Adult Social Care and Health Scrutiny Committee 5 July 2021

Adult Social Care and Health Scrutiny Committee

5 July 2021

Integrated Care System, Integrated Care Report Title: Partnership, the White Paper and Local Developments

Cabinet Portfolio Integrated Care and Health

Cabinet Member Councilor Marlene Quinn

Exempt Report No

Reason for Exemption N/A

Key Decision No

Public Notice issued N/A

Wards Affected All

Mark Palethorpe Executive Director of Integrated Health and Social Care, Accountable Officer CCG [email protected] 01744 671822 Ann Marr OBE Chief Executive, St Helens and Knowsley Hospitals Trust Report of [email protected] 0151 4301242 John Heritage Executive Director of Partnerships, Mersey Care [email protected] 07468 692128 Wayne Longshaw Director of Integration Contact Officer [email protected] 0151 6765721

Ensure children and young people have a positive start in life

Promote good health, independence, and care across our communities X

Borough Create safe and strong communities and neighbourhoods for all priorities Support a strong, thriving, inclusive and well-connected local economy

Create green and vibrant places that reflect our heritage and culture

Be a responsible Council

1. Summary

1.1 This report provides the Scrutiny Committee with an update of the developments at a national, regional and local level. This is a co-produced report that has been developed by officers from the Local Authority, CCG and provider partners from St Helens and Knowsley Hospital Trusts and Mersey Care which recently acquired North West Boroughs. The paper apprises members of the latest developments at national, regional/system and local levels.

1.2 National Picture – The government produced its white paper on 11 February 2021, which signaled the Government’s intent legislate for changes and the Queen’s Speech which announced the Health and Care Bill to be read in the current parliament.

1.3 The new Bill will introduce wide ranging changes to health and social care including:

 Give greater powers of intervention to the Secretary of State for Health and Social Care  Create single national NHS hierarchy – NHS England  Make ICS’s statutory NHS bodies  Abolish CCGs  Create a Duty to Collaborate (Local Authorities and NHS bodies)  Mandate the creation of Provider Collaboratives

1.4 Region/System Level – The North West Region now has three Integrated Care Systems (ICS): Greater Manchester, Lancashire and South Cumbria and Cheshire and Merseyside which was recently designated an ICS on 1 April 2021. The ICSs will become the main vehicle for the planning, resourcing and monitoring of performance for health investment and outcomes for the sub region from the 1 April 2022 when it becomes a statutory organisation. 1.5 The ICS has established a Joint Commissioning Committee in advance of the legislative changes that would establish a single CCG for Cheshire and Merseyside from April 2022. The Joint Committee consists of the nine CCGs to make some commissioning decisions ‘at scale’ across Cheshire and Merseyside.

1.6 The overarching role of the Joint Committee is to enable the Cheshire and Merseyside CCGs to work effectively together and make binding decisions on agreed service areas, for the benefit of the population registered with a GP practice in Cheshire and Merseyside.

1.7 The default principle is that wherever possible, commissioning decisions should be made at ‘Place’ with only those commissioning decisions which make sense to do at scale being undertaken at a Joint Committee of CCGs across the Cheshire and Merseyside footprint.

1.8 It should be noted that the Regional Director for the North West will be stepping down from his role in July 2021 and the current Chair and Chief Officer for the Cheshire and Merseyside ICS have announced that they will not be putting their name forward for consideration to lead the new statutory organisation.

1.9 Local Developments - St Helens Cares has evolved into an Integrated Care Partnership (ICP). The report highlights the timetable for this year of transition, particularly the establishment of Integrated Care Systems (ICS), the dissolution of CCGs and the implications for St Helens.

1.10 St Helens and Knowsley Hospital Trust (STHK) continues to treat some patients with Covid-19 and is committed to restoring services to reduce backlogs in elective care brought about by the pandemic. The Trust has been operating the Mass Vaccination Centre at St Helens rugby stadium which until recently was also occupied by primary care colleagues delivering vaccines. The Trust is also part of two newly developed provider collaboratives; 1) Mental Health and Community Services and 2) Acute and Specialist Trusts, the latter is led by the CEO of STHK.

1.11 North West Boroughs was formally acquired by Mersey Care on 1 June 2021. Mental Health and Community services have been transferred to the acquiring organization along with staff TUPE-ing across to Mersey Care to ensure a seamless transition of services for our residents.

2. Recommendations for Decision

The Scrutiny Committee is recommended to:

i) Acknowledge that 2021/22 is a year of significant transition brought about by the forthcoming legislation.

ii) Recognise the context and the changing landscape for health and care in the Borough and in the wider Cheshire and Merseyside system

iii) Note the focus of local providers working collaboratively to restore services, reducing backlogs impacted by the pandemic, and bringing forward ways of working to improve services for our residents. 3. Purpose of this Report

3.1 This report updates the Scrutiny Committee of the legislative developments resulting from the White Paper and most recently the Health and Care Bill announced in the Queen’s Speech. The new Bill will introduce wide ranging changes to health and social care and is likely to become law by 1 April 2022. The Cheshire and Mersey Care ICS will become a statutory body and the local CCGs will be dissolved with effect from 1 April 2022.

3.2 St Helens Cares has been at the forefront of integration and partners have taken preparative steps with the early development of an Integrated Care Partnership (ICP) with robust governance arrangements to ensure that we continue to lead the way in Cheshire and Merseyside.

3.3 Changes to the provider landscape is taking effect in a number of ways; 1) new legislation, 2) the impact of the pandemic and 3) transactional arrangements through the acquisition of the former North West Boroughs Healthcare NHS FT by Mersey Care NHS Foundation Trust.

4. Background /Reasons for the recommendations

Legislation and System Requirements

4.1 The Health and Care Bill will, when enacted in law introduce the widest set of reforms for Health and Care for almost a decade.

4.2 The new Bill will introduce wide ranging changes to health and social care including:

4.3 The statutory Integrated Care System (ICS) for Cheshire and Merseyside will have a considerable remit, being responsible for in excess of £4.5bn of health spending. Key functions include:

i. Making decisions about local NHS planning and funding allocations ii. The responsibility for the commissioning functions of the CCGs and some of those of NHS England, as well as CCGs’ responsibilities in relation to Oversight and Scrutiny Committees iii. Have a unitary board - this will be directly accountable for NHS spend and performance within the system, with its CEO the Accounting Officer for the NHS resources allocated to the ICS iv. Be responsible for: o developing a plan to address the health needs of the system; o agreeing the strategic direction for the system; o setting out the plans for both capital and revenue spending for the NHS bodies in the system o establishing a forum for wider system partners to develop collaborative working arrangements (Health Care Partnership) 4.4 The ICS will be able to discharge its statutory duties in three ways:  Commission at the system level  Discharged through provider collaboratives  Delegated to place: Integrated Care Partnership (ICP)

The Cheshire and Merseyside ICS plan places great emphasis on “primacy of place” to focus on health inequalities, outcomes and equity of access. Places are based on local authority boundaries and there will remain nine in Cheshire and Merseyside, of which St Helens will be one.

4.5 A statutory ICS will be in place by 1 April 2022, the time-line for the implementation of the new arrangements is shown in the table below:

4.6 Cheshire and Merseyside ICS requires that each place form an ICP which will have seven core features:

i. have an ICP Board with a breadth of partners i.e. L.A., PCNs, housing, third sector ii. have a designated place lead who will liaise with the ICS iii. develop a vision for reducing health inequalities in each place iv. agree an ICP development plan v. have defined neighbourhoods/localities which will be clinically led by PCNs vi. have public and stakeholder engagement programmes vii. have integrated commissioning between health and social care e.g. shared posts and pooled budgets

4.7 St Helens is well placed to meet these requirements. We have an established ICP Board; we have a designated place lead and a strong vision for reducing health inequalities. Our ICP development plan is taking shape. A number of development sessions are scheduled in June and we have established localities with primary care networks central to our ambitions to create care communities. We have a well-established stakeholder forum and finally our integrated commissioning is the most advanced in Cheshire.

4.8 The governance arrangements are shown in the diagram below:

4.9 All the ICP boards and groups are active and functioning, the governance arrangements in a number of places elsewhere in Cheshire and Merseyside are still at the planning stage.

4.10 The ICS has established a Joint Commissioning Committee in advance of the legislative changes that would establish a single CCG for Cheshire and Merseyside from April 2022. The Joint Committee consists of the nine CCGs to make some commissioning decisions ‘at scale’ across Cheshire and Merseyside.

4.11 The overarching role of the Joint Committee is to enable the Cheshire and Merseyside CCGs to work effectively together and make binding decisions on agreed service areas, for the benefit of the population registered with a GP practice in Cheshire and Merseyside.

4.12 The default principle is that wherever possible, commissioning decisions should be made at ‘Place’ with only those commissioning decisions which make sense to do at scale being undertaken at a Joint Committee of CCGs across the Cheshire and Merseyside footprint.

4.13 The 9 CCGs have worked together on the ToRs and the first meeting is being held in July 2021. The meeting will be held in public. Overleaf is the initial work plan for 2021/22:

Service area to Specific services to be included in the workplan be commissioned of the Joint Committee of Cheshire and Merseyside CCGs ‘at scale’ Mental Health A. Specialist Community Perinatal Mental Health services Services B. Children and Young People mental health services  Crisis services  Eating disorder services C. Agree common standards and develop a common workforce strategy for Improving Access to Psychological Therapies (IAPT) to address widespread variation in access, provision, quality and outcomes D. Adult Crisis services E. Out of area placements and inpatient services Acute services A. Specialist Rehabilitation Services (Neuro, Mental Health, Stroke, complex cases) B. Re-procure Bariatric services during 2021/22. C. Spinal Services D. Influencing services which are provided at scale such as ambulance services, specialist services etc

4.14 It should be noted that the Regional Director for the North West will be stepping down from his role in July 2021 and the current Chair and Chief Officer for the Cheshire and Merseyside ICS have announced that they will not be putting their names forward for consideration to lead the new statutory organisation. The recruitment process has commenced for a Regional Director and also for the C&M ICS Chair. The appointment of the Accounting Officer for the C&M ICS will be made when the Chair is in place.

Provider Landscape, Challenges and Changes

4.15 The health provider landscape faces significant challenges as well as change. St Helens and Knowsley Hospital Trust (STHK) continues to treat some patients with Covid-19 and is committed to restoring services to reduce the backlogs caused by the pandemic. The Trust has been operating the Mass Vaccination Centre at St Helens rugby stadium which until recently was also occupied by primary care colleagues delivering vaccines. The Trust is also part of two newly developed provider collaboratives; Mental Health and Community Services and Acute and Specialist Trusts, the latter is led by the CEO of STHK.

4.16 The NHS issued planning guidance for 2021/22 which sets out 6 priorities:

i. Supporting the health and wellbeing of staff and taking action on recruitment and retention ii. Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19 iii. Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services iv. Expanding primary care capacity to improve access, local health outcomes and address health inequalities v. Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay vi. Working collaboratively across systems to deliver on these priorities.

4.17 The restoration of elective services is a key challenge, the Trust and C&M partners are required to achieve targets set at 70% of the 2019/20 baseline activity for April 2021 rising by 5 percentage points in subsequent months to 85% from July. Secondly the Trust needs to restore full operation of all cancer services as well as deal with any unmet demand during the pandemic, this means:

 return the number of people waiting for longer than 62 days to the level we saw in February 2020 (or to the national average in February 2020 where this is lower) and  meet the increased level of referrals and treatment required to address the shortfall in number of first treatments by March 2022. 4.18 The restoration programme of elective services is further challenged by the increasing demands on non-electivity activity with the Emergency Department (ED) seeing new records set for the number of daily attendances during May 2021. When comparing ED attendances for May 2021 and December 2019 - there has been an 11% increase, which is quite remarkable considering normal demand patterns.

4.19 We have recently seen an increase in community infection rates which we are monitoring carefully along with hospital admissions which may result. The trust is in a better position to deal with spikes in demand, but resources remain challenged and it is evident that there is fatigue amongst some groups of the workforce. C&M are in the process of establishing two Provider Collaboratives (the trust will participate in both):

 Mental Health and Community Services (along with Merseycare and six other providers), and  Acute and Specialist Trusts

4.20 The provider collaboratives will have an initial focus on the recovery programme, offering support and mutual aid to one another. It is envisaged that provider collaboratives will become a significant vehicle, along with place based partnerships (ICPs) to enable the newly formed ICS to discharge its statutory duties. In general terms, the purpose of the provider collaboratives will be to:

 help plan services in the most optimal way  explore and ensure opportunities for the best use of resources supporting the delivery of services (narrowing the performance curve);  tackle variation through transparent data, peer review and support arrangements;  equalise access (tackling inequality across Cheshire and Merseyside) and equalise pressures on individual organisations  maximise the expertise, knowledge and learning opportunities between and across the Parties, to help improve services locally;  provide opportunities for innovation at scale: to improve performance while guarding against any inequality impact;  work collaboratively to meet workforce challenges. 4.21 Significant developments have taken place in Mental Health and Community services. The acquisition of North West Boroughs Healthcare took place on 1st June 2021. What was ‘North West Boroughs Healthcare NHS FT’ (St Helens, Halton, Knowsley and Warrington services) has become the Mid-Mersey Division within Mersey Care NHS Foundation Trust. There has been strong emphasis on a smooth and safe transition of services within the enlarged Mersey Care organisation and a focus on developing strong and positive relationships.

4.22 Mersey Care aim to build upon the strong and positive relationship within the Borough and have made a strong commitment to partnership and continuous improvement. The enlarged organisation has created the role of Executive Director of Partnerships who is a member of the St Helens Cares ICP Board and SRO for the Mental Wellbeing priority which sits within the place ICP plan.

4.23 The CEO of Mersey Care will be the lead for the Mental Health and Community Provider Collaborative across Cheshire and Merseyside. The organisation and the collaborative will aim to drive up standards and deliver continued improvements. A key focus will be to manage the increasing demand for mental health services following the pandemic. This will be achieved by working with partners and particularly primary care to support community mental health transformation and urgent care pathways.

5. Conclusions

5.1 The Health and Care Bill will herald a year of transition, but partners in St Helens have worked hard to prepare the Borough for the changes, St Helens Cares has evolved into an Integrated Care Partnership (ICP) with a robust governance structure in place and operational. We have a strong track record of integrated working and have a high degree of confident of meeting the criteria required to gain the maximum delegation from C&M Integrated Care System (ICS).

5.2 The boards and groups have been established to meet the challenges of reducing health inequalities and delivering our three priorities of:

 Mental Wellbeing,  Tackling Obesity  Resilient Communities

5.3 The St Helens Integrated Care Partnership is in good shape to thrive in the future environment.

5.4 The Leadership in the Region and C&M System will change in the near future as the appointment processes are now in place and within nine months the ICS will be a statutory body following the dissolution of CCGs.

5.5 All providers are facing increasing demands for services following the pandemic and a watchful eye is being kept on local infection rates to ensure we are fully prepared should a fourth Covid- 19 wave develop in Cheshire and Merseyside.

5.6 There are strong partnerships locally, this has been evidenced by our track record of integration and exemplified by our response to the pandemic. There is a determination to build on these strengths, harness the innovations and learning gained during the pandemic by taking these forward as we tackle the increased demand and other challenges that lie ahead. 6. Background papers

6.1 A joint presentation has been produced to accompany this report.