The Health and Adult Social Care Select Committee met to discuss the Integrated Care Board, the Buckinghamshire Healthcare NHS Trust, Adult Social Care and Public Health, and Integrated Neighbourhood Teams. Councillor Stuart Wilson, Chair of the Health and Adult Social Care Committee, welcomed the members and partners to the meeting. Councillor Shade Adoh was re-appointed as vice-chair of the committee.

Integrated Care Board (ICB) Update

Matthew Tate, Chief Delivery Officer for the Integrated Care Board (ICB), provided an update on the role and responsibilities of the ICB and its key deliverables across Buckinghamshire, Oxfordshire and Berkshire West (BOB) since its launch in July 2022.

Tate explained that the ICB is part of the BOB Integrated Care System¹, working with a range of partners across the region. The ICB's core role is commissioning healthcare services with a budget of around £3 billion for a population of almost 2 million. He noted that the ICB has faced multiple changes, including reducing running costs and staffing.

Key achievements mentioned:

• Reducing elective long waits.
• Establishing new community diagnostic centres.
• Strengthening out-of-hospital models and services, such as virtual wards.
• Investing in health inequalities at a local level.
• Investing over £4 million in Buckinghamshire to support the special educational needs and disabilities (SEND) agenda.

Tate also discussed financial challenges, noting that the system ended the previous year in deficit. He also spoke about changes coming to the ICB, including a potential merger with Frimley ICB to create a Thames Valley Integrated Care Board.

Councillor Simon Rouse asked about the joint commissioning arrangements with Buckinghamshire Council, and Matthew Tate responded that they are helpful for joining up services, particularly in mental health and learning disability services. He also acknowledged the uncertainty about the future landscape and assured the committee that the leadership team is working to protect core commissioning.

Councillor Anja Schaefer raised concerns about the management of commissioning and services in North Buckinghamshire, and Matthew Tate responded that the joint commissioning model is focused on the whole county and takes into account links into Milton Keynes.

Councillor Thomas Hogg asked about integrating artificial intelligence (AI) into the ICB, and Matthew Tate responded that the NHS is looking to use AI more and more, and that Buckinghamshire Healthcare Trust has been at the forefront of some of that work.

Councillor Julia Wassell asked about the impact of the 50% staff cost reduction, and Matthew Tate responded that the cash reduction will be available to support the broader spend of the ICB.

Councillor Shade Adoh asked about the impact on Healthwatch, and Matthew Tate responded that the ICB values the insight that Healthwatch gives and that it needs to protect and support an insightful patient voice in its commissioning models moving forward.

Buckinghamshire Healthcare NHS Trust (BHT) Update

Neil Macdonald, Chief Executive, and Jenny Ricketts, Interim Chief Nurse, provided an overview of the key priorities and challenges facing Buckinghamshire Healthcare NHS Trust.

Jenny Ricketts highlighted major milestones, including the 80th anniversary of the National Spinal Injury Centre and the opening of a new 21-bedded ward. She noted increased demand for emergency services but also reduced waiting times.

Neil Macdonald addressed financial matters, noting a drop in direct income and a reduction in the workforce. He also mentioned capital schemes, including the digitalization of the organisation and the redevelopment of the Wycombe site².

Macdonald spoke about the trust's 10-year strategy, which focuses on integrating care, prevention, health inequalities, children, transforming planned care and diagnostics, pathways for frailty and long-term conditions, and supporting colleagues. He noted that the model of care will need to be different in the future due to demographic changes and the rising costs of healthcare.

Councillor Anja Schaefer asked about the financing of integrated neighbourhood teams, and Neil Macdonald responded that the money will flow through a new contractual model.

Councillor Maru Mormina asked about tackling health inequalities, and Neil Macdonald responded that the trust makes data available to clinicians and clinical specialties and asks them to think about health inequalities in the context of their services. David Munday, Director of Public Health, added that the term health inequalities is very broad and that the strategy explains BHT's role in tackling some of those healthcare inequalities.

Councillor Thomas Hogg asked about innovation and metrics, and Neil Macdonald responded that the trust has a research and innovation building and is part of an insights program.

Councillor Lesley Clarke OBE asked about the pharmacy and robotics, and Neil Macdonald responded that the robotic systems are in the dispensary of the pharmacy itself and are designed to speed up the process of getting medications to people quickly when they come into hospital.

Councillor Julia Wassell asked about delayed discharges, and Neil Macdonald responded that the trust has seen the fastest drop in patients with no criteria to reside in the hospital and that it can now get hold of packages of care with a really quick turnaround.

Councillor Shade Adoh asked about partnership working, and Neil Macdonald responded that the strategy was designed largely through professionals working through partnerships and understanding what was the best model of how to configure themselves based on available evidence.

Councillor Anna Crabtree asked about redeveloping community hubs, and Neil Macdonald responded that the trust has a number of community sites and is looking to explore joint development opportunities.

Adult Social Care and Public Health Update

Councillor Isobel Darby, Cabinet Member for Health and Wellbeing, and Craig McArdle, Corporate Director, Adults and Health, provided an overview of key priorities and challenges facing Adult Social Care and Public Health.

Councillor Isobel Darby reiterated that the services work across the county in partnership with various organisations to support residents in living independent, fulfilled, and healthy lives. She noted that the budget for the portfolio is significant and that there is a savings target for the year.

Key challenges mentioned:

• Demand, particularly from those with complex needs.
• Workforce shortages.
• The care market.
• Legislative changes and reform.

Councillor Isobel Darby reported that the Care Quality Commission (CQC) report is due to be published on 18 July and that the red indicator on cabinet performance indicators has now been turned around.

Councillor Lesley Clarke OBE asked about how the council is going to cope with the significant increase in demand, and Craig McArdle responded that the council has to do a variety of approaches and strategies to try and tackle that demand, including getting better information and advice out there, risk stratifying, utilising more new technologies, and making every contact count.

Councillor Simon Rouse asked for assurances that one of the options for day centres is a 'do nothing' solution, and Councillor Isobel Darby responded that she has not been looking at the savings figure and that she is determined to end the uncertainty as soon as it is practically possible to do so.

Councillor Anja Schaefer asked about what the council does to support unpaid carers, and Councillor Isobel Darby responded that the council has a carers strategy and that Carers Bucks is delivering a lot of the services for carers.

Councillor Julia Wassell expressed concern about the consultation on day centres, and Councillor Isobel Darby responded that times change and that the council has to make sure that when change happens it happens in the right way.

Councillor Shade Adoh asked if there is a women's health hub in Buckinghamshire, and David Munday responded that the council is partnering with Bernardo's to deliver an innovative service called the Women's Community Health Worker.

Councillor Thomas Hogg asked for an AI strategy, and Craig McArdle responded that the council can bring back an approach time-wise.

Integrated Neighbourhood Teams (INTs)

Gemma Thomas, Director of Strategy at Buckinghamshire Healthcare NHS Trust, Bobby Pozzoni-Child, Director of Partnership and Transformation at GP Provider Alliance, and Nicola Newstone, Assistant Director for Partnership Development at Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board, presented an update on Integrated Neighbourhood Teams.

Gemma Thomas explained that INTs are professionals from health, the council, and the voluntary and community sector that work within a specific geographic area to provide coordinated and preventative care, to address the needs of the population and improve health and wellbeing.

Councillor Maru Mormina asked whether the strategies of the different bodies that will come to form the INT are aligned, and Gemma Thomas responded that the strategies are aligned and that the integrated neighbourhood teams model has been based on that.

Councillor Julia Wassell asked if the council will have a base in her neighbourhood, and Gemma Thomas responded that the council is looking at having co-location and that it wants to be led by the teams themselves.

Councillor Anja Schaefer asked about a strategy for co-location of services, and Gemma Thomas responded that the council is looking at having co-location and that it is developing in each area to be right based on population health data and local insights of the individuals.

Work Programme and Date of Next Meeting

The committee agreed to include the CQC report and the outcome of short breaks on the agenda for the next meeting. The next meeting will be held on Thursday 2 October at 2pm.