Health and Wellbeing Board

 

        16th March 2022

Report of the Consultant in Public Health, Vale of York CCG and City of York Council

 

Update on the Integrated Care System

 

Summary

 

1.      This report updates board members on the national reforms to the NHS, health and care, and developments locally to plan for the changes which are due to come into force in July 2022.

2.      It also updates board members on the progress of establishing a place-based partnership as a joint committee of the North Yorkshire and Humber Integrated Care Board (‘The York Health and Care Alliance’) together with presenting minutes of the November Alliance meeting for the Board to note.

 

Recommendations

 

3.        Health and Wellbeing Board is asked to:

a)   Note and comment on the developments, including the proposed structure and arrangements for the NHS and care within our region from next financial year

b)   Note the minutes of the November 2021 York Health and Care Alliance meeting

 

 

Background

 

Update on current plans and governance of Integrated Care Systems

 

4.      The NHS White Paper ‘Integration and Innovation’ was published in February 2021; this led to the Health and Care Bill, published July 2021 which set out key legislative proposals for the NHS reforms. In summary, if the Bill is approved and subsequent legislation comes into force, this will lead to Integrated Care Systems (ICSs) being established on a statutory footing and taking on the statutory and allocative duties of Clinical Commissioning Groups (CCGs) in July 2022; from this point NHS Vale of York Clinical Commissioning Group will cease to exist.

5.        Humber Coast and Vale Partnership has operated as a non-statutory organisation for several years now, and in 2020 was designated an Integrated Care System (ICS). Once it is formally established in July 2022, the proposal is that it will be renamed, with the two arms of the ICS being known as ‘NHS Humber and North Yorkshire Integrated Care Board’ and ‘Humber and North Yorkshire Health and Care Partnership’.

6.        Plans for the Humber Coast and Vale Integrated Care System have been emerging over the last nine months, and in October the existing Humber, Coast and Vale Health and Care Partnership consulted on a draft constitution of the ICS.

7.        This sets out the proposed arrangements for the commissioning and planning of health and social care in our region based on:

·        Six places - East Riding of Yorkshire, Hull, North East Lincolnshire, North Lincolnshire, North Yorkshire and City of York;

·        Four sector-based provider collaboratives - Mental Health, Learning Disabilities and Autism, Acute, Community Health & Care and Primary Care;

·        a Humber, Coast and Vale wide Integrated Care Board - operating through 2 strategic partnerships of the Humber and North Yorkshire & York and a number of committees and forums

·        a Humber, Coast and Vale-wide Integrated Care Partnership

8.        An overview of the changes showing the current structures of the NHS locally and a simplified version of the new structures is shown below:

9.        The Integrated Care Board (ICB) will be directly accountable for NHS spend and performance within the system. The proposed outline membership for the ICB for the HCV region is:

·        Independent lay members (Chair and 2 non-executive directors)

·        Place perspective (one local authority member)

·        Provider perspective (one member each from acute trust, mental health trust and primary medical services (general practice)

·        System executive, including the chief executive, chief operating officer, director of finance, director of nursing, director of clinical and professional services, both strategic partnership directors, the people director, the director of transformation,)

·        Subject matter experts (Voluntary Sector, Public health, communities representative)

10.    The Integrated Care Partnership (ICP) is part of the ICS tasked with setting strategic direction and including a wide range of partners. The proposal is that HCV ICP base membership should be the six Health and Wellbeing Board chairs or other local government member, six place leaders, the ICB chair and chief executive, and other members of the ICS Executive in attendance as required.

11.    HCV Partnership has recently announced that it has appointed Sue Symington as its designate Chair, and therefore designate Chair of the anticipated ICB and ICP. In addition, the HCV Partnership (ICS) has recently announced that it has appointed Professor Stephen Eames as its designate Chief Executive, and therefore designate Chief Executive of the anticipated ICB and ICP. Final appointment to the role of Chair and Chief Executive of the ICB and ICP is dependent on the passage of the Health and Care Bill through Parliament, and any potential amendments made to the Bill and the subsequent legislation.

Place-based partnership: implications for York

12.    A key part of the reforms aims to reflect that planning of health and care service best works at three geographic levels:

·        Neighbourhood (population between 30,000 and 50,000 people)

·        Place (population between 200,000 and 500,000 people)

·        System (population between 1m and 2m people)

13.    The national guidance and legislation makes clear that ‘place’ in the new structure should be coterminous with a local authority area, and that the development of place-based arrangements between local authorities, the NHS and providers of health and care will be left to local areas to arrange.

14.    At place level, each area will be encourage to established a place-based partnership, which will be a ‘joint committee’ established between partner organisations, such as the ICB, local authorities, statutory NHS partners or NHS England and NHS Improvement. The relevant statutory bodies can agree to delegate defined decision-making functions to the joint committee in accordance with their respective schemes of delegation. A budget may be defined by the bodies delegating statutory functions to the joint committee, to provide visibility of the resources available to deliver the committees remit.

15.    As this governance develops at York ‘place’ it will need to:

·        Use existing mechanisms to embed collaboration, including joint commissioning and joint working (subject to CYC’s decision making framework and legislative/statutory framework).

·        Support the NHS to determine the most appropriate governance arrangements for the Integrated Care System by facilitating the emerging environment in York e.g. the Alliance Board

·        Ensure a clear line of sight between CYC health and wellbeing budget and joint arrangements, to ensure exit arrangements are in place, with CYC remaining accountable for its own delegated spend and cost controls.

·        Provide corporate assurance through officer-led engagement in the place based ICS partnership and member-led engagement in HWBB.

·        Broaden the functions and role of HWBB to support the place-based ICS partnership, providing opportunity for the Health and Wellbeing Board to play its full part within the Integrated Care System

16.   The York Health and Care Alliance was established in April 2021 as York’s response to these national health and care changes, and to start the work which will be needed if York is to have a place-based partnership able to take on significant responsibility.

17.   The Alliance Board was established as a sub-group of the Health and Wellbeing Board through consultation with the Health and Wellbeing Board. Papers relating to the establishment of the Alliance board, including a description of its purpose and its terms of reference, can be found in Council Executive papers from their meeting on 18th March 2021 (see background papers).

18.   As the Alliance Board transitions into a fully-fledged place-based partnership, its governance may need further refinement, and currently discussions are being held between York partners and the ICB on how best to establish the partnership formally.

19.    It is anticipated that Humber Coast and Vale are soon to announce the process for identifying managerial and clinical leadership at ‘place’ level, including the process for appointing an ‘NHS Place Director’ in each area (a senior NHS employee) and a ‘Place Lead’ (a senior officer or member of a statutory organisation e.g. Local Authority).

Roles of Health and Wellbeing Boards in the future system

20.    The new legislation includes several references to the role of Health and Wellbeing Boards.

21.    Before the start of each financial year, an integrated care board (ICB) and its partner NHS trusts and NHS foundation trusts must prepare a plan setting out how they propose to exercise their functions in the next five years. The integrated care board and its partner NHS trusts and NHS foundation trusts must, in particular:

·        give each relevant Health and Wellbeing Board a draft of the plan or (as the case may be) the plan as revised, and

·        consult each relevant Health and Wellbeing Board on whether the draft takes proper account of each joint local health and wellbeing strategy published by it which relates to the period (or any part of the period) to which the plan relates

22.    In addition, HWBBs are asked to give an opinion on ICB / Trust forward plans, Joint capital resource use plans, Annual reports (which must reflect local Joint Health and Wellbeing Strategies), and performance assessment of integrated care boards carried out by NHS England.

23.    A relevant ICB must appoint a person to represent it on each local HWBB. Functions of a local authority under sections 116 and 116A of the Local Government and Public Involvement in Health Act 2007 are to be exercised by the Health and Wellbeing Board and the Integrated Care Board jointly.

24.    Given this, it is imperative that we develop a strong role for the HWBB in the new system, both through the voice the Chair will have as a member of the HCV ICP, and as the body which sets the strategic direction for health and wellbeing which the York Alliance will work to.

Consultation

 

25.    This paper sets out an update on the progress of national and local reforms, and summarises a policy position taken by partners in York. Therefore most consultation has taken place within health partners in York, including with elected members. Currently, a broad public and third sector consultation is taking place led by the Alliance as part of their Prospectus work, around the type of things which characterise good health and wellbeing in the city, under the banner ‘York’s Health and Care Big Question’. As the development of a York place-based partnership proceeds, it is anticipated that much more public involvement, consultation and indeed co-production where possible is incorporated into this work.

 

 

 

 

 

 

Contact Details

 

Author:

 

 

Chief Officer Responsible for the report:

 

Peter Roderick

Consultant in Public Health

City of York Council / Vale of York CCG

Tel No. 07549123357

 

 

Peter Roderick

Consultant in Public Health

City of York Council / Vale of York CCG

 

Report Approved

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8th March 2021

 

 

 

 

 

 

 

Wards Affected:  List wards or tick box to indicate all]

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For further information please contact the author of the report

 

 

Background Papers:

 

Health and Care Bill 2021

https://bills.parliament.uk/bills/3022

 

Executive report March 2021 

https://democracy.york.gov.uk/ieListDocuments.aspx?CId=733&MId=12509&Ver=4

 

Annexes

 

Annex A: Minutes of the Alliance meeting held November 2021

 

List of Abbreviations Used in this Report

 

ICS – Integrated Care System

CCG – Clinical Commissioning Group

HWBB – Health and Wellbeing Board

ICB – Integrated Care Board

ICP – Integrated Care Partnership