Health and social care organisations in Derbyshire have been working closely together for some time, to improve care and services for people and make them as efficient and effective as possible.
The Joined Up Care Derbyshire Board met in public on Thursday 16 September 2021. We have outlined below the key messages from the meeting and all related papers are available at https://joinedupcarederbyshire.co.uk/about/our-board
Selina Ullah, the recently appointed chair of Derbyshire Healthcare NHS Foundation Trust, was welcomed by colleagues to her first JUCD Board meeting. This appointment follows Caroline Maley's retirement from the post earlier this month.
Patient Story – Improving Autism Services in Derbyshire
A consistent theme in the research has been the need for organisations to put effective feedback mechanisms in place. Many NHS organisations told us that they struggle to analyse qualitative feedback such as stories and are more comfortable with quantitative analysis and data such as survey results. The emerging ICS have been asked to develop the culture and systems to act on feedback. Organisations who invest in feedback possess an ‘improvement mind-set’ and are committed to getting better. They understand that change is possible, and that things can be done differently.
• To shine a light and inform the Board on national changes in Autism
• To give feedback on the longitudinal experience and impact of our services.
• To provide information on the New National Strategy
The Board heard the story of Trevor, who had received a positive experience at the point of diagnosis and the positive impact understanding his condition had since had on his life and self-esteem but had found it challenging to link to post-diagnosis support in Derbyshire and had looked further afield. His experiences with his daughter had seen a more challenging process towards diagnosis, reporting a lack of joined up services and noting improvements that could be made to simple processes to ensure they could work more efficiently. It has also been challenging for his daughter when reaching the age of 18, with CAMHS support ceasing and there being a lack of adult support, exacerbated during the isolation of the Covid-19 pandemic. The Board considered what this experience means for our plans as an anchor institution in supporting employees who are neuro-diverse, the context of a whole-system approach needed to tackle the challenges faced by people with neuro-diversity and how we can enhance system leadership of this agenda from people with lived experience.
Current System Position
Significant system wide operational pressures continue to challenge the ICS as a collective with high demand and activity across all partners. The system’s level of operational resilience remains challenged with the ICS continuing to operate at the highest levels of escalation, with bed occupancy levels across general and acute and mental health more than 95%, where evidence shows that a figure below 90% is optimum. From a critical care perspective, the Royal Derby Hospital are supporting network partners (particularly Nottingham University Hospitals) and Chesterfield Royal Hospital operating at 125% of their normal critical care bedded capacity.
There are some specific services where operational resilience is of concern and impact on our ability to deliver comprehensive care including community nursing and therapy, care staff to support packages of care, theatre and medical assessment unit staffing. Given the pressures currently being faced by both our acute hospitals, this is a particular concern. Our System Operational Resilience Group continue to oversee the response and co-ordinate partner actions and collective actions to manage the current pressures. It has been and continues to be a considerable system effort in solving the challenges faced.
Our journey towards a statutory ICS
The pace of change was recognised by the Board, with guidance on progression towards the implementation of statutory ICS bodies being received and interpreted very regularly, and this at the time of a system under significant pressure in delivering 'business as usual' services and activities. Our capacity to implement these changes will be reviewed.
1. National ICS Guidance and Assurance
August 2021 has seen the publication of several key national guidance documents that will inform the work underway within JUCD. Each of the documents published has been reviewed by the ICS Transition Leadership Group. This series of guidance is primarily focused on supporting the legal establishment and operational readiness for April 2022 and includes materials such as the ICS Readiness to Operate Statement (ROS) and the ICS Establishment Guidance (Due Diligence). NHS England/Improvement has confirmed that the ICS ROS will be the primary mechanism for reporting and assuring progress towards ICS establishment.
NHS England/Improvement has provided feedback on System Development Plan and Transition Plan. These documents set out the steps we need to take to become a statutory ICS on 1 April 2022, including the closedown of NHS Derby and Derbyshire CCG, and to develop our system so that we can effectively deliver our ambitions for the people of Derby and Derbyshire. Feedback was very positive with a recognition that our system plans are well developed with a clear direction of travel to evolve and mature our ways of working. Areas noted for further development included setting out the role of the ICB organisation and the ICP, and that of place and provider collaboratives at scale.
2. Developing the ICS Operating Model
There is a focus on the function of the statutory Integrated Care Board (which is the organisation coordinating and delivering NHS care) and the Integrated Care Partnership (a statutory committee of the ICB involving a broad range of NHS, local authority and other public sector partners). On Wednesday 15th September, NHS England/Improvement issued an engagement document' promoting discussions on the creation of ICPs, which supports discussions that have been ongoing by the JUCD Board over recent months.
This process is complex to ensure we maximise our opportunities for partnership working to improve local health and wellbeing and reduce health inequalities, build upon those structures and processes that already exist and should continue, and discharge the duties placed upon us by the forthcoming guidance. Understanding the roles and the relationship of and between the Integrated Care Partnership, the Integrated Care Board, our existing Health and Wellbeing Boards, the role and links with Place Partnerships and the way we include and consult other partners including the voluntary sector, education, our district and borough councils and anchor and other partners is crucial, and this remains and ongoing conversation through September, with further discussion at the October JUCD Board meeting.
3. Other transition items
The Transition Assurance Committee reviews delivery against the plan to establish the new ICB and ICP and provides assurance to the Board. Items currently in scope for review include the memorandum of understanding which sets out oversight agreements and ways of working between respective parties involved in the transition; the work to understand the transfer process related to the decision to include Glossop within the boundary of the Derbyshire ICS; the mapping of functions of the CCG and others which require consideration in the formation of the new bodies and; due diligence across a range of areas in line with the nationally-mandated checklist.
System Financial Position
The Board had an in-depth conversation about the system's current financial status, including the ways we are addressing the underlying financial deficit within the NHS. Opening facts were that Derbyshire NHS currently allocates more money to its providers than it receives, resulting in an underlying financial deficit. Additionally, our provider organisations spend more than they are allocated. Finally, if we were to deliver all the care we are required to deliver, it would far exceed the allocations we currently receive. It is the job of the ICS to review these issues and to find solutions.
A strategic proposal in allocating and managing our finances is the value created by using our financial and other resources in new ways. Value in this context might be health outcome, quality of care, equity, user experience and resource consumption. All resources are finite, and this balance of allocating resources is not something we can move to quickly, but it will allow direct comparisons between opportunities to allocate resource to inform decision making and prioritisation.
We will take steps to align our transformation approach, with single calculations of investments and savings, reviewing our allocation and spend alongside each other. This needs to be allied to the work defined through our strategic intent and population health management priorities, with an understanding of how the financial flows work through our system through to our places, to ensure we can bring our system back to financial balance whilst also delivering the health and wellbeing improvements we desire across Derby and Derbyshire.
Place and Provider Collaboration
The Board heard updates on our work in developing our collaborative Place Partnerships, which have included the continued development of the operating model for place-based working, with involvement and support from all partners. This is benefitting from the receipt of ongoing national guidance and the progress with other building blocks within the Derby & Derbyshire system. Our approach to seeking the views of local citizens will be piloted in smaller areas, making use of the existing community engagement assets available to us in places, and benefitting from some of the system level engagement mechanisms we have been developing.
Our work to implement providers collaborating at scale is related to the place developments but requires a separate development journey to ensure we are in line with national guidance in this area. Consideration of the range of leadership models available has seen a recommendation for a Provider Leadership Board which brings together an alliance
approach among providers. This is important for our governance processes, as we seek to promote decision-making as close to the patient as possible. The conversation continues, and we must have our model agreed by 31 March.
System Leadership and Organisational Development
Through the discussion arising from many of the agenda items, a theme of collective leadership principles to help align the aspirations and common purpose of the system. The
People and Culture Strategic Oversight Group are building on the existing organisational development programme to further bind the shared work on the transition process, our
approach towards a different financial regime, our workforce development and the clarity we can share on our main priorities as a system.
Our next Board Meeting in public will be held on Thursday 18th November at 9am.
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