Agenda, decisions and minutes

To approve, and the Chair to sign as a correct record, the Minutes of the meeting of the Partnership held on Tuesday 13 June 2023.

RESOLVED:

That the Minutes of the meeting of the Health and Care Partnership held on 13 June 2023 be approved and signed by the Chair as a correct record.

To consider the Health and Care Partnership Tracker 2022/23 and information

regarding actions agreed at previous meetings.

RESOLVED:

The actions arising from the previous meeting held on 13 June 2023 were noted.   All other actions were completed or in the process of being completed.

Councillors to declare any disclosable pecuniary interests, other registerable interests, or non-registerable interests (including other pecuniary interests) they may have in the business to be transacted, and officers to declare any interests they may have in any contract to be considered.

None.

To consider:

BLMK ICB Report

Annex A: Target Operating Model consultation and organizational structure

Presentation: BLMK ICB Final Structure

The Partnership received a report from the Chief Executive, BLMK ICB.  Key areas of the report were highlighted:

·            From February 2024, most “Specialised Commissioning” would be delegated to ICBs by NHSE.  Specialised Commissioning related to the commissioning of high-volume specialised services, such as chemotherapy, radiotherapy and dialysis.  Very few of these services were currently delivered within the region, with most being delivered through hospitals in London or Oxford.  As the fastest growing ICB within the East of England, and one of the fastest growing nationally, there was a strong argument that more of these services should be delivered locally.

·            The Denny Review on health inequalities was due to be published shortly, and had received the support of all four Healthwatch groups in the region.  The ICB would consider the review and any recommendations in due course.

·            The success of the Health Inequalities funding model put in place by the BLMK ICB had been recognised nationally, and other ICBs were looking to replicate the model.

·            Financial pressures were being keenly felt by the ICB, councils and other partner organisations, all of whom were looking to make economies where they could.  Collaboration would be key to ensuring that gaps in essential services did not result from savings, and partners would be working together to ensure that their services worked in tandem with each other.

·            The ICB had recently held an employment seminar to consider the links between health and employment outcomes.  It had highlighted the connections between unemployment and ill health, and the stresses and strains that could result from becoming “trapped” in unstimulating employment.  The JLT was considering the findings of the seminar.

·            The ICB was currently reviewing its governance and structures, and had published its revised organisational structure.  This was a difficult period for many staff, as many of them had been placed on notice of change or redundancy.  Partners had helped to inform the new structure, to ensure that it provided a suitable operating model for the future.

Members of the Partnership considered and discussed the presentation.  Many areas of health and care locally were improving as a result of integration, such as the hospital discharge work, but one area that did not seem to be changing for the better was dentistry.  The Partnership heard that dentistry had been delegated to the ICB on the 1 April this year, once the annual contracts had already been agreed, giving the ICB little room for manoeuvre.  The specialised commissioning, covered earlier in the report, perhaps provided opportunities to improve access to complex dentistry locally, but otherwise no changes were anticipated soon.

Although work was being undertaken to improve data compatibility amongst the partners, it remained the case that partners were using incompatible computer data systems, e.g. across MKUH, MKCC and CNWL.  Members queried when measures would be in place to make these disparate systems more compatible.  The Partnership heard that progress was being made, but a fuller answer with details would be provided after the meeting, following consultation with technical colleagues.  ...  view the full minutes text for item HCP11

To consider the Bletchley Pathfinder proposal

The Partnership received a report from the Chief Executive of Milton Keynes City Council.  Key areas of the report were highlighted:

·            The key drivers of the Bletchley Pathfinder were the recommendations of the Fuller Report, and the priorities of local partners.  In short, this meant providing proactive, personalised care and support to people through a multi-disciplinary approach, and to help people stay well for longer as part of a stronger focus on prevention of ill health.  These objectives encompassed many areas of health and care, but an important thread running through it all, was the imperative to address health inequalities, to provide everybody with the same opportunities to lead a healthy and fulfilled life.

·            A neighbourhood working pilot had first been discussed by the partnership in February 2023, and again in June when the JLT was asked to use Bletchley for the pilot and to carry out background work in preparation for a September 2023 start.  Lots of work had now been undertaken by partners, including colleagues from Healthwatch MK, the NHS, Inspiring Futures Through Learning and MKCC.

·            Initial findings had helped identify the immediate tasks and challenges.  The first being how to develop personalised multi-agency responses, for which the proposal is to develop a “Team Bletchley” of professionals from those agencies and involving the voluntary sector, with a focus on delivering shared objectives.  Secondly, there was a real need to understand and develop ways of working that would enable the various partners to properly engage, without duplication and conflict.  There were differences of opinion and approaches to engagement, for example the relationship between schools and primary care was under-developed.  Thirdly, there was a need to put together a standard conferencing model for addressing issues that required input from several partners, which could be a family-focussed issue for example, or could be something wider.  At the moment there were several models employed by the different agencies and they were all very different.

·            Initial plans include the development of a “Bletchley Health Coach” model, the development of local support and activity groups, building on work that has already taken place on the Lakes Estate, and the introduction of programmes supporting families to eat well.  It was not proposed to construct “one size fits all” solutions; there were many groups and charities already carrying out good work in Bletchley and it was proposed that this work be built on and developed.

·            The Governance model was presented in the papers, of which a key element was the Bletchley Pathfinder Delivery Board, which would need to be independently chaired.  An indicative budget was also presented for consideration, with monies coming from ICB funds for health inequalities and place based co-ordination.

Members of the Partnership considered and discussed the presentation, which was welcomed.  The Bletchley Pathfinder offered a real opportunity to make a meaningful difference to resident’s lives, and members looked forward to learning more about the outcomes.  The project team were urged to consider “tearing up the rule book” where unnecessary bureaucracy presented obstacles.  ...  view the full minutes text for item HCP12

To consider, recommendations for the use of health inequalities funding

The Partnership received a report from the Director of Public Health.  Key areas of the report were highlighted:

·            The BLMK ICB made £2M of NHSE health inequalities funding available to places within the ICS, with each place receiving £500K.  Use of the fund was not tightly prescribed, but should be used to support measures to help reduce health inequalities.

·            It was recommended that around 70% of the fund be used to tackle inequalities as a part of the Bletchley Pathfinder, with activities such as lower cost access to fitness activities, school breakfast clubs, cooking classes and access to healthy food and a free bike loan scheme, with activities designed and delivered in collaboration with the voluntary and charity sector.

·            The remaining 30% would be used to support work to reduce inequalities within the community and primary care across Milton Keynes.

Members of the Partnership considered and discussed the presentation.  At the present time it was understood that the health inequalities funding would be a recurrent fund, i.e. a similar fund made available in future years for the same purpose, but this could not be guaranteed.  Public Health were asked to consider prioritising regeneration areas of the city in respect of the 30% of remaining funds.

RESOLVED:

1.      To approve the recommendation to deploy 70% of the available health inequalities funding on a large scale intervention as a part of the Bletchley Pathfinder work, with the remaining 30% to be used for community and primary care projects.

To consider, progress on active MK Deal priorities:

a. Improving System Flow

b. Reducing Obesity

c. Children and Young People’s Mental Health

a) Improving System Flow

The Partnership received a report from the Medical Director, MKUH NHSFT.

The key focus of this work was keeping people out of hospital that did not need to be there.  The longer someone spends as a hospital patient, in a hospital bed, the worse it is for their health and the more difficult it can become for them to return to the community.  In addition, Milton Keynes has a population whose average age is increasing, leading to an exponential increase in demand on hospital beds.  These difficulties are made worse by a hospital system that is complicated and inefficient in parts, with significant duplication of work at various stages of the process.  The system required simplification and streamlining; the team were on the right track and had made good progress in some significant areas, but it would take time to effect the levels of change desired.

MKUH had recently carried out some work with Healthwatch and residents, which confirmed that the current system left patients feeling helpless and unable to exert control throughout their hospital experience.

Recent developments and plans included a virtual ward, funded for 2 years.  This allowed patients to be properly treated in their own homes, rather than being admitted to hospital, through the use of a range of technologies.  Currently around 75 patients were being cared for using the MKUH virtual ward.  An integrated discharge hub was also being set up, collaboratively between MKUH, MKCC and CNWL, to streamline and facilitate patient discharge.  It was planned to have this up and running properly within the next two months.  A Health and Care Academy was being developed to provide training for therapists and carers; it would help fill vacancies and provide a better career pathway for those professions.

The Partnership considered the report and presentation.  In the context of the approaching winter, would these current initiatives be able to assist in what was likely to be a high demand period for the hospital?  It was planned to have the discharge team in place by the end of November, along with an increased capacity for the virtual ward.  By these measures it was hoped that some of the pressure would be taken off.  It was also important to seek to prevent those problems that led to hospital admissions, e.g. falls in icy conditions, and partners were working with the voluntary sector to consider what could be done.

Partners discussed the growing role of technology in supporting patients to remain well and under supervision whilst remaining in their home.  The Director of Adult Services explained that MKCC operates a support service which is significantly enhanced with the use of such technology.  The MedTech area was a rapidly developing area and new solutions were coming on line regularly, this could be deployed quickly and would become an increasingly important part of health and care systems generally.

b) Tackling Obesity

The Partnership received a report from the Director of Public Health

This was about helping residents to  ...  view the full minutes text for item HCP14

To consider, the Milton Keynes Better Care Fund Plan 2023 - 2025

The Partnership received a report from the Director Adult Social Care.

The BCF Plan had been worked up and agreed collaboratively with key partners, and submitted to and approved by NHS England.  The BCF has previously been an annual plan, but this year a two year plan had been prepared.  The plan would inevitably be varied over the period as it moved into the second year, due to the likelihood of change in areas such as system flow, demand for dementia care, and the availability of technology.

RESOLVED:

1.      That the Partnership express its thanks to the Better Care Fund team for the work carried out for the benefit of residents of Milton Keynes.

2.      To approve the Milton Keynes Better Care Fund Plan 2023-2025.

To note, the next meeting of the Health and Care Partnership is scheduled to take place on Wednesday 8 November at 2.00 p.m.

It was noted that the next meeting of the Health and Care Partnership would be held on Wednesday 8 November 2023 at 2.00 pm.