Agenda item

Committee are to receive a presentation and are invited to ask questions to representatives from NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board, regarding community services engagement (note: no papers are required or attached).

The NHS Bath and Northeast Somerset, Swindon and Wiltshire Integrated Care Board (BSW ICB) Community Services Engagement presentation was presented by invited guests Caroline Holmes and Gordon Muvuti. Councillor Helen Pighills, Cabinet Member for Community Health and Wellbeing was also present. The PowerPoint slides were provided.

The presentation provided an update on the board’s integrated community base care programme, which would be informing the recommission of community services from April 2025, whose area included the western part of Vale of White Horse (VOWH).

Below provides a summary of the discussion:

·       A member asked for clarity around the list of contracts and their ability in gaining new contracts with providers, and the different types of health services that would be provided. It was explained that in Swindon it was Great Western Hospitals NHS Trust and they held the community services for the scheme. With regards to Shrivenham (on the BSW ICB border) there were specific areas, such as community nursing and speech therapy, that were provided by Oxford Health. There were also contributions to three Minor Injury Units.

·       A member asked if the GP system fitted into the framework of the programme. It was explained that Elm Tree Surgery was one of the practices within the Swindon locality within the Integrated Care Board and was one of the primary care networks, which spread out into Oxfordshire for social care services and VOWH for some community services. Aim to operate fluidly around geographical boundaries and not let that affect people’s experience of care services.

·       A member commented on the digital platform and how it was progressing to be incorporated into the programme. It was responded that the ICB was developing an integrated care record, which was currently at a variety of levels of integration but was progressing. Aim to see increased opportunity of using digital platforms, such as apps and home monitoring.

·       A member asked for further clarification on dealing with crossing boundaries through their contracts and whether they overlapped. It was recognised that there was an ongoing need for neighbouring Integrated Care Boards to work together and there was real opportunity to build these relationships.

·       Cabinet member for Community Health and Wellbeing was welcomed to ask a question with chair’s permission. She asked about moving people from hospital care to home care and would this be possible in this overlapping boundary. It was responded that not much would change within the current framework, as this was already being done. A change in provider would not change this. Using Swindon as an example, performance levels were good but there were challenges with ambulance queues and handovers at Great Western Hospital.  Discharges were performing well.

·       Vale Council Leader was welcomed to ask a question, with chair’s permission. She asked about the connection between Oxford services and Swindon services, looking through the eyes of Faringdon and the western side of Vale of White Horse District. GP services for Faringdon were mainly BOB ICB, and hospital provision was BSW ICB, whereas Shrivenham GP services would be mainly through BSW ICB. It was therefore important to have good connections between services. The guests from BSW ICB did acknowledge there was a need to reach out to more groups within Oxfordshire, and Oxfordshire County Council, to ensure more positive links and connections. Existing pathways won’t change, but BSW ICB should make links with Oxfordshire County Council as they develop health services. Guest speakers suggested that they would take this away for consideration.

·       A member asked how the board envisaged working with VOWH District Council, being the main link into the area. It was responded that the board would look into this as they were currently in the process of appointing a new Deputy Chair of the strategic Integrated Care Alliance in Swindon, as well as looking into committee effectiveness and memberships. Guests from BSW ICB commented that they could work with Vale officers to look at joining up forums where VOWH can be involved, for both councillors and officers.

·       A member asked further questions on the digital platform, regarding the integrated care record, and whether this was something theBuckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB) was also going to do. If that was the case, members asked what the impact would be if patients were referred between geographical areas without this integrated record. The BOB ICB was trying to implement digital provision into community centres. A guest speaker agreed with this issue but expressed that there was currently no solution to this, but due to the NHS growing the “spine” of the NHS database, they believed a solution could be found. A lot of information can be shared across partners, but different areas may have their own bespoke systems (possibly several systems together), so this can be confusing when sharing information with other areas. There may be potential to address this through procurement process and looking at embedded cultures and working practices.

·       A member asked what were the key risks to the service becoming sustainable? The guest speakers responded that a big case for change was noting the number of beds needed and the possible influx of admissions if no changes were made, which would lead to a much larger amount of funding that would be needed to run the services. If we looked at supporting people in their own homes and support prevention (helping people to stay healthy, lifestyle, mental health), this would help sustainability rather than being a reactive service. This programme gives us opportunity to challenge and move towards being more sustainable and preventative. A cited example was 6% population growth by 2038 for the BSW ICB. Noting mainly 60+ age group and the fact that this group develops more chronic conditions, often more than one. Our workforce was changing and aging, retiring earlier also, impacting the services. Demographic changes would raise the cost of hospital services, noting that this was a national issue. If we did nothing, this was unsustainable, so we were working to transform our services to prevent the risks, treat people earlier and prevent conditions where possible. Technology may assist in this, and not all solutions were expensive.

·       A member asked about health scrutiny – it was confirmed that health scrutiny was combined with other scrutiny areas for Swindon. Noted that Oxfordshire County Council had a separate health scrutiny overview committee. Chair suggested that we should ensure all partners have effective and constructive scrutiny, this could be looked at.

Chair concluded the meeting as there were no further questions, the guest speakers were thanked for their time and expertise and it was hoped that the communication would be sustained between VOWH and the BSW ICB.