Agenda item

Progress update on transition to the Integrated Care System

This report will consider a progress update on the transition, governance arrangements and priorities for the Integrated Care System which will be implemented in April 2022.


6.1          Councillor Coleman provided a brief overview of the move towards a health administrative system which would see the decommissioning of clinical commissioning groups (CCGs) and the creation of a new integrated care partnership board to support an integrated care system (ICS).  The ICS would co-ordinate the delivery of local health services to 8 north west London boroughs and represented the coming together of different parts of the NHS. 


6.2          Jo Ohlson explained that the current system of CCGs would be disbanded in February 2022 subject to parliamentary approval of the legislation and any delay would see the CCGs continue as a statutory body.  The terminology was also in the process of being agreed but it was anticipated that there would be two statutory bodies established.  Robert Hurd had been appointed as the chief executive officer of the ICS and would replace the interim CEO, Lesley Watts, and he had already begun to meet with colleagues ahead of his start date on 6January 2022. The ICS anticipated the appointment of a chief nurse and a draft constitution had been prepared which specified a constitutional membership governance mandate, as specified by NHS England.  In terms of ICS priorities, it was reported that delivering the areas Covid response was key.  Numbers of Covid cases were increasing exponentially and this coincided with winter pressures, exacerbating concerns about increased susceptibility to flu caused by low immunity.


6.3          Councillor Coleman observed that the ICP had made successful progress, beginning slowly at a senior level and had gathered momentum with signs of improved communication on multiple levels. At the same time the disproportionate impact of health inequalities minority ethnic communities, had been recognised.  The NHS, and NWL in particular had acknowledged that structural racism existed and was endeavouring to working directly with black communities, a bold decision which was commended. Exploring the configuration of the ICP board, Jo Ohlson confirmed that there would be improved local authority representation on the board and recognised that the integration of partners and the integration of component parts of the NHS were both equally challenging. 


6.4          Part of the change process would involve the development of provider collaboratives and this would be considered both in acute mental health services and community collaboratives to ensure a greater convergence in service standards and delivery.  This would not necessarily dilute services and Jo Ohlson described a detailed piece of work in community nursing and the delivery of intravenous fluids where small refinements had allowed people to remain in their homes whilst being treated.  Other refinements included improved rapid response times to urgent care cases which had helped to alleviate pressure on the London Ambulance Service.


6.5          Jacqui McShannon confirmed that despite challenges in Children’s Service, there had been improved partnership collaboration at a local, placed based borough level.  There had been a greater inclusion of local authorities and this would continue to evolve despite some false starts and challenges to overcome. There had been a welcome commitment from health colleagues which indicated a positive direction of travel. Children’s Services could not be an isolated voice and greater advocacy was required throughout the collaborative and newly integrated system.  Jacqui McShannon welcomed the establishment of a dedicated team on children and mental health, together with the implementation of a new board that would report to the ICS and HWB.  Greater clarity was anticipated as the terminology and systems links between the new and evolving statutory bodies still caused confusion.  Sue Roostan recognised that there were challenges and a decision had been taken within the ICP to have an all age framework throughout the different campaigns, including for example, frailty campaign. She assured the Board that the ICP had taken a decision to identify four campaigns to allow greater focus and prioritisation but it would continue to monitor and review the possibility of having a children and young peoples’ specific campaign in the future.


6.6          Janet Cree echoed comments about the ICP perspective regarding the children and young people’s programme. The ICP was drawing upon existing learning and experience to work increasingly more closely with children’s services in the local authority.  Communication channels would continue to be monitored to ensure greater clarity and sharing of information at a local level and which would feed into the NWL ICP programme.  She acknowledged the challenges articulated by Jacqui McShannon to ensure that there was clarity about care being delivered and that this covered all ages but that this could also be specifically children focused where required.  There had been a sense of change within the ICP as it reorientated towards working across the whole ICS system and a small example of this was a weekly meeting within the gold meeting system regarding paediatrics to report the challenges that might be experienced.


6.7          Councillor Coleman referenced the current NWL palliative care consultation, which was expected to conclude on 23 February 2022, and highlighted the different approach required for children’s palliative care compared to adults. He enquired if this would be acknowledged within the consultation framework. Janet Cree confirmed that the consultation was focused on specialist adult palliative care and acknowledged that there was a different approach to how children’s end of life care was managed and supported. However, this would not preclude an all age approach as benchmarking work would be undertaken to ensure that the service aligned to national standards.


6.8          Lisa Redfern asked which healthcare priorities and services would be scaled back or paused while the booster delivery programme was prioritised.  Jo Ohlson confirmed that this was a rapidly moving situation and that further communication about primary care priorities about this was expected imminently. Some guidance had just been issued about clinical priorities but these would need to be followed up. The guidance letter had confirmed that a level four incident had been declared and that the booster vaccination programme would be prioritised for the next three weeks. In addition, resources would be used to support emergency care pathways and there was currently a review underway to identify the most urgent priority cases for elective surgeries.  Whilst that they would try to keep many services going as possible, what this translated to in real terms was that there would a reduction in non-urgent outpatient services with staff redeployed to deliver the booster campaign.  Primary care GPs had been contacted and requested to support a doubling up of the booster campaign and additionally, to continue to support urgent and emergency care pathways. The expectation was that practices would continue to be accessible but that they would also identify the most vulnerable patients, including for example, asthmatic children.  Further information about priorities was expected and these would be reviewed again in January.


6.9          Exploring the logistics around supporting the delivery of the booster programme, Councillor Coleman focused on the need to have more people trained to vaccinate, which would release GPs to continue to deliver primary care.  Jo Ohlson stressed that delivering the booster programme presented a huge logistical challenge to scale up the programme to deliver the expected increase of 250k vaccines per week and this extended beyond the provision of GPs. It also required a significant increase in the number of vaccinators and vaccine supplies. Councillor Coleman asked if a request for vaccinators was made, would there be sufficient resources available to train them.  He indicated that council staff within the borough would be willing to respond and support such a request.  Janet Cree confirmed that there was limited capacity to train more vaccinators to vaccinate within the next three weeks and that they were currently trying to deploy trained staff as efficiently as possible.  There would be a period of mobilisation to meet the surge in demand, followed by inactivity so it was important to maintain consistent and clear messaging. Vanessa Andreae commented that GPs had oversight of lay and clinical vaccinators which comprised of nurses, students and non-clinical health staff and she expressed her concern that routine primary care services would be in hiatus during this time. There would be further delays to non-life threatening conditions and treatments which would be difficult and frustrating for those having to self-manage their conditions.


ACTION: Sue Roostan to circulate details about vaccinator training


6.10       Jim Grealy sought clarification about the frequency of ICP and ICS governance meetings and the differences of this. In the context of ‘power of place’ he also noted the lack of reference to H&F patient group meetings.  There had been a proud history of coproduced bottom up health engagement in the borough but there continued to be a lack of trust from patients who were concerned about the vaccine.  In the current situation, social distancing may increase and so it was important to include a local aspect.  Jo Ohlson recognised the borough as the place for local service delivery and that NWL priorities would be structured to reflect to ensure a locally strategic allocation of resources and decision making.  The development of local standards for community services such as primary care, mental health and access to care homes reflected place based delivery so that residents would know what to expect to receive either in a care home or from a GP consultation.  It was important to understand the variation in local conditions and coproduction was key, particularly in terms of supporting minority ethnic groups and disabled people. 


6.11       Councillor Quigley commented on the prime minister’s announcement at short notice to deliver the booster programme by the end of December. There was a collective responsibility to provide clearer, strategic guidance to ensure that expectations could be properly managed.  She shared her fears and anxieties as person who had been advised to shield and had received her booster, however, there were many who were unsure of what to expect over next few weeks.  Sue Roostan assured Councillor Quigley that she and her colleagues had a strong awareness of the collective responsibility around vaccine delivery and planning and that they were committed to implementing a plan of action for H&F.  While it was recognised that the discussion had circulated back to the issue of Covid dealt with earlier, Councillor Coleman welcomed the commitment of health colleagues who had advocated so strongly on behalf of the borough and the needs of its residents.  He reiterated his view that the number of hubs and vaccinators available in the borough need to be urgently revisited.




That the report and actions were noted.


Supporting documents: