England have been working on a proposal to set up a regional (online) staff support hub funded by NHS partners, available for all of the sector, including voluntary sector. This is an enhancement to not replacement of local provision. NHSE allocating £2m to hubs nationally, about 10% coming to this region to develop regional hub. It was agreed to ask the HWB enabler group to look at in detail and make recommendation.
Leadership Programme Update – Civility Saves Lives, looking to develop a programme to promote a just and civil culture throughout the system, with Toolbox talks and access to a range of programmes, more details to follow.
CPICS – A joint project between Anglia Ruskin University (who have been given funding from Health Education England) and CIP ICS.  Looking at a local system, encouraging health and care careers and accessibility into the sector, developing knowledge and skills and integrating settings. The work will be led through the R&R and SED groups and has to be developed by March 2024.
Workforce Productivity Agenda – data analysis shows that C&P is one of highest growth projections of all regions. The challenge is that whilst financial investment in the workforce has increased, productivity has decreased. The challenge for the system is to secure workforce supply and deliver productivity improvement in 23/24 and assess workforce requirements for future years and determine what levers and levels of investment in education and training are needed to secure supply.
Provisional Future Agenda Items
September – Efficient & Effective Ways of Working, Education Learning & Development
Implications for the VCS
How are we embedding the Leadership Compact into all of our work and through our organisations?
Ensure we are engaged with the Wellbeing work, supporting the continuation of the Staff Support Hub and any plans to develop a Regional Hub as well as discussions around possibility of extending mental health service to and from our sector.
Opportunity to engage with the Leadership Programme and Civility Saves Lives, look out for further details.
Engage with the joint project with ARU to support with our talent pipeline.
Actions
As above
Date, time and venue of next meeting and name of representative who will be attending
15 September, 13.30, face to face – venue tbc, Sharon will attend

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