4a Development of Integrated Care in Barnsley – Cover Report
4b Development of Integrated Care in Barnsley – Report of the Barnsley Place-based Partnership
Cllr Ennis OBE vacated the Chair for this item and Cllr Richardson took up the position.
The following witnesses were welcomed to the meeting:
Wendy Lowder, Executive Director Adults & Communities, BMBC
Julia Burrows, Executive Director Public Health, BMBC
Julie Chapman, Service Director, Adult Social Care & Health, BMBC (virtual)
Andrew Osborn, Interim Service Director, Commissioning & Integration, BMBC
Adrian England, Chair, Healthwatch Barnsley
Dr Mehrban Ghani, Chair, Accountable Clinical Director, Barnsley Primary Care Network and GP Partner at the White Rose Medical Practice
Jeremy Budd, Director of Strategic Commissioning & Partnerships, Barnsley Clinical Commissioning Group
Jamie Wike, Chief Operating Officer, Barnsley Clinical Commissioning Group
James Barker, Chief Executive, Barnsley Healthcare Federation
Gill Stansfield, Deputy District Director and Clinical Transformation Lead, Barnsley General Community, South West Yorkshire Partnership NHS Foundation Trust
Cllr Jenny Platts, Cabinet Spokesperson, Adults & Communities, BMBC
Cllr Jim Andrews, Cabinet Spokesperson, Public Health, BMBC
Jeremy Budd introduced the report, informing the Committee that despite operational pressures and a challenging year the partnership have continue to work collectively to achieve objectives in the Integrated Health and Care Plan. Co-production and teamworking is at a high level in Barnsley and the lulls and peaks over the last 12 months have allowed them to push forward with priorities but they have also had to reflect on the impact of Covid on the delivery of the plan. Key activities include:-
· the development of a mental health strategy
· tackling health inequalities by offering mental health checks, hypertension case finding
· influencing people’s behaviour to partake in cancer screening programmes
· Managing the substantial increase in demand for primary care appointments and planning to introduce additional workforce in primary care, to work alongside the GP and provide a wider range of provision
· Approval of the refreshed Healthy Care Plan focussing on the four priority areas of workforce; prevention; improved access; and joined-up care
The plan has now been refreshed for 202/23.
Recent legislation (The Health & Care Act 2022) means that the Integrated Care Board will come into effect from 1 July, the CCG will cease to exist from the end of June and there will be a new Team Barnsley as part of the Integrated Care Board. There is an exciting opportunity for the group to work together to develop a five-year strategy for the Integrated Care Board to make sure that Barnsley has the right involvement, engagement and communication with the people of Barnsley.
Covid has impacted upon staff – they are tired but they are enthusiastic about moving forward. Managers need to ensure that they are offering the best for health and care staff.
Urgent & Emergency Care remains pressured but nonetheless can continue to be provided in a timely way and it is rigorously monitored. They make sure that there are effective pathways in and out of hospital and the ‘discharge to assess’ process is one of the best in the country. Because of the impact of Covid, people are sicker when they are presenting and that has some issues, particularly around mental health placements, however there are plans to return the out of area placements back to zero by April 2023.
In the ensuing discussion and in response to detailed questioning and challenge the following matters were highlighted:
There needs to be a clear distinction between urgent care and what needs to be looked at in due course. Out-of-hours appointments are available and some departments are open 24 hours a day, but there isn’t enough staffing and diagnostic support to effectively support this further. There is an aspiration to do more but that comes with financial and resourcing implications that need to be considered. Early help and screening is important as is the quality of information. There is a standard around patients with suspected cancer being referred for an appointment by their GP within 14 days and although the breast screening service was suspended for six months but they are almost back on track
Witnesses are not aware of a vote to shorten GPs’ working day as recently reported in the national press and surgeries continue to be open out-of-hours. Social prescribing has now been extended to under 18s and the My Best Life Service has been introduced to allow professionals to refer people to a range of local, non-clinical services. Social prescribing does have a positive impact, here are an increased number of social prescribers across Barnsley, and the range of people who are able to refer into social prescribers have been extended, eg police, social care. There is now a social prescriber based at the Emergency Department (A&E). Work continues with the Area Councils and Ward Alliances and the VCSE sector to build capacity across our communities enabling the social prescribing service to connect people to community support.
During Covid, GP surgeries had to follow stringent infection control measures, and non-compliance would result in the CQC closing them down. Telephone appointments were used to assess need and an increasing demand for appointments whilst, at the same time, a falling number of GPs, have added to the problems. Guidance has now changed and they are moving more towards face-to-face appointments again. After the May Day Bank Holiday, iHeart Barnsley will offer face-to-face appointments in the first instance unless patients request an alternative.
There are several challenges associated with attracting employees to the care market. Because some providers and care homes have mixed tenancies (ie some clients self-funding, some supported by the local authority) it can directly impact on the business model and health and social care partners can only influence certain parts of it. At present, health and social care are currently competing to employ the same people. They do have ideas about how they can work collaboratively in the future but the government white paper on the health and social care workforce will need to be introduced first.
The CAMHS contract will follow the normal tender process when it is due for renewal and will be opened up to other providers. The contract is regularly monitored (monthly) against key performance information and the service offer has been extended up to the age of 25. The partnership expects to return to zero out of area placements for adult mental health by April 2023.
There are lots of appointments that have had to be cancelled by the provider due to staff sickness. Children’s appointments have been higher for a number of reasons. There have been changes to the computer system at the hospital, but the messaging service does not give the full functionality that they would like so this will be revisited. Missed appointments have not been flagged up as an issue in primary care.
The partnership are confident that there will be some bigger changes this year in the development of the shared care record. Primary Care records should talk to one another and they have until April 2023 to do that. The Yorkshire & Humber model is already tried and tested and there is a commitment to adopt that across South Yorkshire. They will be pushing it forward and across the partnership will be investing to make the changes happen. They are confident that they will make good strides forward over the course of the year.
There are mechanisms in place for frequent LTF testing for staff. Community Services staff are testing twice weekly and have not experienced any issues with the availability of tests.
(i) Witnesses be thanked for their attendance and contribution; and
(ii) Members note the report