Agenda item

This report sets out submissions from the NHS Kent and Medway Integrated Care Board (KMICB) which sets out the transformation priorities for community services across Kent and Medway, with a particular focus on the evolving Neighbourhood Health Model. It outlines the strategic direction of the KMICB following the reprocurement of community health services and the award of a new long-term contract.

Discussion:

The Committee received the report which detailed submissions from the NHS Kent and Medway Integrated Care Board (ICB) and set out the transformation priorities for community services across Kent and Medway.

The Chief Executive, ICB added that they were looking at what the right model of care was for the system and were working to four care models, to develop robust access to primary care, clear neighbourhood care, clear intermediate care and subsequently the right model of care designed for acute services and the future NHS. The report outlined the process being undertaken to deliver neighbourhood health and the expectation for the contract awarded to Kent Community Healthcare NHS Foundation Trust (KCHFT) as the lead provider, to drive forward neighbourhood health by developing an integrated model across primary care, community service, community mental health and the voluntary and community sector. Transformation of this scale would take time across the eight year contract and initial work had begun by exploring changes in the service model through 2026/27 to bring consistency of services across Kent and Medway, with targeted support being offered through neighbourhood healthcare where it was needed.

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

Transformation plan – reference was made to the lack of detail in relation to the transformation plan, as only headlines were provided. The Committee was informed that the report outlined what would be done differently. There was an expectation for this contract to deliver transformation and it was anticipated that by the end of this year, there would be a 24/7 neighbourhood community front door. Constructive conversations continued to take place on expectation of the year one transformation plan and how that will be delivered, with focus on utilisation of the local joint strategic needs assessments (JSNA) to drive the plan and identity key areas to work on, for example services relating to frailty, dementia, palliative care and end of life care were key areas of focus.  Emerging conversations were also taking place between the previous provider and KCHFT on the integrated children’s services that could be brought forward.

Impact of the proposed integration of providers: reference was made to the proposed integration of KCHFT and Medway Community Healthcare (MCH) and concern of what the impact this would have on delivery of the contract and on transformation, along with any possible delays. It was explained that an improvement plan was in place, and it was believed that the proposed integration strengthened the ability to deliver improvements further. The reasons behind the organisations collaborating on the procurement had been to help ensure stability of services and therefore partnership working between the organisations was already well embedded.

Children and young people: it was expressed that the report highlighted inequalities that directly impacted children and young people, in particular, long wait times for assessment and it was asked what specific work was being undertaken by the ICB to address those inequalities, in particular as a result of the upcoming reforms to the provision and support for children with Special Educational Needs and Disabilities (SEND). The Committee was informed that conversations were ongoing with partners on the SEND reforms and its implications. In terms of inequalities, works would be undertaken on population profiles to gain clarity on specific areas of need.  It was suggested that a report focussing on the transformation plans for the children and young people elements of community services transformation be presented to the Children and Young People Overview and Scrutiny Committee.

Primary care access in Medway: in response to a comment about the inadequacies of the primary care system, the Chief Executive, ICB acknowledged the significant work needed to improve primary care and explained that he had commissioned the National Association of Primary Care to investigate access into primary care across the whole of Kent and Medway, which was due to conclude the following month.  There was yet to be an explanation as to why the deprivation scale had not been a driver to access increased capitation of financial funding or headcount in GPs in the system.

Communication of service transformation - assurance was sought that communications on service transformation would be shared with residents. The Committee was informed that population profiling was crucial and that there would be transparency on the allocation of resources across the system. There was a particular need to focus on primary care and address issues with emergency care demand that could be provided elsewhere. In relation to consultation with residents, the feedback had been that services were not integrated and language used was not understood. There were also issues around navigation of the system and inconsistencies in access. All feedback was being used to develop a new approach.

Voluntary community sector (VCS) in shaping neighbourhood health – reference was made to the need for local VCS leaders to be part of neighbourhood health plans, and that the current scope did not ensure that the VCS were equal partners. The Committee was informed that conversations had been taking place to ensure that neighbourhood health was rooted in Health and Wellbeing Boards to ensure local government was embedded in the shaping of design, as well as the VCS. At present, there was a very clinical model of care in place but there was a need to explore the broader models of services to wrap around the neighbourhood care model.  Early conversations were also taking place with VCS leaders on the forms of alliance that were needed to identify ways they can work into neighbourhood care that were beneficial to everyone.

More information: It was commented that further information was needed on exactly what was being done and how, as this was currently unclear but was crucial in order for the Committee to understand the way forward and be able to hold the system to account. Partners agreed to bring an update on the engagement strategy and a detailed service transformation plan to future meetings of the Committee.

Decision:

The Committee noted the submission from the Integrated Care Board, as set out at Appendix 1 to the report, and agreed that:

a)    A report be presented to the Children and Young People Overview and Scrutiny Committee on the transformation of Children’s Community Services.

b)    KCHFT to attend a future meeting and present its full service transformation plan