Agenda item

To provide an update on integration activity at the West Berkshire, Berkshire West and BOB level.

The Board considered a report and presentation (Agenda Item 9) regarding health and social integration.

Nick Carter stated that he was addressing the Board in his capacity as Chair of the Berkshire West 10 Integration Board and sought to provide the Board with an update on progress and his own perspective of integration.

Integration was defined as a method to ensure patients were at the heart of service design and delivery by overcoming professional boundaries, however it meant different things to different people. Nick Carter expressed the view that integration in West Berkshire was more like cooperation than a full state of dissolved boundaries between organisations. Integration occurred within the health sector and between the health sector and social care.

Nick Carter provided an overview of the history of integration and noted the large amount of activity over the last 20 years. In particular he noted that in 2015, Sustainability and Transformation Plans (STPs) saw 44 areas created and tasked with reducing costs and improving services. West Berkshire was part of the Buckinghamshire, Oxfordshire and Berkshire West footprint.

Nick Carter expressed the view that integration at the BOB level was ambitious but it was too soon to see any improved outcomes. It was health sector dominated and not particularly driving integration in West Berkshire.

The Berkshire West 10 had and established governance structure and work programme. Most activity was focussed on frail elderly and while there had been some good work, performance of some projects was disappointing.

The majority of discussions about integration in West Berkshire had been based on the Better Care Fund (BCF), however the funding was used in the main to keep the system running. There was a mixed picture regarding the success of the projects.

Turning to the metrics used to monitor the success of the BCF, it was clear that integration had not managed to reduce non-elective admissions. However it should be noted that Berkshire West, as a system, performed well in comparison with other areas in the country. Likewise with delayed transfers of care, there was no apparent correlation between integration and a reduction in numbers.

Nick Carter concluded that there was not yet evidence to support the assertion that integration saved money, reduced hospital activity or improved patient outcomes. It had improved working relationships but there were still some challenges regarding organisations seeking to hold onto their sovereignty. The Accountable Care System had drawn some attention away from integration at the Berkshire West level and the operating environment remained unstable.

Cathy Winfield expressed the view that the presentation had been helpful and she agreed with a large part of it. She advised that she was less concerned with national targets as what the ‘do nothing’ position would have been was unknown and likely to be worse. She noted that financial changes and churn at senior leadership level had been the backdrop for integration in recent years but she remained optimistic about its potential. Cathy Winfield reported that the health system had been well prepared for the winter and working relationships were now significantly stronger. There was some concern that the children’s mental health work, which was clearly successful, was not being reported to the Integration Board. An upcoming away day should help the Integration Board to stock-take its projects.

Councillor Lynne Doherty left the meeting at 10.50am.

Dr Bal Bahia thanked Nick Carter for the presentation and raised a question about whether integration was a goal that the Health and Wellbeing Board felt they owned.

RESOLVED that the report be noted.