Agenda item

Members are asked to consider and comment on a report setting out a proposal to form a Joint Committee (Section 75 agreement) between Humber and North Yorkshire Integrated Care Board and City of York Council, as approved by the Council’s Executive in November 2024.

Members considered a report setting out a proposal approved by the Council’s Executive in November 2024 to form a Joint Committee (Section 75 agreement) between Humber and North Yorkshire Integrated Care Board (ICB) and City of York Council.

The Director of Public Health and the Assistant Director of System Planning, Humber and North Yorkshire ICB provided an overview, and in response to questions from the committee it was noted that:

·       This was an important step in the integration of health and care in York, alongside a shift in focus from acute care to prevention and the adoption of the neighbourhood model. With reference to any anticipated changes in health structures, it was noted that while these could change, core principles could survive those changes and the joint committee should enable better joined-up delivery.

·       With reference to the joint committee’s relationship with the Health and Wellbeing Board, it was noted that the latter was a statutory body and would be kept updated on issues of assurance and outcomes, but the core of its business including around wider determinants of health across York would remain the same.

·       No major changes were proposed to the governance of the Better Care Fund which would remain and continue to report to the Health and Wellbeing Board.

·       In response to concerns about the extent of consultation carried out, it was noted that there had been elements of consultation around this piece of work through existing structures which had been quite extensive; this report was instead focused on ensuring funding went where it was needed. While a full public consultation was not proposed, it had gone through the democratic process and a wide range of partners had been involved in the design, including the York Health and Care Collaborative, which included members with lived experience.

·       The example of Warwickshire ICB working with Fire and Rescue services on a frailty hub was noted, and it was confirmed that opportunities for similar work with Fire and Rescue through the York and North Yorkshire Combined Authority would be explored.

·       The need to measure performance effectively was emphasised; and it was noted that while not covered by this report, these would be developed over the coming years; this would entail more interdisciplinary teams and care plans being shared with multiple organisations to increase efficiency and improve patient experience, and it was noted that there were various examples of integrated teams freeing up time and resources in this way.

·       Several members raised concerns over the omission of climate considerations from the report, and it was confirmed that while this had not been noted in the governance arrangements covered by the report, the climate implications of travel and older health estate were acknowledged; partners were having strong conversations around this and the York and Scarborough Hospital Trust had a robust and sustainable carbon reduction plan in place; climate considerations also formed part of the neighbourhood plan to ensure more services were walkable to residents.

·       A variety of health sectors would be covered by the joint committee, although it was noted that pharmacy contractually in a different way; firewalls between different sectors were needed but efforts would be made to address concerns raised by the committee around pharmacy provision. With reference to small specialist services, it was noted that specialised commissioning had always sat outside local commissioning and would be done through the health collaboratives represented on the Place Board.

·       Reassurance was sought over the equity of resource allocation across the six Place areas covered by the ICB, given York’s historically low allocation. It was noted that at present this was based on historic allocation across Clinical Commissioning Groups, and that the ICB would review how it allocated growth and any new funding across Places. It was clarified that the £10.5m referenced in paragraph 10 of the Executive report was existing ICB resource and not new money.

·       In respect of decision making and governance, a partnership agreement would be developed and signed; it was noted that issues had not gone to a vote within the existing Place partnership but mechanisms were in place if needed, and issues around the development of the joint committee’s mechanisms could be brought back to scrutiny as required.

·       With reference to budgeting and potential overspends and underspends, appropriate provisions would be included in the Section 75 agreement. While the Council would assign some funding to the joint committee it would continue to meet its obligation to set a balanced budget, and work would continue on the draft set of financial risk principles at Annex 1 to the report.

·       York’s universities as well as several schools were part of the partnership, and while North Yorkshire Council was not part of the Place Board, all options to work together to improve services would be explored.

Resolved: To note the developments in health and care integration, and the opportunities, challenges and implications for the health and wellbeing of York’s residents.

Reason:     This is a key development in the York health and care system, and it is important the committee are engaged, involved and briefed.