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

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.

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

• Could an approach be made by the Health Alliance team to seek VCSE membership of the Population Health Equity Board?

18^th August 2023: Miriam Martin and Michael Firek attending