Agenda item

This paper provides the Committee with an update from the newly appointed Chief Executive of NHS Kent and Medway Integrated Care Board.

Discussion:

The Chief Executive of Kent and Medway (ICB CE) introduced the report which framed the national context and the changes required to respond to the 10 Year plan.  He highlighted the challenges across the health and care system and the opportunities for positive change. He explained that he had been asked by NHS Englandto present a report of his findings of the local and strategic diagnosis of the Kent and Medway system, since being in post, which would be concluding in December and would be shared with the Committee in due course. He had also commissioned some work to understand the underlying causes to the deficit in resource and finance of the system, which was due to conclude in the new year.

Members then raised a number of questions and comments, which included:

• GP workforce – in response to a concern raised about the insufficient numbers of GPs in Medway, the ICB CE and the Director of Primary and Community Care explained that work was underway to fully identify the contributory factors as to why GP rates were low across Kent and Medway so that solutions could be implemented to address the issues and create a unique attractiveness to work in Kent and Medway.  It was added that generally GPs were wanting to work differently and explore working across different settings, as well as general practice and it was believed that the neighbourhood health model would assist with opportunities to facilitate that. The ICB undertook to report back on the findings of the report and the ICB response to that in due course at a future meeting.
• Impact of Local Government Reform (LGR) – in response to a question around the various different plans referred to in the report and the impact of LGR on them, the ICB CE explained that regardless of the restructures of the ICB and those created by LGR, plans for transformation needed to be made to respond to national policy and priorities as well as local challenges but that the ICB would respond to any impacts from LGR as and when necessary.
• Staff morale – in response to a question about staff morale in the context of huge restructuring within the ICB, the ICB CE explained that a voluntary redundancy scheme was currently open but that staff were understandably anxious and the ICB was doing its best to support staff and keep them informed. He added that some staff were in very clinically led roles and therefore the possibility of moving those teams to a different organisation to preserve those services for patients was being explored.
• Engagement – the ICB CE explained that there would be an emphasis on service user engagement which was welcomed and work was ongoing on how best to approach engagement with the public to deliver the message that the NHS locally was managing a deficit and how it planned to address that.
• Health facility at the previous Debenhams site – disappointment was expressed that the health facility that had been planned at the previous Debenhams site in Chatham was no longer going ahead. The ICB CE explained that some schemes were not financially viable, that being one but that the focus on neighbourhood health remained and therefore the ICB remained focused on identifying opportunities that were financially viable to take forward. Primary Care needed to drive the strategy to identify what services could be moved out of acute settings into the community.
• Out of Scope Community Services – reference was made to the services which were not part of the core scope of the community services contract and were being reviewed to establish if they should be recommissioned or redesigned, depending on the population health need. It was confirmed that service users would be involved in the review and the Committee would be kept fully informed.
• Mitigating risks – The ICB CE explained that one risk he had identified was that due to the requirements around workforce reduction within the ICB, there may not be sufficient staff to actualise the ambitions around transformation of services so to mitigate this, partnership working was ongoing with providers to create a joint transformation team to ensure the best resource across the system was focused on delivering outcomes.
• Working with the community and voluntary sector (CVS) – in response to a question the ICB CE confirmed that CVS organisations played a valuable role in delivering services within the health and social care system and in his previous role he had commissioned a CVS alliance.  He would take the time to work through the CVS landscape in Kent and Medway and would work with partners, in particular both Medway Council and Kent County Council, to ensure a robust and resilient CVS offer.
• Integration with local authorities – the ICB CE recognised the importance of collaborative and partnership working with the Council and that the ICB needed to be clearer on its long term vision around neighbourhood health and its contributions towards local authority council plans.
• Culture at the ICB – reference was made to the recent report on culture within the ICB and the ICB CE confirmed that he recognised the content of the report within the ICB and considered it to be accurate. His expectations of staff were to be open and inclusive and he was working on reiterating the core purpose of the ICB to the workforce so they were able to reflect on the difference they were making in their roles to the health care system of Kent and Medway.
• ICB restructure – the ICB CE explained there were various models being approach across the country in response to the requirements for ICB’s to restructure and reduce staffing costs.  For Kent and Medway there had not been a decision to merge with another ICB but certain back office functions, such as legal services as an example, may be explored to share the function with other ICBs across the south east.
• Community Services procurement – in response to a question about whether the new ICB CE would have done anything differently in relation to the procurement, he explained that he had the benefit of hindsight and agreed with the decision to group the various services into one tender. He did accept that because there was not yet a clinical model for neighbourhood health in the locality, it presented a challenge in that the contract may have to evolve as the landscape on this shifted. He would also have used the opportunity to consider whether the contract should have instead been an NHS and local government commissioned service.
• All age mental health contract – reference was made to the concerns the Committee had previously made regarding the all age mental health contract being directly awarded to the Kent and Medway Mental Health Trust (KMMH) and the ICB CE was asked if he was confident of the decision, in the context of KMMH’s recent Care Quality Commission report. The ICB CE explained he was supportive of the model around all age mental health services being delivered by one trust as this supported the integration of services across the all age pathways and transition from children to adult services. He was building confidence in the organisation’s ability to manage this and was in the process of assessing due diligence and capacity within KMMH to be able to appropriately manage the service it was inheriting. 

Decision:

The Committee notes the submission from the ICB as set out at Appendix 1 to the report.