Thursday 19 September 2024, 10:00 - 12:30

Severus Meeting Room; First Floor, West Offices

Chair: Ian Floyd

Present
Ian Floyd (Chair) (IF)	Chief Operating Officer	City of York Council (CYC)
Mark Bradley (MB)	Place Finance Director, North Yorkshire and York	Humber and North Yorkshire Integrated Care Board (H&NY ICB)
Professor Karen Bryan (KB)	Vice Chancellor	York St John University
Sarah Coltman- Lovell (SCL)	York Place Director	H&NY ICB
Dr Rebecca Field (RF) - part	Joint Chair of York Health and Care Collaborative	York Medical Group
Professor Mike Holmes (MH) – on Teams	Chair	Nimbuscare
Anne-Marie Roberts (AR) – on behalf of Emma Johnson	Director of Clinical Services	St. Leonards Hospice
Peter Roderick (PR)	Director of Public Health	CYC
Alison Semmence (AS)	Chief Executive	York Centre for Voluntary Services (CVS)
Cllr Lucy Steels-Walshaw (LSW)	Executive Member for Health, Wellbeing and Adult Social Care	CYC
Michael Melvin (MM) – part, on behalf of Sara Storey	Director Adult Safeguarding	CYC
Melanie Liley (ML)	Chief Allied Health Professional	York and Scarborough Teaching Hospitals NHS Foundation Trust (YSTFT)
Dr Helena Ebbs (HE) - on Teams	Clinical Place Director, North Yorkshire and York	H&NY ICB
In Attendance
Rachael Hammond (RH)	Graduate Trainee	York and Scarborough Teaching Hospitals NHS Foundation Trust (YSTFT)
Natalie Caphane (NC)	AD System Planning and Improvement	York Place, H&NY ICB
Zoe Delaney (ZD	AD Community Integration	York Place, H&NY ICB
Stephen Eames (SE) - part	Chief Executive	H&NY ICB
Hannah Taylor (HT)	Project Support Officer	York Place, H&NY ICB
Tracy Wallis (TW)	Health and Wellbeing Partnerships Co-ordinator	CYC
Apologies
Gail Brown (GB)	Chief Executive	Ebor Academy Trust
Michelle Carrington (MC)	Place Director for Quality and Nursing, North Yorkshire and York	H&NY ICB
Brian Cranna (BC)	Director of Operations and Transformation, North Yorkshire and York	TEWV
Cllr Claire Douglas (CD)	Leader of City of York Council	CYC
Claire Hansen (CH)	Chief Operating Officer	YSTFT
Simon Morritt (SM)	Chief Executive	YSTFT
Sian Balsom (SB)	Manager	Healthwatch, York
Gary Young (GY)	Deputy Director Provider Development	York Place, H&NY ICB
Sara Storey (SS)	Director Adult Social Care and Integration	CYC
Martin Kelly (MK)	Corporate Director of Children and Education	CYC
Emma Johnson (EJ)	Chief Executive	St. Leonards Hospice
Zoe Campbell (ZC)	Managing Director North Yorkshire and York	Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV)

1. Welcome, apologies for absence and minutes.

The Chair welcomed everyone to the meeting. Apologies were as noted above.

MH, ML and AS all declared an interest for Item 3 Community Frailty Services and Core Principles of an Integrated Commissioning Model; the Chair agreed there was no need for them to leave the room for this item.

The minutes of the meeting held on 8 August 2024 were approved.

There were no matters arising.

2. Feedback to the ICB on the Design for the Future Blueprint Proposition and York Future Model (for Internal Partnership Circulation only)

SCL informed she had shared the feedback within the report pack with the Executive Director of Communications, Marketing and Media Relations. Workshops for the York Future Model have taken place and feedback is due by the end of September 2024.

The ICB's System Leaders Forum have agreed to move the Future Blueprint forward to a strategic outline case and this will be agreed at the October System Leaders Forum.

3. Community Frailty Services an Core Principles of an Integrated Commissioning Model

SCL introduced the item explaining that the approvals for Frailty Services currently sit with the Place Director but over the coming months there is an intention to bring some of the strategic planning decisions through to the Place Board as part of the Place delegation plans.  ZD shared some background on what services the Frailty Hub offers, the Jean Bishop Centre being the inspiration for the York Frailty Hub model focusing on patient experience and how the service has expanded from the original Advice and Guidance line and which services are involved in the Frailty Hub. The Frailty Hub model aligns with the Humber and North Yorkshire (HNY) Core Community offer and the commitments proposed in the HNY Design for the Future Blueprint.

ZD shared that since the Hub's implementation in November 2023 it has supported 3000 crisis cases which has resulted in over 1100 Emergency Department attendances. A deep-dive showed that only five out of the first sixty Frailty Crisis Response Hub clinical contacts on 4-week follow up had been admitted to hospital showing the service helps people to stay at home. A pilot by Yorkshire Ambulance Service (YAS) of Call before Convey began on 12 August which has so far resulted in 34 conveyances prevented which if the rate continues the service could support 603 YAS ED conveyances to be prevented each year.

Ending ZD shared some case studies from people using the system and feedback received from some paramedics who have used the Frailty Hub service, one example showing that around six hours were saved by using the Frailty Hub service.

Detailed discussion included:

· Shifting resources from acute into community services and the pace in which they are shifted

· Offering student placements at the Hub if possible

· Performance at the trust has not been impacted by having the Frailty Hub and at what scale would the trust start to see an impact

· Further strengthening the Hub with other interfaces

· What is on offer for people who do not meet the Frailty Hub criteria

· Scaling up moving from a pilot to transformation for more impact

· Assurance that the Frailty Hub will continue

· How the Frailty Hub is being publicized

York Health and Care Partnership approved the recommendations within the report:

· Approve the ongoing service delivery of the York Frailty Crisis Response Hub.

· Note the intention for York Place to run a contract award process under the Provider Selection Regime (PSR) with the intention of awarding the contract for the Frailty Crisis Response Hub.

· Support the ongoing discussions and strategic steer over the next 18 months with particular a view to proposing a longer-term commissioning model to facilitate the integration of primary, community and social care services in line with the Core Offer developed and led through HNY community reconfiguration and Design for the Future work.

Action:

· ML, MH and RF to explore the option of Student placements within the Frailty Hub with the Trust and Primary Care

· NC to look at cost per contact within the frailty hub and compare to the indicative resource savings in avoided conveyances and ED attendances.

· NC to look at longer term projections for frailty and the impact of the hub, including consideration of scaling up the model to deliver system efficiency by reducing resource required in an acute setting.

4. York Joint Committee establishment, Section 75 Agreement between Humber and North Yorkshire Integrated Care Board and City of York Council

IF presented the report and reminded members of previous discussions that demonstrated the importance of creating something that doesn’t limit ambition and is owned by all partners. A report was approved by the Committee in April 2024 to explore options of a Joint Committee between the City of York Council and Humber and North Yorkshire Integrated Care Board to explore a Joint Committee operating with a Section 75. It was agreed a report would come in September 2024 as a stop/go point to proceed to the ICB/Council for approval. Currently across the system there is a £25m Section 75 Better Care Fund and this proposal would increase the Section 75 to £37m from 1^st April 2025, with the potential to increase to £337m.

SCL informed some of the reasons for setting up a joint committee include having better joined up services for residents, it will help to avoid costly decisions and it can facilitate provider organisation-agnostic and team-based approaches at all levels and evolving to more joined up care. The model for the Joint Committee will all be brought together with a signed partnership agreement signed by all partners. SCL emphasised that the model we want to create is much more than a mutually agreed Section 75 between the ICB and Council, and that this was really about Place operating as an Integrated Provider Organisation, working as one system, taking decisions together, for the benefit of our staff and population. Sharing the timeline SCL informed the plan to outline the proposal, process and governance to the Council and ICB Executive, followed by formal Council meeting and the ICB Executive Board in November 2023. Shadow arrangements would commence in December or January culminating in a final decision point in February/March 2025 outlining the intended outcomes and budgets.

PR continued the presentation and  stated that the Joint Committee model will mirror North East Lincolnshire but strenthen the financial section and reflect the complexity of the geographical issues within York Place's Bounderies. Continuing PR shared some of the principles underpinning the Joint Committee Section 75 and services and funding proposed for inclusion, noting that some services will be brought in at a later date for the best outcome.

Detailed discussion ensued on:

· Proposal of a six-month review point to check in with how it is working.

· Making decisions that don't compromise what is already taking place.

· Importance of creating something that works for York and not simply offering the same as other places, to ensure we deliver the very best possible outcome for the Place, the ICB, the Council and Humber and North Yorkshire.

York Health and Care Partnership were happy to approve the recommendations to:

i) Note the progress that has been made since the last Board update.

ii) Approve the decision in principle to develop and establish a Section 75 partnership agreement, and the NHS Place Director and Council Chief Executive to request approval from the ICB Board and City of York Council Executive to enable the new agreement to start on 1^st April 2025. 

iii) Approve the decision in principle for supplementary legal advice being sought to undertake revisions to the financial section of the agreement.

iv) Approve in principle that the Section 75 should be completed and signed in time for the agreement to become operational from 1st April 2025.

v) Note the intention to develop a signed partnership agreement to sit alongside the Section 75 partnership agreement to formalise integration arrangements.

5. System Assurance Report

NC shared some key areas of the System Assurance report including some improvement in Urgent and Emergency care but still some work needed to stabilize. The Trust are not meeting the 2024/25 improvement trajectory for the 4 hour A&E target though it has seen some improvement, Ambulance Handover times have improved to just under 40 minutes in August.

NC indicated that there are 702 people over the 52 week wait for Children and Young People's speech and language therapies, and an item will be going to the Trust's board meeting in September, the Primary /Secondary care interface group is continuing and areas where we are not meeting the trajectory are seen.

Discussion ensued that speech and language therapies, noting it is a national issue, York St John's University will be opening a master's course in September 2025 for speech and language therapies.

PR noted that the flu vaccination campaign dipped below 50% uptake in 2023/24 and encouraged all to push the campaign within their organisations.

Action:

NC to look to include the impact on people within the System Assurance report.

SCL acknowledged the need to review the assurance report in the context of Joint Committee plans.

6. Any other Business and Close

There was no other business raised.

Next Meeting: Thursday 24 October 2024