Governing Body Meeting Papers - 20 April, 2023

Minutes

MINUTES OF NHS DERBY AND DERBYSHIRE ICB BOARD MEETING IN PUBLIC

Thursday, 16^th March 2023

via Microsoft Teams

Confirmed Minutes

Present

John MacDonald (JM) ICB Chair (Chair)
Tracy Allen (TA) Chief Executive DCHS & Place Partnerships (NHS Trust & FT Partner Member)
Jim Austin (JA) Chief Digital and Information Officer
Dr Avi Bhatia (AB) Clinical & Professional Leadership Group participant to the Board
Dr Chris Clayton (CC) ICB Chief Executive Officer
Julian Corner (JC) ICB Non-Executive Member
Helen Dillistone (HD) Executive Director of Corporate Affairs
Margaret Gildea (MG) ICB Non-Executive Member
Carolyn Green (CG) Deputy Chief Executive DHcFT (NHS Trust & FT Partner Member)
Keith Griffiths (KG) ICB Executive Director of Finance
Ellie Houlston (EH) Director of Public Health – Derbyshire County Council (Partner Member for Local Authorities)
Zara Jones )ZJ) Executive Director of Strategy & Planning
Dr Andrew Mott )AM) GP Amber Valley (Partner Member for Primary Medical Services)
Amanda Rawlings )AR) Chief People Officer
Brigid Stacey )BS) Chief Nursing Officer & Deputy Chief Executive Officer
Sue Sunderland )SS) ICB Non-Executive Member
Dr Chris Weiner )CW) ICB Chief Medical Officer
Richard Wright (RW) ICB Non-Executive Member

In Attendance

Dr Penny Blackwell (PB) GP Place Lead
Helen Blunden (HB) Interpreter
Frazer Holmes (FH) Interpreter
Tamsin Hooton (TH) Programme Director, Provider Collaborative (part meeting)
Dawn Litchfield (DL) ICB Board Secretary
Suzanne Pickering (SP) Head of Governance
Sean Thornton (ST) Deputy Director Communications and Engagement

Apologies

Andy Smith (AS) Strategic Director of People Services – Derby City Council (Local Authority Partner Member)

ICBP/2223/086: Welcome and apologies

John MacDonald (JM) welcomed everyone to the meeting. Apologies were noted as above.

ICBP/2223/088: Declarations of Interest

The Chair reminded committee members of their obligation to declare any interests they may have on issues arising at committee meetings which might conflict with the business of the ICB.

Declarations made by members of the Board are listed in the ICB’s Register of Interests and included with the meeting papers. The Register is also available either via the ICB Board Secretary or the ICB website at the following link: https://joinedupcarederbyshire.co.uk/derbyshire-integrated-care-board/integrated-care-board-meetings/

Tracy Allen (TA) declared a conflict of interest in item ICBP/2223/094 – Integrated Place Executive Chair and GP Lead Roles, as TA is the current Executive Lead for Place. Dr Chris Clayton (CC) presented this item. It was not deemed necessary for TA to leave the meeting due to the need for her to inform discussions. Due process was followed accordingly

Dr Andy Mott (AM) declared a conflict of interest in item ICBP/2223/095 – General Practice Provider Board, as AM is the Medical Director for this area of work. AM presented the paper and subsequently left the meeting whilst a decision was made. Due process was followed accordingly.

No further declarations of interest were noted.

ICBP/2223/089: Minutes of the meeting held on 19^th January 2023

The Board APPROVED the minutes of the above meeting as a true and accurate record of the discussions held

ICBP/2223/090: Chair’s Report

JM presented his report, a copy of which was circulated with the meeting papers; the report was taken as read and the following point of note was made:

• The junior doctors strike over the last few days was well managed; JM thanked everyone for their support to minimise any disruption during this period and apologised to patients for any inconvenience caused.

The Board NOTED the Chair’s report.

ICBP/2223/092: Chief Executive’s Report

Dr Chris Clayton (CC) presented his report, a copy of which was circulated with the meeting papers; the report was taken as read and the following points of note were made:

• Areas of system resilience, operational challenges over winter and managing industrial action across the system were recognised; thanks were given to colleagues for their support in working through these areas and the collective planning work undertaken throughout the system partnership. The junior doctors’ industrial action concluded this morning; the recovery period will be worked through, with advice and guidance taken should any further industrial action occur.
• The broader Urgent and Emergency Care plans build a picture of the work being undertaken locally. The Board agenda today references this, whilst considering the building blocks of tomorrow, demonstrating progress on integrated care, thoughts on strategic integrated commissioning, health inequalities and population health, whilst also collectively taking assurance from the system in a streamlined manner.
• Other areas of national business were highlighted in the report.

The Board NOTED the Chief Executive’s report.

ICBP/2223/093: Delegation of Pharmacy, Optometry and Dental Services and Joint Commissioning Arrangements for Tier 1 and Tier 2

JM considered this to be an important change in the responsibilities of the Board. The proposals have been scrutinised by the Audit and Governance Committee, and key messages provided for assurance.

CC advised that the commissioning of pharmacy, optometry and dental services was part of the pre-2012 infrastructure of Primary Care Trusts; following the 2012 Act they were subsequently undertaken by NHSE and managed on a regional basis. Since the 2022 Act, and a change in the operating model of NHSE, thought has been given as to how local systems could take on the commissioning of these services, with a holistic view of providing a whole population approach and overview to the care needs of communities; this is an important direction of travel. There is support for bringing consideration of these services locally as they are integral community services, particularly Places, and there is excitement at having the ability to oversee them. The paper sets out a sensible way of balancing localism with at-scale working, describing the tiers of operating to be worked through with NHSE and joint committees of ICBs. It is recognised that there will be reiterations post-April to allow continued development. These proposals represent a safe, effective, and pragmatic approach to balance the risks.

Sue Sunderland (SS), as Chair of the Audit and Governance Committee, added that the documents were reviewed by the Audit and Governance Committee in February, setting out the key governance mechanisms for working at an East Midlands level. National guidance has been issued, providing a robust governance structure; however, there are still some elements to be confirmed by NHSE, which the Executive Directors are aware of and are working to resolve. The Committee took assurance on the progress made.

Helen Dillistone (HD) added that the documents received covered both the Tier 1 and 2 arrangements. The joint working agreements between NHSE and ICB, and the joint working agreements between ICBs, and the mechanism by which they would be worked through, were provided for information. The Scheme of Reservation / Delegation and the Financial Instructions will be updated once signed in March in preparation for April.

Zara Jones (ZJ) reminded the Board that Derby and Derbyshire are the host for the 999/111 contracts for the East Midlands ICBs; further thought is being given to working on a broader Midland’s footprint for 111 services. Commissioning these additional services will provide the ICB with learning opportunities in its role as a commissioner.

Questions / Comments

• Dr Andrew Mott (AM) supported ZJ’s comment that there will be huge opportunities for aligning these services at ICB level and welcomed the papers around governance. It is however unclear how this will fit into the system at this point. AM’s role on this Board is as the Primary Care Partner Member; he queried what arrangements will be made for Board membership of the additional areas and the significant number of health professionals connected to them, as well as Primary Care more broadly and the work of the Clinical and Professional Leadership Group (CPLG). CC responded that this is an important question on how a joint committee will work whilst maintaining localism. A Broader Primary Care Committee architecture has been established, recognising that this will be strengthened going forward locally; the Board’s view will be strengthened via the Population Health and Strategic Commissioning Committee (PHSCC). There will be a need to ensure that the mechanism is working to ensure strategic alignment whilst maintaining localism. The ICB will continue to iterate and be guided by the strategic work through Nottingham and Nottinghamshire ICB, which will host the work on its behalf; there will be Executive Director connectivity for the management work. It will be a period of learning over the next 12-24 months.
• Dr Avi Bhatia (AB) considered that, from a pragmatic perspective, it will be good to bring these services under the broader ICB umbrella. The direction of travel will be access; there is a need to move away from the concept of access to a GP towards access to the Primary Care service most appropriate. A lot of good work has been done already between practices and pharmacies which could be built upon; elements of this work could be mirrored in other areas to achieve positive outturns.

JM considered that it is important to understand what options are available, and how they will be realised. The Five Year Forward Plan will need to focus on what the opportunities are and how they should be taken forward to realise the benefits.

The Board:

 APPROVED the two joint working agreement documents to enable the delivery of the operating model from April 2023

• TOOK ASSURANCE on the draft national Delegation Agreement and delegated approval and signature to the ICB Chief Executive by 31^st March 2023

ICBP/2223/094: Integrated Place Executive Chair and GP Lead Roles

TA/PB declared a conflict of interest in this item

CC advised that, to support the direction of travel, and the required leadership arrangements to enact Place, the following recommendations are required:

• To support recurrent funding for the role of the Integrated Place Executive Chair, currently being undertaken by Dr Penny Blackwell on an interim basis. This appointment will be made in line with the process followed for the CPLG Chair. It was proposed to support this on a 3-year term, at 4 sessions per week.
• To support recurrent funding for the sub-level Place structures across Derby City and Derbyshire County to provide disseminated leadership and reach the heart of communities. GP Place Leaders have been supported through the CCG architecture for many years and there is recurrent benefit and value of continuing this support. It was proposed to support the GP Place Lead roles in the 7 Places, and 2 additional roles in Derby City, at 2 sessions per week.

Costs are being incurred in the system through the commitments previously made to fund the interim GP Place Lead roles, however there is an additionality to the cost base for individual Place areas resulting from funding the additional sessions necessary to deliver expectations. Tracy Allen (TA) added there is now clarity of the value that the Integrated Place Executive adds in terms of supporting the 2 Place Partnerships that interface with the Integrated Care Partnership, and the importance of having a Chair with the right skills and background to undertake this role.

Regarding local Place Alliance GP Leadership, there is a good case for resourcing GP leaders to play a vital role across the system. There is still a lot of work to do, and GP leaders are well placed to do this work. There is a distinct role for local Place Alliance GP Leads as opposed to PCN Clinical Directors or the General Practice Provider Board in terms of having sufficient time to focus on the relationships with wider Place partners to deliver the Integrated Care and Health and Wellbeing Board Strategies.

Questions / Comments

Richard Wright (RW) cautioned that committing to more expenditure in one area would have consequences on other areas, particularly as finite resources are available across the system, and some big challenges to be faced over the next few years. JM responded that investing in this area would be part of the solution to meet these challenges.

The Board:

 APPROVED the recurrent role of Integrated Place Executive Chair at 4 sessions per week with a fixed term office holder for a 3-year term

• APPROVED recurrent General Practice Place Lead roles at 2 sessions per week with fixed term office holders for a 3-year term
• APPROVED the proposed recruitment process

ICBP/2223/095: General Practice Provider Board

Dr Andy Mott (AM) provided an update on the work of the Derbyshire General Practice Provider Board (GPPB) in the context of the challenges faced by General Practice and requested recurrent funding to deliver the work programme.

Questions / Comments

• JM thanked AM for attending a recent Non-Executive Members meeting to provide an update on the challenges of General Practice. There is a need to understand the strategy and address the challenges being faced by GPs, Places and PCNs. Further conversations on this area of need were welcomed. An equal voice for GPs is critically important. AM would welcome such a discussion at a future development session.
• AB added that this will not fix all the problems in General Practice, although it will augment the ability to do so; the issues around General Practice recruitment, retention and workforce remain. General Practice, as a corporate body, needs to have a seat on the Board; AB enquired how the GPPB will ensure the system that their opinion is that of wider General Practice. AM considered this to be a pertinent question. There is a plan to ensure effective and active two-way conversations in General Practice as a priority; dedicated communications support will be required to achieve this. There is a sub-structure below the GPPB, including North / South Area Boards, to address the different tasks of each area to ensure localism. GPPB members are visible and have previous experience of system roles. Any disagreements will be managed to present a cohesive position; the role of the GPPB is to be that voice. There may be some challenges that are not directly within its gift to resolve; it is about cohesion and agreeing a clear narrative through collective leadership. AB added that, from a CPLG perspective, the work that AM has been involved in has been brilliant in pulling the General Practice voice together.

AM left the meeting at this point

CC presented a strategic view on the benefits of the GPPB. The following points of note were made:

• Unless core General Practice is an integrated part of the ICS it will not be possible to deliver true integrated care. This voice is needed at Derby and Derbyshire level, Places and PCNs; it is important to support this voice to grow.
• AM and colleagues are present on the Gold System Escalation Calls, providing a General Practice view to the system. The progress made in creating this voice was noted.
• General Practise is funded at an individual practice level. In addition to the national contract, there is a national Direct Enhanced Service that pays General Practices to work at a PCN level however there is no funding in the contract to support the infrastructure for at-scale working beyond PCN level. Depending on how it is counted, circa £200m is spent per year with Derby and Derbyshire General Practices for core services and PCN operating; today’s request for funding represents a 0.25% additionality of spend for at-scale working. Normally this scale of change would be managed through the annual planning and contractual processes.
• The progress made to the single voice was recognised, as was the importance of the ask towards the building blocks of integrated care.

The Board:

• NOTED the background section
• SUPPORTED the General Practice Provider Board‘s role in the system going forward
• NOTED the need to develop a Strategy for General Practice within the wider context of Place and Primary Care Networks
• APPROVED recurrent funding for 3 years for the core team

AM returned to the meeting at this point

ICBP/2223/096: System Development

Integrated Care

Dr Penny Blackwell (PB) and Tamsin Hooton (TH) gave an in-depth presentation on Integrated Care: Place and Provider Collaborative Development: 5-year roadmap and next steps, a copy of which was circulated with the meeting papers.

Questions / Comments

• This is a real change to the way the system currently works. Dedicated development time is required to discuss this in more detail and take a view on where the system needs to be in 5 years’ time and beyond and inform the delivery of the Five Year Forward Plan (RW). PB responded that, although some of the detail has been articulated, there is more do. TH welcomed the prospect of having more time to consider the systems needs over the next five year.
• The Joint Forward Plan is currently being developed, linked to the ICP Strategy. Direct development time will be required by the PHSCC to enable the asks of the ICB through a commissioning response. It is sometimes difficult to measure impacts; some of the near-term challenges being faced, and public expectations, need to be addressed to empower cultural changes to demonstrate the benefits of the work being undertaken. An action needs to be taken to make the links between what is being measured and integrated care work (ZJ). PB welcomed discussions at the PHSCC meeting once it has been agreed how commissioning will be undertaken. PB is happy to share the statistics available, and what Business Intelligence (BI) could add by better use of data.
• Accepting living with the interdependence and complexity of the ICS operating model of Place, Provider Collaboratives and Programme poses challenges to the ICB as to how it works within the operating model. The ICB has a key role facilitating and supporting the ICS structures; the BI structures and financial strategies need to work around Place, Provider Collaboratives and Programme, as does commissioning and estates. There is a huge opportunity for the ICB, as the leader of NHS family, to re-look at the way its functions are organised around the operating model and encourage other partners to do the same. Whilst new ways of working are being developed, the old functional processes remain. There is a direct challenge to the ICB and system partners as to whether they can imagine the core processes and enablers around Place, Provider Collaboratives and Programme (TA).
• There is a question around what needs to be done in 2023/24, given that the architecture has not yet fully matured. There is a need to do something for those patients experiencing access difficulties and health inequalities, whilst having agile governance processes to ensure improvements are made quickly. The appetite of risk to develop governance to ensure progress must be gauged (KG). TH responded that Delivery Boards (DBs) should be challenged to articulate how the significant changes required could be achieved this year. The development of community capacity to prevent admission and support discharge, if done effectively, will provide a stronger position for next winter, thus improving elective care; the plan must be translated into reality, ensuring that the governance structures and resources are made available. There is more work to do with DBs to progress the highest impact actions from their existing plans. PB added that one of the Place priorities is to widen the Team Up approach to include falls prevention and recovery and undertake proactive care planning in care homes and the community, focusing on discharge planning. Thought must also be given to prevention and what could be done now and for the next 5 years. Risk is hard to articulate, as confidence in risk is organisational and personal to individuals; this will present a cultural change that will take longer to resolve. Tackling risk and permissions to act is a key factor in discharge flows and planning.
• CC considered that the right areas are being addressed, however it is also about scale and pace, and the here and now. The ICB could make further asks on secondary and tertiary care services; conversations will be required with Provider Collaboratives across the East Midlands. In November, JM committed to integrated care as being one of the solutions. A challenging set of questions was set for provider leaders to respond to, to which an excellent response was provided during a significant operational challenge, whilst maintaining strategic business. CC considered that all the asks on the ICB are reasonable and necessary; although there are still details to work through, including assurance and interlinkage between the system and NHSE, the challenge this poses to providers is greater than the challenge to the ICB.
• There are two ways to look at this area of work: the impacts on patients and care and the changing way in which the system is working. It was requested that the enabling functions be added to this list ICB enablers (JM).
• It was perceived that more than one development session would be required to ensure this conversation continues and informs the Five Year Forward Plan (JM).

Integrated Commissioning

Julian Corner (JC) provided an overview of the development of an Integrated Commissioning approach within the system, as detailed in the meeting papers provided; work so far as been developmental and exploratory in trying to understand what this means. Commissioning is an enabling function and discipline that sits inside a wider understanding of what can be achieved. How to commission needs to be determined by what to commission; integrated care must be enabled by integrated commissioning as an attempt to step back from commissioning individual services in parts and integrate them as a whole. Commissioning is about how the money is spent; currently a lot is spent on the acute crisis end of system. Integrated commissioning is a discipline of thought to bring the ICB back to purpose through the use of data, collaboration, service design and public engagement.

Zara Jones (ZJ) added that the content of the presentation is the output from development discussions at the PHSCC. The purpose, end state, key objectives and priorities of integrated commissioning were outlined. There are key areas to be developed which will form part of the 5-Year Milestone and Plan. There is a clear task to develop integrated commissioning to respond to how the ICB commissioning function is organised at Place, Provider Collaborative and Programme level to prevent duplication; there is alignment and agreement on what is required to be taken forward. The key priority areas were identified, with an emphasis on organising the integrated commissioning function across the Integrated Care Partnership as a whole; to provide consistency, an agreed system approach will be required towards prioritisation.

Dr Chris Weiner (CW) referenced CC’s comment that ‘the challenge to providers will be bigger than the challenge to the ICB’; providers, through integrated commissioning, will be asked to work in a very different way going forward. Integrated commissioning is the big key that could unlock the capacity and ability of Place, Provider Collaboratives and Programmes to move in the direction of providing high quality, safe and effective services that could deliver a sustainable healthcare and wellbeing system. Population health management will be a fundamental part of this process, bringing together the issues on health inequalities, and the delivery of better health outcomes, with a key focus on the primary and secondary prevention agenda. This will influence other strategic aims including Starting Well, Living Well, and Dying and Ageing Well.

Questions / Comments

• How integrated commissioning is organised is important. Providers will face a huge challenge to shift money and resources into the community setting. Development time is required to further consider how commissioning will work, particularly the services being taken on by the ICB from April, to maximise opportunities (JM).
• Important discussions will be held across the East Midlands, Midlands and nationally on what needs to be done. The process being worked through now is one of check and challenge to gain collective confidence. Integrated care, commissioning and assurance are all equally as important; any part that does not move forward will hold things up (CC).
• It was enquired whether the discussions held included the voices of Place, Provider Collaboratives and Programmes to shape views going forward and whether these voices are built into the existing committee structures (JM). ZJ responded that collective voices are being heard across the system, with a pan-system working group established to develop the Joint Forward Plan. There is however a need to focus and work upon the common areas of integrated care, commissioning, and assurance.

Integrated Assurance

Sue Sunderland (SS) provided an overview of the task to consider existing governance and assurance arrangements and how they need to develop with the changes of duty from a system perspective. A meeting with Trust Chairs was helpful to explain what it is hoped can be achieved and provide reassurance on what it was not going to happen. From the outset, it was made clear that any system level assurance will not duplicate existing practice at organisational level. As far as possible existing information will be relied upon to report key information and enable constructive conversations and challenges to take place should any issues of concern materialise. A dialogue will be developed around governance and assurance on the new system duties and what is hoped to be achieved as a system going forward. The ICB’s role is system oversight; fulfilling this role needs to be done in a positive way to help drive change and transformation. The Trust Chairs were encouraged by the discussions held and are more relaxed at the aim being to avoid duplication.

It is hopeful that the Hewitt review will influence positive governance. One of the Trust Chairs involved with Hewitt review provided an insight into its content. Information on the need to cut running costs has recently been received; it needs to be ensured that any governance changes reflect the need to reduce the burden and that arrangements are as supportive and streamlined as possible.

Next steps include understanding what the current sources of assurance are and tackling any areas of duplication and gaps; it will then be considered how this is contributing to the assurance required at system level and how it reflects the challenges presented from integrated care. Where there is not good governance things start to go wrong therefore it is critical that it is developed alongside the other two areas to support them.

Helen Dillistone (HD) added that the key thing is to be clear on what needs to be governed across the system and wrap the integrated governance and assurance around them.

JM stated that, by moving away from an organisational to a partnership focus, this will have opportunities and risks on how to structure the governance. There is a need hold discussions with NHSE on how to shape governance going forward, as some parts of the current system do not reflect system working; the model of distributed leadership needs clarifying.

The Board NOTED and SUPPORTED the direction of travel for the ICB and its constituent elements, particularly Place, Provider Collaboratives and Programmes.

ICBP/2223/097: Integrated Care Strategy Update

Tracy Allen (TA) advised that the Draft Integrated Care Strategy was positively supported by Integrated Care Partnership (ICP) members in February. Work is now underway to finalise it before approval and sign off in April. It was presented to the ICB Board to support the direction of travel and commit to supporting the delivery of the Strategy going forward.

Voluntary Sector colleagues have been equal partners in the steering group established to oversee the compilation of the Strategy; they have made a commitment to develop the Strategy, influenced by insights from the Derby and Derbyshire communities. The Integrated Place Executive supported the work of the voluntary sector to harness and collate community insights across the partnership; this information has been fed to system leads to ensure that there is a golden thread from community insight to strategic key areas of focus and plans. The Strategy is predicated on a fundamental belief that if resources can be integrated for people, processes and tangible assets significant improvements could be made to health outcomes for the Derbyshire population. Since September, in conjunction with the ICP, four strategic aims have been developed to guide the strategy. The enabling functions and services have been considered and the importance extoled of a shared purpose, values, principles, and behaviours, with the architecture and governance wrapped around them to provide support. Three key areas of focus, one from each life course area, have been agreed to test how the different enablers could make a meaningful difference to outcomes for Start Well, Stay Well, and Ageing Well and Die Well. There is a need for all organisations to work together to develop the delivery plans; the way in which organisations work to develop the Strategy is as important as its content. Meaningful engagement will also be undertaken with members of the public to refine the strategy over the coming years.

Questions / Comments

• There is a need to reflect on the role of the ICB in these enablers; further discussion is required on this to define the ask of the ICB Board (JM). TA responded that Jim Austin has been involved in driving the Digital work through the System on the ICB’s behalf.
• It would be useful to map out the key milestones for the next five years (JM). TA stated that although it is early days there is a lot of good work going on; however, by the time the final strategy is presented in April it is hoped to be able to demonstrate these milestones and delivery plans.
• It was enquired whether there is enough engagement from NHS Providers into the ICP, as they have a big role to play (JM). TA informed that the ICP and Integrated Place Executive (IPE) still have work to do with NHS Foundation Trusts to enable them to accept that this will be part of their core business; Provider Collaborative and Place work has helped with this. TA is confident that the right people are involved in the IPE, however there is still work to do to ensure it is connected to Foundation Trusts.
• Discussion is required across the System on how and where to reposition the current resources to prevent duplication of parallel functions for this different way of working. TA advised that the Local Authorities have been actively involved in compiling the strategy; dedicated time has been provided to the core group by Derbyshire County Council, as well as external support; however, there may be a need for further funding to progress without external support in future. The ICB is having to look at reducing its running costs by 30%; this could be a catalyst for a wider discussion on system working.

The Board:

• NOTED the draft strategy and the actions underway to produce a final version
• AGREED with the direction set out within the strategy
• NOTED the role of the ICB in supporting delivery of the strategy

ICBP/2223/098: Operational Plan Submissions

Workforce and Commissioning – Zara Jones (ZJ) advised that a detailed Board discussion of the Plan is scheduled for 29^th March, for submission to NHSE on 30^th March. The overall message is that progress is being made however, there are still some risks and challenges to be worked through to comply with as many as possible national targets. The approach is grouped into three main themes: prevention, access, and productivity. The guidance acknowledges that prevention and the effective management of long-term conditions are key to improving population health and curbing the ever-increasing demand for healthcare services. Key areas of focus will include activity output, workforce, the financial gap, and performance.

Workforce – Amanda Rawlings (AR) advised that there is now a 4.3% growth in workforce included in the Plan, including substantive posts and bank and agency. There is an 8% growth across Primary Care and a 6% growth across nursing; work is underway to understand where these staff will work and the likelihood of being able to recruit them. The next iteration on workforce should be available by 22^nd March and a meeting will be held with the Finance and Estates Committee to look at the findings. Previously workforce has been retrofitted into the financial activity; this is not the approach being taken this year when it will be triangulated to provide a more robust plan. The People and Culture Committee will receive and oversee the delivery of the plan once finalised.

Finance – Keith Griffiths (KG) – The uplift for 2023/24 compared to the current financial year is only £15m more, on a £3b allocation, with a 4.3% growth in workforce. As at 10.3.2023, the system financial gap had moved from £149.5m to £144.4m; there is more work to be done to improve this position before final submission. A productive conversation held with NHSE led to a material reduction in expenditure that is currently being validated. Significant operational challenges are being dealt with to improve access, workforce, and cost of living increases, as well as dealing with the underlying financial legacy from 2022/23. Planning for 2023/24 has been undertaken differently with resources being disproportionately allocated to the deficits in a constructive manner. This will result in a compromise by provider originations to support out of hospital provision.

Questions / Comments

• Concern was raised around the level of workforce increase proposed; if this required increase is necessary, it was enquired whether the resources will be available. It was also asked whether some areas have too much resource which could be moved to help the areas that need it most. This is a huge increase which will be a key driver of the financial gap; if this is to be justified there is a need to understand how the challenges around activity are being addressed and how the gaps will be filled (SS). AR responded that work is now being undertaken to understand the granular detail. It is important to note that some of the growth relates to the EMAS Patient Transport Service contract. Productivity and efficiency should be challenged to utilise people in the right places. Over time the planning process will become more sophisticated.
• JM requested that, as the meeting on 29^th March is so close to the submission day, a risk analysis be provided to enable difficult decisions to be made should the figures not be acceptable to NHSE.

The Board DISCUSSED and NOTED the update provided on the Operational Plan Submission.

ICBP/2223/099: Report into Maternity Services at University Hospitals of Derby and Burton Foundation Trust (UHDBFT)

Dr Chris Weiner (CW) presented the Healthcare Safety Investigation Branch (HSIB) report into maternity services at UHDBFT, a copy of which was provided with the meeting papers. CW expressed thanks to the families involved in the production of this report, recognising their generosity in difficult circumstances. Through this report the System can move forward to deliver higher quality, safer services for pregnant women in Derby and Derbyshire.

It was recognised that this work was initiated by UHDBFT which approached the ICB after identifying a cluster of cases; these cases were investigated internally initially, and questions raised around gaining all possible learning. The ICB commissioned HSIB to undertake a review of the seven serious cases occurring between January 2021 and May 2022. The report has not identified any direct cause or link between issues found within services and the collapses. Ten safety prompts and five safety recommendations were identified by HSIB as detailed in the report and presented to UHDBFT’s Board. The ICB’s Quality and Performance Committee (Q&PC) received the report on 23^rd February. It is important that the ICB Board is fully sighted on implications of this report and had the opportunity to discuss it in the public arena.

Margaret Gildea (MG), as Interim Chair of the Q&PC, added that a presentation was received by the Committee which pointed out that UHDBFT had requested this review and was keen to implement the findings. The positives of the report were noted, as were the clear recommendations for improvement. There was a view that the cultural aspects of concern were being addressed. One issue was raised for consideration; whilst there was no medical causation links between the cases it was asked whether there were any health inequality / second language links, or location issues that might be relevant. Responsibility was delegated to the LMNS Board to receive the response from UHDBFT to prevent duplication and add value where it could make the most difference. The LMNS Board will be asked to seek assurance on a timely and effective response delivery, to be fed back to the Q&PC as appropriate.

Amanda Rawlings (AR) confirmed the report has been to UHDBFT’s Board and Governance Committee; a robust action plan was produced including development work to support the Obstetrics Consultants Team in terms of behaviour change. The action plans will be monitored as they mature and are learnt from and reported to the Board via the Q&PC Assurance Reports.

JM echoed his thanks, and commiseration, to the families for the role they have played over the last few months following the tragic events. The ICB’s role is to receive assurance that the actions are being taken forward accordingly. MG considered that it may also be appropriate to present the findings to the People and Culture Committee.

CC added that the insight to investigating the health inequalities approach was important. The process described, using the mechanisms in place was supported. It was enquired how this angle would be looked at as this felt different to traditional investigations. CW responded that within the initial setting out of expectations a theme analysis was included on the health inequalities agenda; the report does not comment in detail on the health inequalities issues. In the first instance HSIP will be asked for their observations on this perspective, and UHDBFT will be requested to review the cases with a focus on health inequalities.

The report was considered to be open and candid; there needs to be a look at how proactive, automatic psychological and peri-natal support is offered to women who have had traumatic births (CG). CW concurred with this comment, recognising that these families have been through extremely difficult events which will have lifelong impacts. It was noted that UHDBFT has looked to strengthen its governance and family liaison capacity; supporting people through life changing experiences is fundamental. The new Director of Midwifery at UHDBFT has brought in a lot of new learning and strengthening. AR added that the Trust is reaching out to organisations that perform well, as well as those that have been through difficult times, learning how to reshape their governance and approach. Additional capacity will pick up on the family liaison work, as it is fundamental.

The Board DISCUSSED and NOTED:

• the Healthcare Safety Investigation Branch report
• the delegation from the ICB Q&PC to the Local Maternity and Neonatal Services Board of the responsibility for receiving and gaining assurance on UHSBFT’s response to the HSIB report
• the Board THANKED the affected families for their generosity in agreeing to this review, which will help the Derby City and Derbyshire County NHS improve the quality of care for future pregnant women

ICBP/2223/100: Month 10 System Financial Position

Keith Griffiths (KG) provided a verbal update on the financial position as at Month 10. The following points of note were made:

• At the start of this financial year there was a £65m deficit. It was agreed in October/November that the aim was to deliver no more than a £19m deficit through transformation work. Signing up to a £19m deficit was seen as a step too far; there was a need to be bold and use the senior leadership judgement, knowledge, and experience available to improve on this figure.
• A recent conversation with Region has resulted in an improved predicted deficit of £13m due to the receipt of additional allocations.

The Board NOTED the verbal update provided on the Month 10 System Financial Position.

ICBP/2223/101: Audit and Governance Committee Assurance Report – February 2023

Sue Sunderland (SS) provided an update following the Audit and Governance Committee meeting held on 9^th February 2023. The report was taken as read and no further points made.

The Board NOTED the Audit and Governance Committee Assurance Report.

ICBP/2223/102: Derbyshire Public Partnership Committee Assurance Report – January / February 2023

Julian Corner (JC) provided an update following the Derbyshire Public Partnership Committee meetings held on 24^th January and 28^th February 2023 respectively. The report was taken as read and no further points made.

The Board NOTED the Derbyshire Public Partnership Committee Assurance Report.

ICBP/2223/103: Quality and Performance Committee Assurance Report – January and February 2023

Margaret Gildea (MG) provided an update following the Quality and Performance Committee meetings held on 26^th January and 23^rd February 2023. The following points of note were made:

• The report on maternity services was discussed.
• The ICB is not currently compliant with a number of statutory operational targets. The risk included in the Board Assurance Framework relating to this was revised and amendments were made to highlight the position further.

The Board NOTED the Quality and Performance Committee Assurance Report.

ICBP/2223/105: Population Health and Strategic Commissioning Committee Assurance Report – February and March 2023

JC provided an update following the Population Health and Strategic Commissioning Committee meetings held on 9^th February and 9^th March 2023 respectively. The report was taken as read and no further points made.

The Board NOTED the Population Health and Strategic Commissioning Committee Assurance Report.

ICBP/2223/106: Board Assurance Framework Quarter 4 2022/23

Helen Dillistone (HD) advised that significant developments have been made since the discussions held at the January meeting, through discussions at the corporate committees. It was requested that the Board sign up to the Risk Appetite Statement setting out the ambition on the approach to adopt.

The Board:

• APROVED the Quarter 4 2022/23 Board Assurance Framework
• APROVED and signed up to the ICB Board’s Risk Appetite Statement contained in the ICB’s Risk Management Policy
• CONSIDERED whether the risk appetite scores are realistic in relation to the ICB being at the beginning of a five-year plan; and that mitigations may be slow to show progress and achievement

ICBP/2223/107: ICB Corporate Risk Register Report – February 2023

HD presented this paper which was taken as read. No material changes have been made since the previous month

The Board RECEIVED and NOTED:

• the Risk Register Report
• Appendix 1, as a reflection of the risks facing the organisation as at 28^th February 2023
• Appendix 2, which summarises the movement of all risks in January and February 2023

ICBP/2223/108: Child Death Overview Panel Annual Report 2021/22

Brigid Stacey (BS) presented this annual report, which was taken as read. The ICB is in a statutory partnership with both Local Authorities and Police. The report demonstrated the processes and robust arrangements in place.

The Board NOTED the Child Death Overview Panel Annual Report 2021/22 for assurance purposes.

• Audit & Governance Committee – 22.12.2022
• People & Culture Committee – 17.12.2022
• Public Partnership Committee – 29.11.2022 and 26.1.2023
• Quality & Performance Committee – 22.12.2022 and 26.1.2023

The Board RECEIVED and NOTED the above minutes for information.

ICBP/2223/110: Ratified minutes of the Health and Wellbeing Board Meetings

Derby City Council – 10.11.2022

Derbyshire County Council – 6.10.2022

The Board RECEIVED and NOTED the above minutes for information.

Closing items

ICBP/2223/111: Forward Planner

The forward planner was NOTED.

ICBP/2223/112: Any Other Business

No items were raised.

ICBP/2223/113: Questions received from members of the public

No questions were received from members of the public.

Date and Time of Next Meetings

ICB Business Meeting                                  ICB System Focus Meeting:

Date:        Thursday, 20^th April 2023              Date:       Thursday, 15^th June 2023

Time:      9am to 10.45am                            Time:     9am to 10.45am

Venue:     via MS Teams                               Venue:     via MS Teams