Agenda item

To receive an update from the NHS Gloucestershire Integrated Care Board on the One Gloucestershire Integrated Care System.

121.1  The Integrated Care Board Chief Executive delivered a presentation on the One Gloucestershire Integrated Care System (ICS). She provided Members with an overview of how the Integrated Care System worked, including its vision for health and care in Gloucestershire and key priorities, such as transformation initiatives and plans to improve care across Gloucestershire in the future. She further explained that the NHS Gloucestershire Integrated Care Board (IBC) was responsible for deciding how NHS money was spent in the local area and consisted of a formal Board structure with Executive and Non-Executive Directors.

121.2  The Integrated Care Board Chief Executive went on to explain that the One Gloucestershire Health and Wellbeing Partnership or ‘Integrated Care Partnership’ (ICP) included representatives from health, social care, public health, and voluntary sector partners and was responsible for writing the interim Integrated Care Strategy for Improving Health and Wellbeing in Gloucestershire. She confirmed that this strategy had been approved and published back in December 2022, and offered to circulate the published document to Overview and Scrutiny Committee Members.

121.3  In relation to issues and challenges particular to Gloucester, the Integrated Care Board Chief Executive confirmed that respiratory health was an issue in the city and that there had also been ongoing challenges with local dentistry provision. She noted that the ICP were focusing on tackling health inequalities, particularly in relation to children and young people, and provided an overview of the 10 priority areas to assist with the development of the One Gloucestershire workforce.

121.4  At this stage in the meeting, the Integrated Care Board Chief Executive invited questions from Members.

121.5  Councillor Wilson referred to the narrative in the presentation concerning the development of a Gloucestershire Citizens Panel and asked for further information as to how the panel would operate. The Integrated Care Board Chief Executive confirmed that the ICB were in the process of advertising for representatives and would be in a position to provide further information over the next few months.

121.6 The Chair also noted his interest in the Citizens Panel and suggested that the Overview and Scrutiny Committee might be keen to revisit this initiative and partnership working in the future. He stated that although oversight of health and social care was primarily a responsibility of Gloucestershire County Council, decisions made by the ICB and partnership would have an impact on City Councillors’ wards and constituents.

121.7 The Integrated Care Board Chief Executive delivered an additional presentation on the ICB’s approach to contract management, explaining that the ICB was a commissioning organisation and worked to design pathways for local health service procurement. She provided an overview of the stages of contract management, some of the existing contractual arrangements with Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Health and Care Foundation Trust, South Western Ambulance Service NHS Foundation Trust, Primary Care providers and local GP Out of Hours Services. The Integrated Care Board Chief Executive also provided Members with an overview of remedial actions to address under-performance or contract breaches.

121.8  In response to a query from the Chair regarding the contract with community pharmacies. The Integrated Care Board Chief Executive advised that pharmacy contracts were transferred to the ICB on 1^st April 2022. She noted that there had been a key focus on Dentistry and Optometry and provided Members with an overview of a new IT system which enabled Optometrists to view hospital results.

121.9  Councillor Gravells reflected on some recent scrutiny projects undertaken by the Health Overview and Scrutiny Committee for Gloucestershire County Council, noting that the Health Scrutiny Committee consisted of a number of elected representatives including one representative from each District Council. He shared with Members some of the work undertaken by the Committee on NHS111 services and noted that the recent inspection from the Care Quality Commission of Out of Hours services had confirmed some of the initial findings of the Health Overview and Scrutiny Committee. He expressed the view that it was important that health scrutiny should also recognise positive achievements, such as steps forward in reducing inequalities and advancements in robotics and Ophthalmology. The Integrated Care Board Chief Executive confirmed that she would be happy to feed back to the Overview and Scrutiny Committee on the ICP work around tackling inequalities.

 121.10         In response to a query from Councillor Wilson concerning executive decision making, the Integrated Care Board Chief Executive explained that the ICB was made up of 25 Members and included representation from NHS providers and Gloucestershire County Council. She noted that the ICP included representatives from the Gloucestershire District Councils and other partner agencies such voluntary sector organisations. The Integrated Care Board Chief Executive further explained that funding decisions were made by the ICB.

121.11          In response to a query from Councillor Conder relating to housing, the Integrated Care Board Chief Executive confirmed that the ICB had an interest in housing on hospital discharge, and that following discussions with the County Council, the NHS had agreed to fund several housing posts, such as frailty housing. She also referred to partnership working through the Gloucestershire Strategic Housing Partnership.

121.12          The Chair requested clarification on the term ‘Heat on Prescription’. The Integrated Care Board Chief Executive explained that Gloucestershire was one of the first counties taking part in a Warm Home Prescription pilot scheme which helped eligible residents pay their heating bill. It was noted that the scheme was targeted at residents who were experiencing difficulties with heating their homes during the difficult winter.

121.13          The Chair queried whether consideration had been given to working with libraries in Gloucestershire, to which the Integrated Care Board Chief Executive responded that there were small schemes in place, including working with local schools.

121.14          Councillor Durdey asked the Integrated Care Board Chief Executive what the local challenges in Gloucester were, and how Councillors may be able to assist with addressing these challenges. The Integrated Care Board Chief Executive noted that there was lots of community energy in Gloucester and confirmed that some funding was already being distributed to community networks and small groups. She felt it was key to ensure recognition of health inequalities and suggested that Councillors could assist with mapping the local support available. In relation to ongoing challenges, she noted that demand for Primary Care services had risen by 20% and that there was a need to think of different ways to deal with this demand, such as signposting to alternative services where appropriate.

121.15          Councillor Hilton outlined some difficulties he had experienced with making an appointment at his local GP surgery and asked what was being done to improve the quality of primary care in Gloucester. The Integrated Care Board Chief Executive noted that there was a challenge with recruiting GPs to work in areas of increased inequality and referred to her earlier comments around the 20% increase in demand for Primary Care services. She stated that the NHS was undertaking deep dive investigations to understand what had caused the spike in demand. She noted that residents with urgent medical issues would receive an on-the-day appointment and that colleagues were looking into modernising some of the telephone services.

121.16          Councillor Hilton raised concerns about the telephone appointment route and made a comparison to his experience of booking an appointment with his dentist. He also referred to the NHS app as an example of technology working well in this area. The Integrated Care Board Chief Executive acknowledged that Councillor Hilton’s surgery was in a particular hotspot area and that the deep dives would produce results within the next few months. She advised Members that some GPs were overrun with telephone calls and that staff had to triage and signpost where appropriate.

121.17          A discussion ensued around some Members’ positive experience with making appointments at their GP surgeries in Quedgeley and Kingsway.

121.18          Councillor Gravells raised concerns about patients behaving aggressively towards GP receptionists. He referred to work undertaken by the Health Overview and Scrutiny Committee around GP vacancies and noted his view that it was encouraging to see the ICB’s work in encouraging GPs to work in Gloucestershire. He also referred to Government initiatives to increase the number of GPs across the UK.

121.19          In response to a query from Councillor Sawyer regarding integrated IT systems, the Integrated Care Board Chief Executive confirmed that each individual part of the NHS system operated their own IT system, however initiatives such as ‘Shared Care’ records were in place and that it was hoped that there would be further IT pilots in due course.

          RESOLVED – That the Overview and Scrutiny Committee NOTE the presentation.