Agenda item

To consider the report on community services provision, inclusive of tendering and integration of service plans.

The Chairman clarified that there were several service transformation projects underway at present but that the report presented today related to adult community services.  Children’s services commissioning was being reviewed and would be on a future agenda for the Board’s consideration.

The Chairman introduced Debbie Fielding, Chief Officer Wiltshire CCG, who was asked to present the report on adult Community Services Transformation.

In presenting the report note was made that the Board, in its shadow form, had also considered several update on the review of adult community service provision.  It was also noted that an important part of the proposed service provision would be the clustering of GP hubs and the CCG were working closely with GP colleagues to develop services around GP practices.  With this in mind, it was proposed that primary care services would be based around 23 clusters, each with a population of around 20,000.  A Care Coordinator would be assigned to each cluster and it was understood that there was almost a full complement now appointed.

The above model of care would be aligned to meet the needs of the population throughout their lives, striving to ensure people were able to live independently at home for as long as possible.

The priorities for joint health and social care development were also highlighted.  These included the STARR scheme (for supporting those coming both in and out of hospital), multi-disciplinary working and work around Transfer of Care.  Noting the latter it was confirmed that a pilot project had been running at the Bath RUH to identify patients who, with the right packages of care, should be better placed to leave hospital at an earlier opportunity.  

It had been noted that a rapid response within one hour of crisis contributed to reducing unnecessary admissions.  The Care Coordinators would take on the responsibility of working within this timeframe and were expected to work in conjunction with a simple point of access for healthcare professionals.

In noting the positive joint commissioning of voluntary and community sector services already in existence, the Community Transformation Programme would also be exploring other opportunities in this area.

Maggie Rae, Corporate Director Wiltshire Council, thanked all involved in the current delivery of community services and was pleased to see the proposed local service model presented, noting the national mandate issued by central government for integration of health and social care services by 2018.

The Board recognised the need for cultural change and for the public to be kept abreast of services changes in the future, noting that as the integration of service developed there would be a natural change in culture and expectations.  Strong, clear and consistent communication of this message would also be required.

All were in agreement with the content of the report and its aims but recognised that the timeframes around the retendering of contracts could be problematic.

The Chairman, in expressing concern over the timeframe, noted that it could impact on integrated services with uncertainty on how partnership working could be developed given that future providers would not be known.

The Chief Executive of GWH reiterated that the hospital, as the current community services provider under contract, were also concerned with the impact retendering of contracts could have in terms of service delivery for the local population, delaying investment in services and creating uncertainty for staff.

Clarification was made that the report clearly outlined the expected service model for the community and that initial guidance received from central government implied that retendering of contracts, which had already been extended by a year, would need to take place as outlined.

The Chief Executive of GWH asked that the Board take into consideration the cost implications to the GWH as the current provider to meet the needs of the proposed model.

In noting the differing models of integrated services around the country and uncertainty on legislative requirements around tendering it was suggested that the views of NHS England should be sought. 

Deborah Fielding confirmed that a meeting was due to take place between the CCG and NHS England the following week.  It was therefore suggested that at this meeting information on working arrangements around the country as well as clarification on whether any flexibility remained in relation to the tendering of contracts would be sought.  Following this meeting an options paper would then be prepared by the CCG for consideration by the CCG Board prior to a report being presented to the Health and Wellbeing Board.

Maggie Rae noted the concerns raised by GWH and clarified that the Council would also be impacted by the service realignment, noting that the Council would be required to reorganise its care model in line with that of any partner organisations.

Further comments included that further comparison work could be undertaken on other local authorities and working patterns for health professionals.  Borough of Poole Council had undertaken a review of health and social care working arrangements and drawn on best practice from Holland and it was felt considering their working model might be of benefit.

In concluding discussion the Chairman thanked all in attendance for the positive debate that had been undertaken at the Board’s first public meeting and resolved as follows:

Resolved:

1)    To note progress made to date;

2)    To receive an update on the model of care at the Board’s next meeting;

3)    To receive an update on the vision for integration at the next meeting of the Board; and

4)    That following the CCG Board meeting in October, where the outcome of the meeting between the CCG and NHS England will be discussed, an update on the discussion would be circulated to Board members for consideration.  To be circulated before the next meeting.