Agenda item

            The Committee considered the following report:

“1.0      Purpose of Report or Summary of main Issues

1.1             The Department of Health (DoH) has recently published for consultation, proposals for the development of a Future Planning Model, which will replace existing commissioning arrangements and processes in place within Northern Ireland (NI).

1.2              This work will see the development of a new Integrated Care System (ICS) model in NI, whereby local providers and communities would be empowered to come together to plan, manage and deliver care for their local population based on a population health approach, with regional and specialised services planned, managed and delivered at a regional level. The deadline for the submission of consultation responses is Friday 17 September 2021.

1.2       This report and appendices available of mod.gov set out the draft Council response for Members’ consideration and approval. 

2.0       Recommendations

2.1       The Committee is asked to:

                                           (i)     Note that health colleagues are attending the August/ early September cycle of Members’ Area Working Groups to provide an overview and discuss the emerging proposals.

                                         (ii)     Consider and approve the draft consultation response, subject to any additional feedback from the Members’ Area Working Groups captured and raised verbally at the Committee meeting.

                                       (iii)      Agree that the response is submitted by 17 September 2021, highlighting that this remains subject to full Council approval in early October with any amendments being submitted at that stage.

3.0       Main report

            Key Issues & Current Position

3.1       In 2005, A review of commissioning health services within NI found that the system was overly bureaucratic and lacking in clarity of accountability of decision making, detailing the need for changes in the way we plan, manage and deliver health services.  The need for reform was subsequently reinforced by the Bengoa Report ‘Systems not Structures’. 

3.2       Following the commitments set out in the Health and Wellbeing 2026: Delivering Together plan to transform the health and social care system, the DoH has brought forward proposals for a new blueprint for the future of planning and managing health and social care services in NI. 

3.3       The emerging proposals are based on an ICS approach which seeks to bring together partners within health and social care alongside other sectors including voluntary and community sector and local government, to plan, manage and deliver services based on the needs of the local population. A number of core principles underpin the ICS approach being proposed, including:

·        Seek to increase autonomy and accountability at local decision making levels;

·        See the delegation of decision-making and funding to local levels, except for regional and specialised services;

·        Allow for planning, management and delivery of specialised services at a regional level; and

·        Adopts an outcome-based approach.

3.4       The new model will ultimately enable local groups to take more control over planning and funding for services delivered within their areas to meet local needs. It will recognise the wider determinants impacting health and wellbeing and adopt a whole-system and integrated approach to planning and addressing these.  The consultation document highlights the experience and evidence captured in responding to Covid-19 pandemic and what can be achieved if we come together to work as ‘one-system’. Setting aside bureaucratic processes and breaking down barriers between sectors and organisations has allowed services to be delivered in a responsive and agile way to meet local need.

3.5       The consultation outlines the proposed vision, objectives values and principles which underpin the new ICS approach.  Whilst further developmental work and detailed planning is required, the proposed ICS model will adopt a tiered approach as set out below.

            Figure 1: ICS tiered approach. 

            Draft BCC Consultation Response

3.6       A detailed draft BCC response has been complied for Members consideration. Feedback is provided on the specific questions set on different aspects of the proposed framework.  In summary, the response supports the development and introduction of an Integrated Care System (ICS) model and focus on adopting an agile, whole-system and outcomes-based approach to the design, delivery and management of health, social and community services.

3.7       Addressing health inequalities and improving health and well-being outcomes within Belfast are key priorities for the Belfast Community Planning Partnership (CPP) and Council.  The commitment to an outcomes-based approach is at the heart of the Belfast Agenda, the community plan for Belfast, as well as the provision of direct Council services and support to citizens and communities. The Council works collaboratively with multi-agency partners to alleviate many of the health inequality challenges that exist within Belfast and we welcome and support the commitment to continue to plan and manage services informed by local input and intelligence, which underpins the proposed ICS model. 

3.8       A summary of Council’s main comments is outlined below:

·        Strongly recommend that in designing the new ICS model and supporting tiered structures, due consideration is given to how this can take account and build upon existing Community Planning and local structures. This would avoid potential duplication, maximise the contribution and commitment of cross-sectoral/ inter-agency partners and address the wider determinants of health. It is important to note that there has ongoing engagement between Council officers and health colleagues to support the alignment of planning processes and structures within the city.

·        Seek further engagement and input into designing how the ICS model will operate at multiple levels, strategically and operationally, and how service users, local communities and local intelligence on health pressures (e.g. mental health and emotional well-being, substance misuse) help shape the overall strategic approach.  It is important that regional measurements align with and are informed by local and community impact measures and ‘bottom up’ checks and balances are built into area level decision making.

·        Whilst recognising the need to introduce a regional body to provide coordination, consistency, oversight and accountability as well as planning and managing specialist services, it is important that consideration is given to its relationship with local structures and addressing common localised health challenges, with appropriate flexibility built into any resourcing / funding model brought forward.   

·        In designing the proposed regional group, consideration must be given to its relationship with local structures and how the plans and performance framework links with local level planning. It is also important that a common approach is adopted to developing local delivery plans, associated performance accountability frameworks and measuring success/ impact of services and interventions – adopting an outcome-based approach.

·        Support in principle the proposed creation of Area Integration Partnership Boards (AIPB), however, would recommend that further consideration and discussion takes place on the proposed composition of AIPB.  The proposed nomination of 1 lead officer to represent Community Planning/ Council on the AIBP is not suffice. Highlight that the Council wishes to explore its own potential role and representation on AIPB and within the ICS model given its role in delivering services and support, and strong connections with local communities.

·        Important that the AIPB and the proposed sub-structures at a ‘locality’ and ‘community’ level relate and align with CPPs, structures and key areas of work i.e. development of integrated area planning model, to avoid duplication. 

·        In developing the new ICS model, consideration must be given to ensuring boundaries are co-terminus with the 11 local council boundaries; highlighting the fact that currently two Health Trusts (i.e. Belfast HSCT and South Eastern HSCT) currently cover Belfast LGD. This approach would support and enable a more integrated, place-based participatory approach to planning and delivery of services.

·        Highlight the synergies between the development timescale for the ICS model and the co-design of the refreshed Belfast Agenda (2022-2026) underway, with March 2022 being a key joint milestone. Opportunity presented to align and integrate the planning processes and support a collaborative and whole-system approach to addressing population health needs.

·        We welcome the discussions to date with DoH colleagues and would relish the opportunity to continue engagement to maximise the opportunities and impact of the new ICS model and explore how we strengthen the linkages and alignment to Council and Community Planning, including; strategic direction; governance arrangements; timeframes; roles and expectations; co-design processes; representation and levels of representation. 

·        We welcome the opportunity to continue to engage with DoH colleagues and other partners to help bring forward the ICS model; further considering the governance arrangements to be brought forward and how they relate with existing local structures as well as understanding the anticipated timescales and sequencing of the proposed three-phased approach to introducing the new ICS model.

            Members Engagement

3.9       It should be noted that colleagues from the Belfast Health and Social Care Board are attending the Members’ Area Working Groups this month to outline the proposals for a new ICS model and discuss Members views. The draft Council response has been prepared in parallel, any comments raised by Members at the AWGs will be raised at Committee and the response amended accordingly.

            Financial & Resource Implications

3.10      There are no direct financial implications arising from this report.

            Equality or Good Relations Implications/Rural Needs Assessment

3.11      There are no equality, good relations or rural needs implications in relation to the draft consultation response.”

            The Committee:

·            noted that representatives from the Belfast Health and Social Care Board would be attending the next round of Area Working Group meetings to outline the Board’s proposals to develop a new Integrated Care System (ICS), which would enable further consideration and discussion by the Members; and

·            approved the draft consultation response available here, subject to the inclusion of any additional feedback from the aforementioned meetings and agreed that the draft document be submitted by the deadline of 17th September 2021, advising that it was subject to Council ratification on 4th October.