Tag Archive for: representation

Summary of Voluntary Sector Representation from Boards/Committees (Oct-Nov 23)

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C&P ICB Commissioning & Investment Committee and Improvement and Reform Committee

 6th October 2023

 Miriam Martin (Caring Together)

  • Non-emergency patient transport services – an update on planned procurement process and timetable. Now open for tender. New service will commence in October 2024.
  • Integrated urgent care –Current contract extended by two years to Oct 25 when new contract will start. Extension was agreed to ensure opportunity to engage stakeholders and patients in creating the spec.
  • Winter capacity – In 2023/34monies have been received including some monies for adult social care.
  • Targeted lung health checks – paper identified options for roll out in preparation for an expected national lung cancer screening programme. The committee approved the end to end service model to be outsourced to a single provider.
  • Cardio-vascular disease programme – Monies have been made available from Public Healt to support CVD prevention. The committee approved the proposal to support improved outcomes in the detection and treatment of CVD risk factors.
  • Managed Care Hub – The committee approved a proposal to establish a facility in the North Cambs/Peterborough partnership to provide a dynamic managed care hub targeting hard to reach patients. This provides an opportunity for the Voluntary sector to engage and become part of a holistic service offer for a range of conditions.

The next meeting is 15th December.

 

Quality Performance and Finance 

27th October 2023

Rachel Talbot (Cambridge CAB)

Finance They are on track and doing pretty much the best in the region however the Deputy CEO warned that this Winter will bring as many difficulties as during Covid. She asked that everyone do what they can to make savings wherever they can.

Prescribing Facing a large overspend although apparently doing better than most areas. Key problems = population increase; cost of drugs; increasing/better  diagnosis of conditions like diabetes (= more statins); overprescribing.

We are the 4th lowest cost per 1000 patients. Nd 4th best for procurement. Sharing more amongst regional and national networks.

Learning disabilities 54 deaths up from 23 in 2019. Leading cause of death = respiratory system.

National:

  • Continuing industrial action in the NHS has had a significant impact on patients, with almost 400,000 appointments having to be rescheduled during June, July and August 2023 as a result
  • of strikes
  • Demand for cancer services continued at record levels in July 2023, with the number of urgent suspected cancer referrals at 130% of pre-pandemic levels.
  • The NHS M4 year to date financial position is £794m above plan

Local: October headlines

  • The systems financial position-at Month 6- shows in deficit
  • A&E performance 4 hour performance : is off trajectory for September at a system level 67% against a trajectory of 71.1%;
  • Overall outpatient activity: remains below the set operational plan, currently at 92%.
  • Cancer performance is becoming increasingly more challenged. The 28 Day Cancer Faster Diagnosis standard has regressed from the previous month, falling below the 75% target
  • Annual Physical Health Checks (APHC ) for Severe Mental illness register patients: For Qtr 2 C&P delivered 59% (2284) of our annual target of 4027 checks. The End of the year forecast position: 110% of target of 4027, a 75%uptake against SMI register.
  • Inappropriate Out of Area Bed days – Mental Health: has reduced from 920 bed days a month in April to 690 in latest month (July).
  • Patients not meeting the criteria and not discharged: Performance continues to be strong, and significantly better than the same period in 22/23, and ranks in the top quartile nationally.
  • Urgent Community services: The number of referrals and response within 2 hours continues to show month or month improvement with a 25% increase in referrals April to August
  • Theatre Productivity: Remains high at 79.2% comparative to peers although below the target at 85%.
  • Diagnostic activity across all areas is performing above the planned level at 102% (CUH 103%, NWAFT 101%, and RPHFT 104%).

 

System Leadership Group

13th November 2023

Sharon Allen (Arthur Rank)

Following the meeting in September to review structures and working of Local People Board and it’s sub-groups, this group has combined the work of two previous groups; Leadership and Organisational Development and System OD and is co-chaired by Anita Pisani, Deputy CEO at Cambridgeshire Community Services and Sam Carr, Assistant Director Systems and Organisational Development, CCS who also has a system role.

The group has four objectives:

  • Work as a system to embed Compassionate Culture through design and delivery of OD interventions and ensure the Leadership Compact is embedded through the system;
  • Develop a systematic and coordinated approach to managing talent and succession planning across the ICS;
  • Use staff surveys (NHS and system partners) to identify improvement actions;
  • Develop system leadership, teaching everyone to work beyond our own organisational boundaries to support the needs of local people. Create collaborative and inclusive cultures across the ICS that engenders joint working and common purpose.
  • We discussed Talent Management and the support being provided to progress this and how we can ensure this is genuinely system wide, recognising the challenges of different parts of the system not being equally resourced or able to offer comparable T&C for colleagues. NHS England is currently piloting a programme called Scope for Growth and information was shared on this.
  • The importance of everyone in our system being aware of and integrating the Leadership Compact (which is referenced in our VCSE strategy) was reinforced to foster a shared approach to leadership across our system.

Update on Leadership programmes:

  • An update of Springboard programme was given and information circulated separately to Health Alliance
  • Mary Seacole is a programme aimed at middle managers and the programme is looking for additional facilitators, particularly from the North of the county, training will be provided.
  • A further cohort of Leading Beyond Boundaries is underway and we have several Health Alliance colleagues on this programme and it will be good to hear back from them in due course about their experience. The alumni event that had to be postponed due to impact of industrial action is still be rescheduled.
  • Stepping Up and Ready Now programmes are leadership programmes for colleagues from ethnically diverse backgrounds. A local provider has been sourced, and the system needs to determine how to resource secure this. BLMK (Bedford, Luton and Milton Keynes) ICS has suggested a joint approach which will share costs and places and the group agreed to pursue.

Actions for VCSE partners or Health Alliance

  • It would be good to know how many Alliance members complete any form of staff survey and particularly any who are willing to share results for comparison across the system.
  • Consider applying for Springboard Women’s Leadership programme – also any women leaders in our sector who are willing to share your career journey at one of the sessions, please contact Mel Paine, melanie.paine1@nhs.net – it would be great for more colleagues from across the system to hear from voluntary sector women leaders!

 

Local People Board

17th November 2023

Sharon Allen (Arthur Rank)

A risk was raised under the BAF (Board Assurance Framework) about the reservist programme that has been running. The funding for the project managers supporting this programme is ending at the end of March and the board was asked to note this and the risks to the programme. This is of course a risk across many programmes and one that the voluntary sector is very familiar with so I raised the point that the ICS needs to be aware of all projects that are at risk due to loss of specific funding to determine how best to prioritise any ongoing support.

There was also discussion about where Freedom to Speak Up Guardians sit within the approach to managing risk.

There was an update on the structure and the Enabler groups that sit under the People Board:

  • EDI (rep Gemma Manning, ARHC)
  • Leadership and OD (Sharon Allen, ARHC)
  • Recruitment (Sharon Allen, ARHC)
  • Retention (Tbc)
  • Education and Development (Kay Hardwick, ARHC)
  • Workforce Planning (tbc)
  • Health and Wellbeing (Kat Shepherdson, Hunts Vol Forum?)
  • Futures (tbc)

Brief update on ‘Above Difference’ Programme starting Jan 2024, Health Alliance has three members joining who will share feedback.

Presentation from Jo Oldfield from the Training Hub which supports GP practices and Primary Care Networks (PCN’s) with Organisational Development, recruitment and retention, learning and development, leadership and strategic growth. The Training Hub is the delivery arm for national NHSE primary care workforce initiatives locally.

The Health and Care Academy is delivering an ICS careers expo for Year 10 students and potential apprentices/ new recruits, on the 27th & 28th March 2024 at ARU-P.

I continue to raise the point about the challenge of trying to implement initiatives that are One Workforce focused when there are such differences across our sectors, this is acknowledged which is positive. The ICB has employed Bev Hoskin as Head of Pay and Reward across the system, a very challenging role. I have had an induction meeting with her in my role as HA rep on the People Board and shared what we have done. It would be good to invite her to a future HA meeting.

Actions for VCSE partners or Health Alliance

  • Are any Health Alliance members able to attend the Enabler groups where we do not currently have representation?
  • It would be good to know which Health Alliance members have a Freedom to Speak Up Guardian, there is a system wide network which we need to be linked into.
  • Look out for details of ICS careers expo in March and ensure Health Alliance members participate.
  • Are colleagues happy for me to share the work we did some time back from Hunts Voluntary Forum CEO network on T&C in our sector (anonymised) with Bev Hoskins

 

 

 

Summary of Voluntary Sector Representation from Boards/ Committees (June – Aug 2023)

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QUALITY PERFORMANCE AND FINANCE COMMITTEE

23rd June- Rachel Talbot

There has been an increase in referrals to paediatric services for preschool children along with an increase in need for children with complex needs. As well as this there are long waiting lists for speech and language therapy.

There is still concern about the number of inappropriate out-of-area mental health placements with work being done to reduce these.

The dementia tour bus that visited care homes across Cambridgeshire and Peterborough earlier in the year was a great success.

27th July- Rachel Talbot

There has been a reduction in turnover of staff since the beginning of the year. Mental Health nursing however had seen an increase in turnover.

A discussion took place about the Learning Disability Health Needs assessment. There was a list of recommendations however with lack of funding these may be difficult to implement.

Ambulance handover time has improved and is being sustained and is now the best in the region.

PEOPLE BOARD AND SUBGROUPS

12 July -Education and Development workshop ARCH representation

The Oliver McGowan training the ability to recruit the right amount of staff and the cost of training were discussed.

Background-the- The Health and Care Act 2022 introduced a requirement that regulated service providers must ensure their staff receive Learning Disability and Autism training appropriate to their role. The suggested training is the Oliver McGowan training.

17 July- Leadership and OD subgroup- Sharon Allen

There is a shift in focus from NHS from Serious Incident Review to Patient Safety Incident Reporting Framework (PSIRF). Understanding what within the organisational system led to an adverse outcome. All NHS and commissioned organisations have to introduce PSIRF and Arthur Rank are doing this.

Sharon had taken part in the System Change Consulting Programme (a Health Education England-funded programme) and she fed back at the meeting. The programme had several modules and they are now available online.

https://eoe.leadershipacademy.nhs.uk/development-support/system-leadership/system-od-and-transformation-learning-modules/

The Leading Beyond Boundaries training had 78 nominations including several from Health Alliance members and all have been offered a place.

If organisations undertake staff feedback and are willing to share results and action plans contact Sharon Allen or Anita Pisani

COMMISSIONING, INVESTMENT AND IMPROVEMENT AND REFORM COMMITTEE

18TH August – Michael Firek

Someone to Talk To- Young people’s Mental Health Service the ICB has agreed to continue to fund this service until June 26. It is a jointly commissioned piece of work with Cambridgeshire County Council and supports young people 13-25 with complex mental health needs. The service is currently delivered by Centre 33.

Continuing healthcare efficiency plan- A plan has been received and approved to reimplement clinical tier rates for nursing care beds. A revised and simplified set of rates has been discussed with providers to manage costs and be more reflective of the client’s needs.

Cambridgeshire and Peterborough ICS Outcomes Framework- work is continuing on this. The intention of the framework is to encompass patient and user experience as well as workforce, culture and leadership elements alongside clinical, care and service outcomes.

PA Consulting- These were engaged on Feb 23 to develop a resource model informed by population health, outcomes and the health economic value of change. Work is currently under way to develop logic models that will help the system to assess the economic benefits of different interventions.

Mental Health Investment Standard (MHIS) Review- more than £183m of funding goes into Mental Health and Learning Disability and Autism services. The ICB has done a deep dive review of expenditure for 22/23 to understand the activity, quality, experience, performance and value for money of the services provided for the local population. Several learning points were identified.

Continuing funding for 23/24 was agreed upon. There was a recommendation to pursue 3-year contracts with Voluntary and Community Sector Organisations who were delivering services funded by the Mental Health Investment Standard (MHIS) or the Service Development Fund.

Health Serious Violence Needs Analysis Workshop – July

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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/

Quality, Performance and Finance Update – June

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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

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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

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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

/by
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