Agenda item

Daniel Leveson (BOB ICB Place Director, Oxfordshire) has been invited to present a report with an update on the Oxfordshire Place-Based Partnership.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Daniel Leveson (BOB ICB Place Director, Oxfordshire) had been invited to present a report with an update on the Oxfordshire Place-Based Partnership.

The following points were explained to the Committee in relation to the Place-Based Partnership.

1.    The Partnership struggled with the governance around it, as it did not have formal delegated authority from the ICB. There had been ongoing discussions as to whether or not authority would be delegated, but that national guidance outlined that the engine room of integration should be Place. The Partnership had also been running for approximately a year.

2.    The Partnership was developing well, and the Place Director brought the leadership of the Partnership together.

3.    A wide array of organisations and stakeholders were represented in the Partnership including the County Council, General Practice, the City and District Councils, the Chief Executives of Oxford Health Foundation Trust and Oxford University Hospitals Foundation Trust, Healthwatch Oxfordshire, and Voluntary Sector Representatives.

4.    The ICB Place Director’s role was focused on identifying individuals and populations that would benefit from joined-up care.

5.    The Partnership focused on bringing resources together for improving outcomes for residents.

6.    The Committee were also informed that the Partnership focused on the following priority areas/populations:

Ø  Children and Young People: including school readiness, SEND, children and young people’s emotional health and wellbeing.

Ø  Adult and Older Adult Mental Health and Wellbeing: including the adult and older adult mental health, those with Learning Disabilities and neurodiversity.

Ø  People with Urgent Care Needs: including children, adults and older adults with multiple illnesses and frailty.

Ø  Health Inequalities and Prevention: including the promotion of healthy lifestyles, working with communities and taking into account the role of anchor institutes and major employers.

The Committee queried the steps that the Partnership were taking to establish strong relationships, both amongst its core membership as well as with wider partners. It was responded that Partnership working was going well, and that the Partnership took basic measures including having meetings in-person. There was a clear set of priorities that the Partnership was collaboratively working towards. A maturity matrix was also adopted, and the Partnership would routinely refer back to this to determine its overall direction of travel. It was emphasised to the Committee that good relationships formed the basis of this Partnership at a fundamental level.

The Committee enquired as to the degree to which transparency was at the heart of how the partnership operated, and whether there were any challenges in this area of transparency. It was responded that the Partnership somewhat relied on trust, and that trust was not always easily measurable. It was also explained to the Committee that the current system in which the Partnership operated did not necessarily enable the Partnership to exercise transparency very well, as the regulatory system had not kept up with this. But there were incremental changes within the system that were necessary, including a stronger understanding of risk and a practice of risk-sharing.

The Committee queried if any reassurances could be provided that the Partnership operated in a manner that avoided duplication of other bodies or their associated activities, such as the Health and Wellbeing Board. The ICB Place Director explained that he was a member of both the Health and Wellbeing Board as well as the Place-Based Partnership, and that this helped to ensure that the Partnership avoided duplication of the Health and Wellbeing Board and its work. It was also added that the Health and Wellbeing Strategy would help with avoiding duplication, and that that would constitute the overarching systemwide strategy for Oxfordshire’s health and wellbeing.

The Committee enquired as to whether the Partnership, at Place level, had any role with respect to strategies on capital and capital allocations across Oxfordshire. It was responded that from an NHS point of view, the capital allocations would be run through the ICB in the context of a nationally-run programme. However, the capital programme would be built up from within the three Places of Buckinghamshire, Oxfordshire, and Berkshire West. It was also explained that the only means through which Oxfordshire’s hospital infrastructure could be improved would be via accessing small pots of money or vast sums of funding under the New Hospitals Programme.

The Committee referred to how the report mentioned learning and the experiences of other Place-Based Partnerships, and queried how Oxfordshire’s Place-Based Partnership had been learning from the activities and experiences of other partnerships. It was responded that the ICB Place Director had been in close contact with various networks including in Manchester and West Yorkshire, which were two Places that had been held up as good examples. It was also emphasised to the Committee that there was a benefit to having three Place-Based Partnerships under the BOB ICB footprint, as all three Place level Partnerships did and could collaborate effectively to drive improvements to health and wellbeing collectively.

The Committee enquired as to how the partnership would develop a culture of learning and evaluation, and how any learning and evaluation of the Partnership’s activities would be implemented in practice. It was responded that learning and evaluation was a practice that was undertaken across the system, and that evaluation was being undertaken alongside other partners such as the University of Oxford, particularly in relation to the Partnership’s health inequalities work. The BOB ICB Place Director also referred back to the Partnership’s maturity level, which would be used to test the degree to which the Partnership was performing well and effectively achieving its aims and priorities.

The Committee referred to how the report mentioned the importance of a shared vision and purpose for the Partnership, and queried how this vision and purpose was being developed as well as the degree to which this had been achieved. It was responded that the overall vision of the Partnership would be determined by the systemwide Health and Wellbeing Strategy, and that the NHS would operate in a manner that supported the development as well as the delivery of the strategy.

The Committee referred to how the report mentioned the Mental Health Outcomes Improvement Programme. It was queried as to what this programme entailed, and how it would improve the ways in which the Partnership worked on improving mental health in the county. It was explained to the Committee that this was a whole system programme. In the past, contracts for specific services were commissioned. However, moving forward, the Partnership would work towards bringing the system together to agree on Adult and Older Adult mental health services but with a long-term vision to create a more integrated all-age mental health service. It was explained that the hope was to create an outcomes-based contract that was focused around incentivising the right outcomes as opposed to simply incentivising the activities undertaken as part of mental health services.

The Committee referred to how the report made reference to shared data and information, and enquired as to whether there were any examples that could be provided on how the Partnership was supporting this at both the population as well as the individual levels? It was also queried as to whether there was any means through which such data and information sharing could be enhanced. It was responded that there was a lot of work undertaken within the County Council as well as the wider system. An example that was cited was that the County Council and the ICB would be aware of residents who had experienced a fall, and how residents in particular areas may be more prone to experiencing falls. It was also added that there were some barriers around information governance to some extent, and that people may understandably be nervous regarding how their personal health data was utilised. Another example of where shared data and information was working well was around the hospital at home between community and acute providers, where there was an increased use of a single system. It was added that by approximately January to February 2024, the system would have a shared care record which would constitute a repository of information from acute, community, mental health, primary care, and local authority providers.

The Committee emphasised that there were recent challenges related to workforce recruitment and retention, which were not unique to Oxfordshire but nationwide. It was queried as to how this would affect how the Partnership operated, as well as whether the Partnership would take collective measures to address these challenges. It was responded that there was a workforce shortage, and that there was a workforce plan that was proving difficult to recruit to. The Committee was informed that further steps would be taken within the Partnership as well as the wider system to try to improve not only staff recruitment but also retention. There was a need to pool resources as much as possible within the system so as to be able to deliver services effectively and make use of existing staff in the most efficient and effective manner.

The Committee AGREED to make the following recommendations:

1. For the Place-Based Partnership to operate in a manner that avoids duplication of other bodies or their associated activities; including the health and wellbeing board.

2.  For the Place-Based Partnership to consider collective work around finding avenues to improve oral health throughout the county, particularly for vulnerable groups or disadvantaged communities.

3.    To develop robust processes through which to monitor the effectiveness of the Place-Based Partnership and its work, and to ensure transparency around this.

4.    To develop robust principles and processes around transparency of decision-making within the Partnership, so as to mitigate the loss of place-based statutory board CCGs which were open to the public.