Agenda item

The Bromley Out of Hospital Transformation Programme update was given by Dr Angela Bhan, and Ms Vanessa Reeves from IMPOWER Consulting Ltd attended to answer any questions. Dr Bhan stressed the importance of moving forward with plans for developing joint commissioning strategies between LBB and with the CCG. It was noted that a final report on this matter had now been completed and should be available shortly. 

Dr Bhan informed the Board that in Bromley, there was currently a poor level of health and social care integration, combined with inadequate secondary and tertiary integration. Demand was rising, and problems were compounded by increased longevity, chronic disease, and high levels of physical disability and learning disability in the Borough. She stated that the rising pressures on health care demand meant that by 2020 there was projected to be a £72.3m funding gap. What was required was “Transformation” to “break the lock” and to break the historical issues that had brought about the current situation which was a dysfunctional cycle.

Dr Bhan felt that it was important that analytical work undertaken by all relevant parties, incorporating the JSNA (Joint Strategic Needs Assessment) findings, work undertaken by GP’s, hospitals, and the Health and Wellbeing Board, should be joined up. Dr Bhan stated that it was clear from research and engagement sessions that the health and social care system needed to be proactive, co-ordinated for people and professionals, and that the system needed to be more accessible.  Dr Bhan outlined the outcomes that LBB and the CCG would be looking to achieve with respect to the Integrated Care Networks. These would be consistent health and care outcomes across quality, safety, value for money, and in terms of performance. Within each ICN (Integrated Care Network), providers would be incentivised individually and as part of the network to deliver their contributions. It was hoped that the significant change of focus and redirecting of financial incentives would be the catalyst required to successfully implement the new model of care.

The Board heard that it was anticipated that there would be three ICN’s operating in the Borough. The ICN model had three layers. The core would consist of an ICN Hub of 15 GP practices, and around this inner “core” would be two other supporting layers. The first of these two supporting layers would consist of a Case Management Team. The CMT would work to target patient groups and needs, and develop and manage the implementation of the care plans. They would also help with the issue of “accessibility” in aiding both professional and the public to access the most appropriate care. The “outer layer” of an ICN would consist of a “Borough Wide Specialist Offer” that would be responsible for providing and enabling services on a borough wide basis. The success of the ICN’s would depend on effective leadership.

Dr Bhan mentioned that the ICN’s in Bromley would need to develop a preventative culture and approach; this would apply to primary prevention, secondary prevention and tertiary prevention. She also felt that it was important for there to be more involvement from community groups and from the voluntary sector, and that community pharmacists would be commissioned to provide a wide range of services under the new system.

Cllr Ruth Bennett commented that it was key that one named person be allocated as a Coordinator and to have overall responsibility for project implementation. 

Cllr Dunn asked:

1.  Was it anticipated that the March 2017 target date be realised?

2.  What would be the Governance around the change programme?

3.  Was there a local example to observe?

Teresa Reeves (IMPOWER) responded that the improvement plan and the governance structure was being discussed by the local authority and the CCG.  She stated that it was the case that robust governance arrangements would be established and that care networks would be guided by a Steering Group, and that local residents would be involved. With respect to the March 2017 deadlines, it was too far into the future to confirm if the deadline would be met. LBB and the CCG would be better placed to confirm this at the end of the financial year. In terms of local examples that could be observed, it was the case that a local example had not yet been fully established. However it was the case that there were certain areas where a rollout had taken place; one such area was Solihull, and it was hoped that Bromley would be a able to learn from this example.

The Chairman commented that LBB and Bromley CCG were setting the way forward, and asked when a final decision would be made? Dr Bhan answered that it may not be prudent to speak of a “final decision”, but rather to think of the process as a journey that we were all moving forward on. Where we were at currently was in effect the next stage on from “local care networks”. Dr Bhan expressed the view that as far as ICN’s were concerned, all involved were on “a direction of travel” rather than focusing on making one big and final decision at the end of a process.

The Chief Executive for LBB, Mr Doug Patterson, informed the Board that the local authority were involved in discussions concerning the integration programme and that this was a matter that Cllr Robert Evans was bringing to the Cabinet. He stated that if the current plans went ahead, LBB would be investing in the region of £60m-£70m into the integration programme for social care projects. Because of this, LBB would require a significant input around how plans would be developed and implemented, and it was important that Members were aware of this.

Cllr Robert Evans wondered if the new system would bring cost savings, and if there would there be shift of money into local services. He was also concerned about the possible creation of a new level of bureaucracy. Dr Andrew Parsons stated that the aim of ICN’s were to encourage new ways of working, and that it was envisaged that money would be siphoned out to the local community.

Dr Bhan felt that savings would be made by encouraging pre  vention and by moving people out of hospital sooner. Dr Bhan assured that the focus would be on what was right for LBB, and that there was no cause for concern in terms of creating another level of bureaucracy.

Cllr William Huntingdon Thresher wondered if GPs were fully signed up to deliver to the required timescales. Dr Bhan responded that this was not easy as GPs had different ways of working, and sometimes these patterns were difficult to change. However, Dr Bhan remained hopeful, and consultations were ongoing.

Mr Ian Dallaway noted the importance of the voluntary and community sector and suggested that they unite and map assets. He suggested that they could join together to form a community based Care Board. This could possibly become a steering group or possibly the main steering group.

The Chairman welcomed the report and the update provided by Dr Bhan. He stated that a series of important steps were being taken forward and that the Board would be updated in December 2015. Any views and recommendations going forward would be welcomed.

RESOLVED that the Bromley Out of Hospital Transformation Programme update be noted and that the Board be kept informed of future developments.   

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