Monday 16 January 2023, 12:30 - 15:00

Severus Meeting Room; First Floor, West Offices

Chair: Ian Floyd

Present
Ian Floyd (Chair)	Chief Operating Officer		City of York Council (CYC)
Simon Morritt	Chief Executive		Y&STHFT
Professor Karen Bryan	Vice Chancellor		York St John University (representing higher education)
Sarah Coltman- Lovell	York Place Director		York Place: Humber and North Yorkshire Integrated Care System (H&NY ICS)
Alison Semmence	Chief Executive		York Centre for Voluntary Services (CVS)
Cllr. Nigel Ayre	Executive Member for Finance and Major Projects		CYC
Professor Mike Holmes	Chair		Nimbuscare
Michelle Carrington	Executive Director for Quality & Nursing		York Place H&NY ICS
Gail Brown	CEO		York Schools & Academies Board
Martin Kelly	Corporate Director of Children and Education		CYC
Sian Balsom	Manager		York Healthwatch
Emma Johnson	Chief Executive		St. Leonards Hospice
Stephanie Porter	Interim Director of Primary Care		York Place H&NY ICS
Jamaila Hussain	Corporate Director of Adult Service and Integration		CYC
Present via MS Teams
Simon Bell	Finance Director		York Place H&NY ICS
Sharon Stoltz	Director of Public Health		CYC
Zoe Campbell	Managing Director		Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV)
In Attendance
Anna Basilico	Senior Programme Manager		York Place H&NY ICS
Michal Janik	Project Support Officer		York Place H&NY ICS
In Attendance via MT
Gary Young	Lead Officer Primary Care		York Place H&NY ICS
Debbie Mitchell	Chief Finance Officer		CYC
Apologies
Rebecca Field	Joint Chair of York Health and Care Collaborative	York Medical Group

Minutes – draft

Item

Title

Led by

Welcome and apologies for absence

The Chair welcomed everyone to the meeting and introduced new member of the partnership Martin Kelly, Corporate Director of Children and Education for City of York Council.

The minutes of the meeting held on 19.12.2022 were reviewed and there were no matters arising from the last set of minutes and the Executive Committee.

There were no declarations of interest in the business of the meeting.

Chair

Patient story

Mike Homes started the meeting by sharing how Nimbuscare and partners are working together to meet the health and care needs of asylum seekers.

Patients have been provided with good access to healthcare during their time in York, including access to a GP and referrals to specialists where required.

Mike shared a patient story about an individual who had more than one Long Term Condition and presented with health issues on their arrival to York. Further support has been offered from Refugee Action York who welcomed the individual and other asylum seekers into the community and offered psychological and wellbeing support from the local mosque. The patient feels safe and well looked after.

A discussion took place on challenges for professionals and a language barrier issue is a common theme across organisations.

Partners conveyed the importance to understand the voice of vulnerable groups to empower these groups. The YHCP requested a paper to be presented back to partners on vulnerable community's needs.

Action 1: Community resilience board to provide regular updates on communities via highlight report.

Mike Holmes

Jamaila Hussain lead

Overarching priority: System pressures

· System Pressures report

Following December meeting and partners feedback the format of the system pressure report has been improved with individual partners providing a summary position highlight key issues and pressure points for their organisation verbally at the meeting. Additional feedback on the format of the report was provided and partners suggested to extend time for this agenda item to encourage valuable discussion and to explore the data presented in more detail.

Partners provided individual update on the system pressure from the summary slide:

Public Health:

· Public Health are still waiting for confirmation of the budget. Pressures remain similar to December 2022.

General Practice

· Opel levels remain high across general practice. Work is ongoing across PCNs to pool data at place, this is a positive step forward towards agreeing a dataset that accurately reflects the pressures across general practice which could also inform a routine waits recovery plan. General practice has seen an increase in number of appointments offered.

Planned Care:

· Pressure continues to increase for planned care activity, a challenging Christmas period for UEC has impacted on the number of cancelled electives. Planned industrial action (including community nursing and 111) will add to the pressure. The system has planned well for the action and is prepared, learning from other areas. Partnership working has meant that the situation has slightly recovered, although the Trust remains at Opel level 4.

Emergency Care:

· Pressures continue to increase with a significantly challenged Christmas period leading into early January. As above, this impacted on elective care with increase cancellations, but partnership working has meant the situation has slightly recovered.

Adult Social Care (ASC):

· Referrals to ASC are higher at this point in the year compared to the same time period in 2022 (52 referrals). Whilst discharges are increasing, pressure will continue to be felt in the community and care providers, so the focus needs to be on patient flow for all settings.

Quality:

· The quality group continues to meet and will hold a series of deep dives focussed on existing concerns with an output of ‘I’ and ‘We’ statements.

CVS:

· The social prescribing team report increased concerns about the cost of living, individuals reducing their prescriptions to cut costs, and a lack of transport and interpreter services. The voluntary sector report concerns about the cost-of-living crisis and energy prices.

St Leonards:

· Recruitment remains an issue. St Leonards opened additional beds over Christmas period– now 10 operational beds. Plans in place to extend this further as part of wider system response.

Following the system pressure report, discussion took place regarding funding allocation process. Partners recognised that by focusing investments on front door resources and prevention could make an impact and take pressure from Emergency Department.

Action 2: Bringing funding discussions to YHCP to strengthen partnership decision making – HNY health inequalities funding to be discussed and signed off at the February YHCP executive committee – Peter Roderick and Sharon Stoltz lead

Action 3: Primary Care leads to look at local solutions for bank holiday cover for general practice to reduce pressure on system – Mike Holmes lead

Action 4: To improve uptake of additional short-term beds at the hospice to ease discharge pressures. Emma Johnson/ Michelle Carrington lead

Urgent and Emergency plan

The action plan supports YSTHFT with CQC regulatory requirements primarily impacting on delayed discharges. This is being led by Quality Improvement Group jointly chaired by ICB and NHSE and progress, outcome and risks from that work will be shared at the end of January.

Discussion took place regarding discharge and current schemes being in place to support this work. Data is being collected on the number of discharges being made a day per pathway. Partners recognised that investing in community resources to look at the discharge pending would further support this work. As part of the winter plan, schemes will be evaluated and those that are not progressing alternatives are being considered and for valued schemes substructure will be put in place.

Action 5: Forward planning – the YHCP has previously committed to coordinating a York Place winter plan for 2023 - Sharon Stoltz lead

Action 6. Work to understand how the YHCP holds itself to account for the delivery of the 2022 UEC plan -Michelle Carrington lead

Anna Basilico

/partners

Michelle Carrington/

Gary Young

ICB delegation, Place funding, resources

Sarah Coltman-Lovell, recently appointed York Place Director, provided an update on York Place arrangement highlighting the York Health and Care Prospectus and the York Health and Wellbeing Strategy as key guiding documents to help the YHCP realise its ambitions. Sarah emphasised key points related to maturity of the partnership and vision for the next 1-5 years with ambitions on how to get there.

To strengthen the YHCP's shared programme of work, partners suggested to undertake decision making in shadow form where it was in the YHCP's power to do so.

In addition, partners were also interested to find out what functions are being provided across the wider footprint such as nursing and quality function that runs across North Yorkshire patch, and what delegation responsibilities leaders from each partner organisation holds.

Action 7: Future paper to be brought the YHCP outlining what we could do differently and where shared decision making could be undertaken over the next year - Ian and Sarah lead

Discussion took place on funding and resources available at system level recognising that this need to be utilised differently to deliver services on an ICB allocation given. There was a joint commitment from partners to work together on funding allocation and identifying priority schemes that would make the biggest impact.

Sarah Coltman-Lovell

Engagement

Sian Balsom delivered a presentation on engagement and highlighted that partnership working should promote a listening and responsive culture across the system ensuring that decisions are made close to the people and communities they serve.

The discussion took place in relation to communication and engagement and partners were interested to learn what could be done at place level and what required permission from HNY ICB.

A gap in a designated engagement lead was recognised in York Place, and it was reminded that resources would be allocated from the ICB to support engagement following the consultation outcome. Karen suggested that master level students could support some of the engagement work as part of their study project.

Further work is needed to scope and align existing resource to increase the effectiveness of all the partners engagement activity. Sarah, Sian and Anna will take this forward with communication leads in HNY ICB and CYC.

Partners emphasised the need for honest conversation with the public on what can be delivered within the funding available.

Action 8: Sarah, Sian and Anna will take this forward with communication leads in HNY ICB and CYC. Paper outlining plan for YHCP engagement and communications to be presented at future meeting.

Action 9: Sarah and Karen to discuss possibility of engagement opportunities for master level students.

Sian Balsom

Resilient Communities Board-Subgroup update

Highlight report has been submitted from Resilient Communities Board-Subgroup with brief summary of sub-group recent activities and progress for the YHCP to note. There were no specific asks of the YHCP Executive Committee at present and the next steps was to present a report to the board March/April in regard to the further direction of commissioning for services across the CVS.

Jamaila Hussain

Community Health and Care-Collaborative

This item has been moved to a future agenda.

Yvonne Elliott

AOB

There were no items of any other business to be discussed at this meeting.

Chair