Agenda item

A report is attached from the Corporate Director for People which outlines the progress made towards developing a governance framework for Wiltshire in readiness for April 1st, 2022 when a statutory Integrated Care System for Bath and NE Somerset, Swindon and Wiltshire commences.

The committee is invited to consider the report in in advance of Cabinet and make comments/recommendations as it deems appropriate.

The Chairman invited the committee to consider the draft report, contained within the agenda pack, ahead of its consideration by Cabinet on 30 November. He also responded to question Q21-03 submitted by a member of the public. A copy of the question and response can be found in Appendix 1.

Corporate Director of People, Lucy Townsend, provided an overview of the proposed arrangements for the BSW Integrated Care System (ICS) and the role of Wiltshire Council in the governance framework.  As a result of the government’s Health and Care Bill, expected to come into law in April 2022, the current Clinical Commissioning Group (CCG) for BSW would be replaced by an ICS NHS Body.  As well as this body, the ICS would contain an ICS Health and Care Partnership, responsible for supporting integration. The Health and Care Partnership would include representatives from local authorities (including Wiltshire Council), other local partners and the NHS.

The director noted that the ICS would operate on so called system (BSW), place (Wiltshire) and neighbourhood levels. The focus of Wiltshire Council would be on the place-based part of the ICS, through a group called the Wiltshire Integrated Care Alliance. As part of the Alliance the council would work with other community providers, including from the voluntary sector and those currently working within the CCG. It was explained that there was a degree of flexibility around what the governance arrangement for the Alliance could look like, as it was not fixed in statute.

It was reported that a governance framework for the Alliance had been agreed in principle at series of workshops and it was proposed to establish a joint committee, similar to the existing Locality Commissioning Board, run through the council and the CCG, but also including other local partners. However, the director stressed that the governance model was adaptable and could change over time as the model developed.

The workshops had also been used to agree key priorities and, as a result, several projects were now underway. Examples of the projects included reviewing how population data could be better utilised, as well as running a pilot scheme in Trowbridge to look at ways of providing wrap around support at a local level. To build upon the proposals discussed at the workshops it was planned to submit a Memorandum of Understanding (MoU) and Collaboration Agreement to Cabinet for approval. The Collaboration Agreement would contain a Terms of Reference for the proposed statutory structures. Both the MoU and Collaboration Agreement would also need to be agreed by the ICS.

During the discussion the following points were made:

• Members thanked the director for the update.

• Cllr Richard Clewer, Leader of the Council and Chair of the Health and Wellbeing Board, reassured members that conversations were ongoing with a wide range of partners at both a political and officer level. He reiterated the importance of a strong working relationship between the politically run local authorities and the NHS.

• The director explained that the complexity of language included in the report largely originated from the language used within the government’s Health and Care Bill.

• It was noted that that decision about the wider role of the NHS in social care would be made a central government level. At a Wiltshire Care Alliance level, the focus of the report, it would be up to local authorities to decide what funding went into the Alliance beyond the Better Care Fund.

• In response to questions about the relationship between the Health and Wellbeing Board and the Integrated Care Alliance, it was reported that the Health and Wellbeing Board was not able to hold the Alliance to account on a statutory basis, but conversations were ongoing about ways in which it could maintain oversight.  

• The director stated that she would welcome further collaboration on development of care models and the wider ICS governance framework.

• Members commented that they looked forward to extra information about the role of scrutiny and the relationship between the Health Select Committee and the new structures as the model evolved.

Resolved

1)    To note the draft proposals to Cabinet on 30 November, which are to:

a) develop place-based working through the Wiltshire Alliance, and

b) agree to the development of a Memorandum of Understanding (including a collaboration agreement) together with new Terms of Reference for the proposed statutory structures;

2)    To ask that officers ensure the final report to Cabinet is written in as plain English as possible so that it is understandable to all.

3)    To receive further reports as the Integrated Care System Governance Framework develops at appropriate milestones.