Agenda item

The Committee received a presentation on the implementation of the North East and North Cumbria Integrated Care Strategy and associated Joint Forward Plan (included within the papers). Led by the North East and North Cumbria Integrated Care Board (NENC ICB) Director of Strategy and Planning, and supported by the NENC ICB Director of Place Based Delivery (In-Hospital Care), key aspects included:

Ø  Process: Developing the Joint Forward Plan

o   National Guidance

o   NHS Plan aligned to our Partnerships

o   How the Plans fit together

o   Process and Timeline

o   Feedback

Ø  Content: Sections of the Joint Forward Plan

o   North East and North Cumbria Plan

o   Service Action Plans

o   Enabler Action Plans

o   Place Action Plans

Ø  Tees Valley Priorities and Strategic Context

Ø  March 2024 Refresh

As per national guidance, the overarching purpose of the Joint Forward Plan (JFP) was to demonstrate how the ICB and its associated NHS Trusts would arrange and / or provide NHS services across the totality of healthcare. Allied to this, it would need to show how legal requirements for the ICB would be met, as well as support the delivery of the NHS Mandate and NHS Long-Term Plan across its footprint (the latter of which would end during the five-year period covered by the JFP (2023/24-2028/29) and would require a refresh).

The medium-term JFP sits between the 10-year partnership-based Integrated Care Strategy (focusing on population health), and the annual NHS Operating Plan (focusing on NHS activity, finance, performance, and workforce). It comprises a host of detailed Action Plans and acts as a summary document. The timeline for its construction was outlined, including opportunities for stakeholder feedback (which was widely encouraged, properly considered, and sometimes acted upon within the context of varying and occasionally directly opposing views). The final version was approved at last week’s ICB meeting, and there were plans for an easy-read document given its existing detail and length. An annual update would take place each March (though maintaining the five-year horizon), and the ICB would seek input from the public, service-users, families / carers, Elected Members, partners, etc., at any point in time.

Feedback received on the proposed content of the JFP revealed several themes. Ensuring the appropriate use of language (to aid readability and avoid stigmatisation) was a key element, as was the need for clarity around the plan’s objectives (including measurable indicators). Balancing local focus within a North East and North Cumbria footprint was always likely to be a challenge given the large geographic area the plan covers, though health and care issues were often replicated across numerous different locations.

Reflecting the system-wide priorities established through the NENC Integrated Care Partnership (ICP) Better health and wellbeing for all strategy, the JFP comprised fifteen service Action Plans which now included trauma-informed services (not originally within the draft version) as well as women’s health (acknowledging that provision was not always right for all women and recognising the national women’s health strategy). Underpinning progress on these fifteen topics were several ‘enabler’ Action Plans concerning aspects such as workforce, finance, data and digital, estates, and environmental sustainability.

From a sub-regional perspective, Tees Valley priorities were outlined, though it was noted that even this smaller part of the overall North East and North Cumbria coverage was made up of a collection of five Local Authority areas each with its own characteristics (common themes did, however, exist, some of which could be viewed as unique to Tees Valley). Recognising the need for strong alignment with Health and Wellbeing Boards, five Tees Valley pillars that supported delivery of organisational, place and system plans had been identified – prevention; admission avoidance and hospital discharge (keeping hospitals / urgent care settings available for those who really need them); mental health, learning disabilities and autism (across all age bands); reducing health inequalities; and sustainability. Ultimately, health promotion and prevention should be at the root of everything services do.

Mindful of the JFPs annual March refresh, the NENC ICB had already identified required improvements in relation to clearer implementation of its content, as well as greater acknowledgement of the voluntary, community and social enterprise (VCSE) sector which plays such an important role in supporting health and care provision. Specific focus on general practice (GPs seeing more people than ever yet still the public continue to raise concerns about access), long-term conditions, and dementia (better clarity over future plans) would also feature. Recognition of anticipated changes to ICB resourcing (not to actual healthcare spend, though) would also be factored in.

Committee comments / questions centred predominantly on the JFPs service Action Plans. In response to a Member query around women’s health, it was confirmed that there was already a specific piece on maternity matters within the ‘best start in life’ section of the plan (part of which was an attempt to drive improvements around pre-birth mental health for both mothers and fathers). For the autism strand, Members expressed a wish to see more autistic-friendly organisations and greater awareness of this condition – officers acknowledged the need for services that can serve all people by making any reasonable adjustments to its existing offer in the context of ongoing resource / demand challenges. With reference to the trauma-informed element of the plan, the Committee felt that numerous organisations needed to be involved in developing this aspect, not just Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), with officers adding that it was the ICBs desire for all healthcare services and their staff to have a basic awareness of trauma so individuals were less likely to experience further negative responses to a previous event.

Ensuring relevance for local areas within an overarching plan, and the inclusion of measurable targets, was debated, with the Committee also emphasising that aspects of good practice within a certain location should be shared on a wider North East and North Cumbria level. Officers described the national context which impacted upon regional planning, with NHS England publishing its operating framework each year setting out key requirements for the whole sector which ICBs then needed to adjust to (including any financial repercussions) – the NHS Long-Term Plan also needed to be taken into consideration. Regarding targets, there were measurables within individual Action Plans that were not reflected within the JFP – the ICB was considering how it could best represent these as part of future versions. As for the dissemination of good practice, the ICB Learning Board enables the sharing of ideas and experiences, with a recent example being the standardisation of specifications for the urgent care offer (a key reason why North Tees and Hartlepool NHS Foundation Trust performs well compared to other NHS Trusts).

Welcoming the emphasis on partnerships and the inclusion of Tees Valley-specific priorities, Members noted the additional pressures that could be created as a result of good performance as services are asked to support similar functions outside their organisation. Officers stated that there were situations where this would occur, and that the ICB was trying to meet demand in the best way possible within the context of a restrictive workforce. In response, the Committee highlighted the value of the voluntary sector in providing additional support to statutory services, with numerous newly retired people willing to give their time – further developing VCSE relationships to assist with the overarching health and care offer should therefore be a key part of future planning.

Commenting on the expected focus on general practice as part of the JFP 2024 refresh, the Committee noted the ability for female patients to request to see a female GP and highlighted instances where a male patient had experienced difficulties requesting an appointment with a male GP. Officers were happy to follow-up specific cases outside this meeting, though confirmed that gender preference should be offered to patients.

AGREED that the North East and North Cumbria Integrated Care Strategy / Joint Forward Plan update be noted.